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Urology/Pelvic floor spasm?


QUESTION: - Hi! I think I have some kind of pelvic floor spasm. My pelvic floor muscles contract time to time involuntarily. Usually this happens especially when aroused and semi-erect or fully erect but also at night with night erection. I also experience retrograde ejaculation.

 Question 1: Is there any possibility that these spasms can cause any harm to my penis, like venous leak or damage to corpus cavernosum, because sometimes when I'm 100% erect the spams might be powerful and it might feel painful? (I have even awaken from a sleep to a this kind of spasm when I was having nocturnal erection.)
 Question 2: What do you think causes these spasms? Is it too tight or too loose pelvic floor muscles, in other words should I do some kegels to strengthen the muscles or just try to relax them?

Thanks for your time!

ANSWER: Tom, as you might imagine, for this type of problem it is not possible for me to make an exact diagnosis or give recommendations over the internet because of the inability to take a more complete history and do a physical examination.  However, I shall try to help you.

The cause of your symptoms may or may not be due to pelvic floor spasms.  Inflammatory disorders in the pelvis may cause the muscles to spasm.  Common conditions that might produce this symptom include prostatitis, interstitial cystitis and inflammatory bowel diseases.  You really need to see a physician, preferably a urologist, to evaluate your condition. The spasms themselves will not do any damage to your penis such as a venous leak or corporus cavernosum malfunction.  

If indeed it turns out that you truly have pelvic muscle spasms, the treatment options include biofeedback, muscle relaxants and relaxing techniques such as yoga, special exercises and warm baths.  Until the etiology of your problem is more defined, I would not suggest doing Kegel exercises.  

When you see the urologist, you should discuss your retrograde ejaculation with him.  To follow is a "macro" I have written on this condition that will help you understand it better.  

First, let me give you some background information on retrograde ejaculation to be sure that you understand the condition and the available treatments for same.    During sexual arousal the prostate gland & seminal vesicles manufactures fluid that account for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement.  Sperm from the testicles (which account for only 1-2 % of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts.  These structures empty into the prostatic portion of the urethra.  At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra (urinary canal) forming the semen.  The average semen volume is 2-6 cc.  With the inception of ejaculation, the bladder neck closes and the semen is forced forward out the urethra by contraction of the pelvic muscles.

Since there are several organs that make the various components of the semen, it is unlikely that all of them are malfunctioning.  Therefore, the most common causes of minimal or absent semen at the time of ejaculation are either a blockage of the ejaculatory ducts or retrograde ejaculation.

Blockage of the ejaculatory ducts may be congenital or acquired usually due to scarring from infection or trauma.  It is best diagnosed by ultrasound of the prostate and seminal vesicles where markedly swollen seminal vesicles are seen.  Sometimes these may be palpable on digital rectal examination.  They can generally be cured by simple transurethral resection of the scarred duct openings through an endoscope.

Retrograde ejaculation occurs when the bladder neck does not close  at the initiation of ejaculation.  This results in semen taking the path of least resistance which is backward into the bladder rather than forward out the urethra. The diagnosis is made by a typical history and the finding of sperm in the first voided urine specimen after orgasm & ejaculation.  This can be congenital or acquired.  Most often is due to malfunction of the pelvic nerves that stimulate closure of the bladder neck.  Common causes of this are pelvic surgical damage and certain diseases of the nervous system such as diabetes, multiple sclerosis & spinal injuries.  Certain medications (such as those used for high blood pressure and emotional problems) may also produce this side effect.  The diagnosis is made by examination of the first voided urine specimen obtained after ejaculation.  The presence of semen elements, namely sperm, on examination of the urine clinches the diagnosis.  The treatment depends on the cause but sometimes drugs containing pseudoephedrine may help to stimulate bladder neck closure with ejaculation.  This medication is taken 30-60 minutes prior to sexual intercourse.  Another option is to take the first voided urine after ejaculation and use this for artificial insemination.    Good luck.

---------- FOLLOW-UP ----------

QUESTION: Okay thank you! So pelvic floor spasms can't cause any harm to penis (venous leak, corpus cavernosum damage) even if I have a very hard erection during the spasms?
 I have also felt pulsating feeling (like a heavy heartbeat) in the prostate area somewhere, may this mean prostatitis?
 I have also quitted my SSRI-medicines about half year ago, and that's when I started to develop this retrograde ejaculation, can this be it or is it just a coincidence? Thanks very much for your help!

Tom, that is correct - pelvic floor spasms even associated with a very firm erection will not damage the penis.  

The SSRI medications may cause a number of sexual problems while taking them such as difficulty obtaining erection, prolonged time before ejaculation or inability to ejaculate.  Retrograde ejaculation is rarely associated with the use of these medications.  Some of the side effects may persist for a year or longer after discontinuing the drugs.  As you apparently did not suffer retrograde ejaculation while on the drug, your present problem is unlikely due to this.  

The "pulsating feeling (like a heavy heartbeat) in the prostate area" may be due to prostatitis.  As mentioned, this can be evaluated when you see a urologist.  Good luck.  


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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