The Covid-19 pandemic and its lockdowns have brought several sexual health issues to the surface. I’ve started to notice a trend of men visiting our clinic for symptoms of increasing groin pain, pain in the scrotum or perineum (the region between the scrotum and the anus), pain with passing urine and some of them have complained of discomfort with ejaculation.

As we examine their history and obtain information of recent changes that the patients have experienced during the circuit breaker, many described longer hours of sitting and working at their computer, neglecting their posture and a good proportion of them are also exercising a whole lot more.

More interestingly, these patient were also reporting increased masturbation. Some of my patients were masturbating about 3-4 times a day.

Here comes the question: Does excessive masturbation cause pelvic pain? Can it also cause pain with urination, penile pain or scrotal pain and any disturbance to urination like dribbling, leakage post urination, sexual pain and including lower back and butt pain?

Masturbation or ejaculation involves repeated rhythmic movement of the lower body, specifically your pelvis. The actual expulsion of semen during ejaculation involves some muscles that are wrapped around the neck of the bladder and also some pelvic floor muscle – namely the bulbospongiosus muscle and the ischiocavernosus muscles.

These muscles go through what I call a forceful rhythmic dance to propel the semen forward along the urethra (which is the urine tube) and out through the tip of the penis in a projectile manner. This expulsion phase of ejaculation has been termed by some as “a point of no return”.

Imagine that these muscle are put through the rigour of repeated contraction with high frequency masturbation in a day. It is possible for these muscle to adopt a high tone, somewhat stiffened with less freedom of movement.

The “spasm” in these pelvic floor muscles and the bladder neck muscles become hotspots of bad inflammation. The inflammation causes more pain receptors to develop and of course, with more pain receptors there is a heightened perception of pelvic pain. Painful points on these muscles are called triggered points.

As visceral organs like the bladder and rectum share a space within the pelvis, the function of the bladder and the rectum gets affected too. Men who suffer from pelvic pain often complain of the following symptoms:

• Pain with urination

• Pain in the penis

• Pain in the areas between the “balls” and the anus

• Urinary urges

• Increased urinary frequency

• Sense of incomplete bladder emptying even though they’ve just gone to pee

• Discomfort with passing motion or constipation

Now I have to emphasise that masturbation and ejaculation are healthy and encouraged in men. Men are strongly encourage to ejaculate at least 2 times a week for optimal prostate health. Regular ejaculation reduces the risk of prostatitis, prostate inflammation. 

There is no clear definition as to what entails high frequency masturbation. However, clearly in the case of these patients I’ve mentioned, their multiple daily masturbation has resulted in a hyper tonic pelvic floor causing pelvic pain syndrome.