Understanding Lichen Sclerosis

Understanding Premature Ejaculation: Causes, Treatment, and Support Premature ejaculation (PE) is one of the most common sexual concerns in males, yet it is rarely talked about openly. Many males experience it at some point in their lives, but when it happens regularly, it can cause frustration, affect confidence, and even put strain on intimate relationships. The good news? Premature ejaculation is very common and treatable. Let’s break down what it is, why it happens, and how it can be managed. What is premature ejaculation? Premature ejaculation is when ejaculation occurs sooner than you or your partner would like, often within a minute of penetration or even before penetration begins. For some males, it happens occasionally; for others, it’s a consistent pattern that impacts sexual satisfaction. It’s important to know that there is no “perfect time” that sex should last. PE is usually defined not just by timing, but by whether it causes distress or difficulty in sexual relationships. Why does premature ejaculation happen? There isn’t just one cause — PE can result from a combination of physical, psychological, and behavioural factors. Pelvic floor muscle involvement: Overactive or tense pelvic floor muscles can lead to reduced control and quicker ejaculation. Psychological factors: Anxiety, stress, performance pressure, or even relationship concerns can all play a role. Learned patterns: Rushing during sex or masturbation (for example, due to fear of being caught in adolescence) can become a habit that carries into adulthood. Medical factors: Hormonal changes, nerve sensitivity, or underlying health conditions may contribute. How can premature ejaculation be treated? Treatment usually combines physical and psychological strategies. Here are some of the most effective approaches: Pelvic floor physiotherapy Learning to identify, relax, and retrain pelvic floor muscles can improve control. Many males with PE actually have an overactive pelvic floor rather than a weak one. Breathing and body awareness Deep breathing and mindfulness techniques can reduce muscle tension and help manage arousal levels. Behavioural techniques Methods such as the “stop-start” technique or “squeeze” technique, when practiced with guidance, can gradually improve control. Psychological support Addressing anxiety, stress, or negative thought patterns around sex can make a big difference. Sometimes, working with a psychologist or sex therapist alongside physiotherapy provides the best outcomes. Medical options In some cases, doctors may suggest medication (such as topical numbing creams or certain oral medications) if conservative strategies aren’t enough on their own. Why seeing a professional helps Many males try to manage PE on their own but don’t see lasting improvement. A pelvic floor physiotherapist can assess muscle activity, teach you how to use (and relax) your pelvic floor effectively, and guide you through strategies tailored to your body and situation. If anxiety or relationship strain is part of the picture, working alongside a sexual health psychologist or counsellor can be very effective. Conclusion Premature ejaculation is common, treatable, and nothing to be ashamed of. If it’s causing frustration or stress in your life, know that help is available — and you don’t have to put up with it alone. Taking the first step to speak with a professional can make all the difference in regaining control, confidence, and satisfaction in your sexual health.

Understanding Prostatitis: What You Need to Know Prostatitis is a common condition that affects the prostate gland, a small walnut-sized organ found in males just below the bladder. It can cause a range of uncomfortable symptoms, including pain, urinary issues, and sexual discomfort. While it can be distressing, it’s important to know that prostatitis is treatable and does not mean you have prostate cancer. What Is Prostatitis? Prostatitis refers to inflammation or irritation of the prostate gland. It is the most frequently diagnosed urological problem in males under 50 and can affect males of all ages. According to the Royal Australian College of General Practitioners (RACGP), up to 15% of Australian males will experience symptoms of prostatitis at some point in their lives. Despite its prevalence, many males feel unsure about what it means and how it’s managed. Types of Prostatitis Acute Bacterial Prostatitis (ABP) ABP is a sudden and severe infection of the prostate caused by bacteria, most commonly Escherichia coli. Symptoms include fever, chills, dysuria, pelvic pain, urinary retention, and systemic illness. It is considered a medical emergency requiring prompt diagnosis and treatment with intravenous or oral antibiotics. Hospitalization may be necessary in severe cases. Chronic Bacterial Prostatitis (CBP) CBP involves recurrent bacterial infections of the prostate with similar but less intense symptoms than ABP. Patients may experience intermittent urinary tract infections, pelvic discomfort, and post-ejaculatory pain. Diagnosis is confirmed through culture of expressed prostatic secretions or post-prostatic massage urine samples. Treatment typically involves prolonged antibiotic therapy for four to six weeks, guided by culture and sensitivity results. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) CP/CPPS is the most prevalent form of prostatitis, accounting for over 90% of cases. It is characterized by pelvic pain lasting more than three months in the absence of detectable bacterial infection. Symptoms include pain in the perineum, suprapubic region, testicles or lower back, urinary frequency, urgency, dysuria, and painful ejaculation. The condition is multifactorial, with contributing elements such as pelvic floor muscle dysfunction, neurogenic inflammation, and psychosocial factors. Management is multidisciplinary and includes pelvic floor physiotherapy, pharmacological agents, and lifestyle modifications. Asymptomatic Inflammatory Prostatitis This form is diagnosed incidentally during evaluation for other conditions, such as infertility or prostate cancer screening. It is defined by the presence of inflammatory cells in prostate tissue or fluid without associated symptoms. No treatment is required as it does not impact health outcomes. Clinical Presentation Common symptoms across prostatitis subtypes include pelvic or perineal pain, urinary urgency and frequency, incomplete bladder emptying, and discomfort during or after ejaculation. In ABP and CBP, symptoms may be accompanied by signs of infection. In CP/CPPS, pain is the dominant feature and may be exacerbated by stress, prolonged sitting, or certain dietary factors. Role of Pelvic Floor Physiotherapy Pelvic floor physiotherapy is a cornerstone of treatment for CP/CPPS. Evidence supports the use of manual therapy, myofascial release, biofeedback, and pelvic floor muscle relaxation techniques to reduce muscle hypertonicity and alleviate pain. Patients are taught diaphragmatic breathing, stretching exercises, and behavioral strategies to manage flare-ups. Comprehensive Management Approach Treatment is tailored to the specific type of prostatitis. For ABP and CBP, antibiotics are the primary intervention. For CP/CPPS, a multimodal strategy is recommended. This includes alpha-blockers to improve urinary flow, anti-inflammatory medications, neuromodulators for nerve-related pain, and cognitive behavioral therapy for associated anxiety or stress. Dietary modifications such as reducing caffeine, alcohol, and spicy foods may reduce irritation. Regular physical activity and proper hydration support overall pelvic health. Key Takeaways Prostatitis is not associated with an increased risk of prostate cancer. While symptoms can be persistent, particularly in CP/CPPS, most patients experience significant improvement with appropriate care. Early diagnosis and a coordinated approach involving urology and pelvic health physiotherapy optimize outcomes. Patient education on the nature of the condition, realistic expectations for recovery, and self-management strategies are essential components of care.

Understanding Daytime Wetting in Children: The “Why” Behind It Daytime bladder accidents, or daytime wetting, are surprisingly common in childhood. While many parents worry that something is “wrong” with their child, the truth is that bladder control is a complex process involving the bladder, pelvic floor muscles, bowel, nervous system, and even emotions. When one part of this system is under pressure, immature, or not communicating well with the others, wetting can occur. How Common Is Daytime Wetting? Research shows that daytime wetting is more frequent than many parents realise: Around 10% of children at age 5–6 experience daytime wetting. By age 7, prevalence drops to about 5%. At age 9, around 2–3% of children are still affected. This means that while most children develop bladder control naturally, a significant number need extra support to achieve dryness. 1. The Developing Bladder-Brain Connection To stay dry during the day, children need to: Feel the bladder filling (sensory signal) Recognise that signal as “I need to go” Respond quickly by activating the pelvic floor and then relaxing it at the right time on the toilet. In some children, this communication loop between the bladder and brain matures later. This can mean: They don’t notice bladder fullness until the last moment. This may result as a sudden strong urge and may present as them “dancing” or holding themselves. Their bladder muscle (the detrusor) may contract involuntarily, pushing urine out before they are ready. This explains why children often appear “fine one moment, bursting the next.” 2. Overactive or “Irritable” Bladder Sometimes the bladder itself is the driver. An overactive detrusor muscle contracts too frequently, leading to urgency and accidents. This may be linked to: Drinking bladder irritants (soft drink, caffeine, artificial colours/flavours). Post-bladder infection sensitivity. Constipation pressing on the bladder and reducing its capacity. Children with overactive bladder often experience frequent small wees, urgency, and may show classic “holding manoeuvres” like squatting or crossing their legs. 3. Constipation and the Bladder-Bowel Link Up to 30–50% of children with daytime wetting also have constipation. A constipated bowel takes up valuable space in the pelvis, which can reduce the bladder’s storage capacity. Treating constipation is often the first and most effective step in resolving bladder problems. 4. Pelvic Floor Muscle Dysfunction The pelvic floor muscles must hold on at the right time and relax at the right time. If these muscles are too tight or discoordinated, the child may not empty properly, which can lead to dribbling, urgency, or urinary tract infections. This is where pelvic health physiotherapists use age-appropriate education and biofeedback to help children learn how their muscles work. 5. Neurodivergence and Bladder Control Children who are autistic, ADHD, or have sensory processing differences often experience higher rates of bladder and bowel challenges. Studies suggest that children with ADHD are 2–3 times more likely to experience incontinence compared to neurotypical peers. The pathophysiology here can involve: Altered sensory processing: bladder fullness may not be felt until very late. Executive function differences: difficulty shifting attention from play or schoolwork to respond to body cues. Anxiety or rigidity: avoiding toilets outside the home due to sound, smell, or sensory overwhelm. Medication effects: some ADHD medications may influence urinary frequency or urgency. The key message: the bladder is working within the unique way that child’s nervous system processes information. 6. Behavioural and Emotional Factors Stressful life events, school changes, bullying, or family transitions can all impact bladder control. In these cases, the child’s nervous system may be on “high alert,” influencing bladder muscle activity and pelvic floor responses. Wetting in these cases is not deliberate — it’s the body’s way of responding to stress. How Treatment Helps When we understand why wetting occurs, treatment can be tailored to the child’s needs. A collaborative approach between pelvic health physiotherapists, GPs, and sometimes paediatricians may include: Bladder training: establishing healthy toileting routines. Constipation management: diet, fluids, or medication if required. Pelvic floor awareness: playful, child-friendly exercises to improve coordination. Behavioural strategies: rewards, charts, or visual schedules. Environmental changes: school toileting plans, sensory adjustments. With the right support, most children improve significantly — and many achieve dryness within months. The Takeaway Daytime wetting is rarely about laziness or misbehaviour. It is the result of interacting bladder, bowel, muscle, and brain factors – all of which can be supported with the right guidance. If your child experiences daytime wetting, know that you are not alone, and that early intervention can help prevent ongoing issues with confidence, social participation, and urinary health. Our team at Pelvic Health Melbourne works closely with families, GPs, and other health professionals to provide child-friendly, evidence-based care.