What is penile & testicular pain?
When the tests come back normal, men with genital pain are often told there is nothing wrong. There usually is: the pelvic floor muscles, which wrap around the base of the penis and the rectum, have become tight and developed trigger points, and those trigger points refer pain forward and down into the penis, testicles and perineum. Sitting, cycling, stress, constipation and holding urine all keep them tense.
Because the pain arrives in the genitals rather than in the muscle causing it, it is frequently treated with repeated courses of antibiotics or offered surgery. A pelvic floor assessment finds the tender muscles that reproduce the pain on palpation, which is both the diagnosis and the start of treatment.
Common signs and symptoms
- Aching, burning or sharp pain in one or both testicles, the scrotum or the penis
- Pain at the tip of the penis, especially during or after urination
- Perineal pain or a feeling of sitting on a golf ball
- Pain during or after ejaculation
- Symptoms that are worse with sitting, cycling, stress or a full bladder
- Urinary urgency, frequency or hesitancy alongside the pain
What causes it?
- Trigger points in the pelvic floor muscles (puborectalis, bulbospongiosus, obturator internus)
- Chronic pelvic floor tension from stress, posture, prolonged sitting or cycling
- A history of infection, vasectomy, hernia repair or injury that left the muscles guarding
- Pudendal or genitofemoral nerve irritation
- Constipation and straining, which load the pelvic floor
- Overlap with chronic prostatitis / chronic pelvic pain syndrome
How pelvic floor physiotherapy helps
Pelvic floor physiotherapy for male genital pain identifies and releases the muscles that are referring pain, lowers the resting tension that keeps them firing, and changes the habits that aggravate them. Assessment is external first and internal only with your consent.
A treatment plan typically includes:
- A detailed history and an external assessment of the pelvic floor, hips, abdomen and perineum
- Manual trigger point release of the pelvic floor and surrounding muscles, externally and, with your consent, internally
- Down-training: diaphragmatic breathing and relaxation to reduce pelvic floor tension
- Stretching and mobility for the hips, inner thighs and lower back
- Sitting, cycling, bladder and bowel habits that stop re-irritating the muscles
- Coordination with your urologist so that infection and structural causes remain excluded
What the research says
The studies below are peer-reviewed and linked to their permanent records so you can read them yourself.
In men with chronic testicular pain and no identifiable urological cause, pelvic floor overactivity was found in most cases, and the authors recommend pelvic floor assessment and physiotherapy before invasive treatment.
Planken E, Voorham-van der Zalm PJ, Lycklama à Nijeholt AAB, Elzevier HW. Chronic testicular pain as a symptom of pelvic floor dysfunction. Journal of Urology, 2010. View study
Palpating specific pelvic floor trigger points reproduced penile, testicular, perineal and suprapubic pain in most men with chronic pelvic pain, mapping which muscles refer pain to which sites.
Anderson RU, Sawyer T, Wise D, Morey A, Nathanson BH. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. Journal of Urology, 2009. View study
This review of chronic scrotal content pain recommends a thorough evaluation followed by conservative management, including pelvic floor physical therapy, before considering nerve blocks or surgery.
Levine LA, Hoeh MP. Evaluation and management of chronic scrotal content pain. Current Urology Reports, 2015. View study
Treatment at Corelife Wellness in Oakville
Corelife Wellness is a dedicated pelvic health clinic at 3075 Hospital Gate, Unit 312, Oakville, next to Oakville Trafalgar Memorial Hospital. Care starts with a free 15-minute consultation by phone, video or in person, followed by a full assessment with our Registered Physiotherapist. Every pelvis is unique, so your plan is built from that exam rather than a template. No referral is needed, and physiotherapy is often eligible under extended health benefits.
How assessment and treatment work, and how to book, are on our main page: Pelvic floor physiotherapy in Oakville.
Helpful reading from our team
When to see a doctor first
Pelvic floor physiotherapy is safe and you do not need a referral, but some symptoms need a medical assessment before or alongside treatment:
- Sudden, severe testicular pain, especially with swelling or nausea: this can be torsion and needs emergency care
- A lump, swelling or change in the size or feel of a testicle
- Fever, discharge, or blood in urine or semen
- Pain with a bulge in the groin that changes with coughing (possible hernia)
