The Stress of Wall Street Is Sending Men to Pelvic Floor Therapy

Physical therapists in New York are seeing an uptick in younger male patients with penile and bladder issues.

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Episode Transcript

Speaker 1 (00:00):
The Stress of Wall Street is sending men to pelvic
floor therapy by Madison Derbyshire read by Bob Danielson. Landon
was working in client services at a large investment bank
in New York when he felt a sudden, acute pain
in his groin. It had been a bad day and
he was stressed. There was constant pain everywhere. Everything just

(00:23):
felt tight. Landon, a pseudonym, said, the burning sensation with
sharp jolts wouldn't go away. Sex was painful, so he
avoided it. It hurt to sit, so Landon stood at
his desk on the trading floor. When his co workers asked,
he told them he had lower back pain, they'd say, yeah, man,
me too. The pain roamed some days left nut, some

(00:46):
days right nut, making it harder to explain to the
specialists he saw. But doctor after doctor ran tests, each
of which came back normal. They all pushed me out
the door, saying, you don't have any infection, Your prostrate
looks normal. You're a healthy young man, Landon said. Many
doctors said some degree of pelvic pain was expected from men.

(01:08):
At one appointment, Landon was so frustrated he started to cry.
He asked the doctor why he was experiencing this, He
just said, because you're a guy, and walked out. Landon
said Landon twenty six had always been a little bit anxious.
A high achiever in school, he had gone straight into
a demanding, high pressure role in finance. I spend all

(01:30):
day delivering bad news to clients and getting chewed out.
He said. He thought about taking medical leave for the pain,
but worried HR wouldn't believe him. No one wants to
talk about penile pain at work. It wasn't until Landon
visited Pelvis, NYC, a specialized physical therapy clinic, that he
learned his pelvic floor, the group of muscles responsible for

(01:53):
bladder control and holding multiple organs in place, was extremely tight.
It's a common problem among men, and yet Landon had
thought only women had pelvic floors. Speaking with Adam Gavilli,
a doctor of physical therapy and the clinic's owner, was
the first time he felt like someone understood his symptoms
and what he could do about them. Many women use

(02:14):
physical therapy to treat pelvic floor problems, particularly after childbirth,
but therapists who treat pelvic floor dysfunction say men, particularly
those in high stress, desk bound jobs such as finance
and corporate law are one of the fastest growing groups
of patients. Rising demand has highlighted a shortage of physical therapists,

(02:34):
only a handful of whom are themselves men or treat
male patients. They say demand for their services has surged
in recent years. Most have wait lists that range from
several weeks to months, and that's just the people who
have diagnosed the issue. Despite how many people suffer from
pelvic floor dysfunction, early research suggests it could be his

(02:56):
high as thirty percent, it remains a little known injury
among men. Many don't even know they have a pelvic floor,
even though it controls basic functions including bowels, posture, and
sexual performance. Most don't openly discuss their symptoms due to
lingering stigma around penile pain and directile dysfunction ed. The
men interviewed for this piece agreed to speak on the

(03:18):
condition of anonymity, but they all spoke about their experience
for the same reason, so other men wouldn't feel as
lonely and embarrassed as they did. With Gavilli, Landen learned
his pelvic floor pain was exacerbated by stress. He practiced stretches,
strength exercises and breathing. Kavilli also performed internal work, massaging

(03:39):
the pelvic floor through the rectum to release the muscles.
It's very invasive, Landon said, but I was just so desperate.
They talked about sports and Gavilli's family for the duration,
which helped. After one session, Landen began to feel relief.
It was expensive three hundred twenty dollars per session out
of pocket, and his insurance wouldn't cover it. Still, he said,

(04:02):
I was willing to pay whatever price. The symptoms of
male pelvic floor dysfunction manifest in various and unexpected ways,
difficulty achieving or maintaining erections, the frequent urge to urinate,
and difficulty defecating. A little understood syndrome related to pelvic
floor dysfunction called hard flaccid, defined as a semi constant

(04:23):
semi rigid state even when unaroused, is also common. It
can cause the penis to retract into the body or
curve and makes it hard to wear pants. The majority
of those I treat are twenty to forty year old
men who have sedentary jobs, don't sleep enough, don't drink
enough water, and don't stretch enough. Said William Klein, a
doctor of physical therapy specializing in pelvic floor issues who

(04:45):
began practicing three years ago based in Williamsburg, the Brooklyn
epicenter of white collar, millennial and gen z Bro culture.
It didn't take long for Klin to develop a full
case load. Klein said, social media, artificial intelligence, and peal
vicfloor aware girlfriends have started bringing patients in sooner after
the onset of symptoms than ever before. When he began

(05:06):
his practice, most of his patients had seen four or
five urologists before finally being referred to physical therapy. Now
many of them come to him directly. Reddit and chat
GBT are definitely referral sources for me, he said one
thousand percent. Chat GPT Echoedkvilli, whose patients have started to
skew younger twenty five to thirty five as men with

(05:29):
desk jobs turned to the Internet for answers. They also
see videos on TikTok promoting keegel exercises, which involve contracting
and relaxing the pelvic muscles to strengthen them as a
way to improve orgasms and bladder control. But where keegels
can help women strengthen their pelvic floor. For many men,
the problem is that their pelvic floor needs to be

(05:49):
less tight. Often the muscles of the pelvic floor have
become overactive and can't relax, said Chad Woodard, a researcher
and doctor of physical therapy who has been practicing pelvic
floor pt for over a decade. That's really common with
my type A high performers, high income, heavily stressed out patients.
The pelvic floor is so linked to stress and emotional

(06:11):
well being that it's common for male pelvic floor pts
to refer patients out to psychotherapy. Early studies on pelvic
floor dysfunction show a high correlation with anxiety and depression diagnoses.
It also shows a correlation with higher incomes and higher
education levels. It's an oversimplification used in the PT community,
Ward says, but the reason these men hold tension in

(06:34):
their pelvic floors is that it's an evolutionary fight or
flight response to stress held over from the hunting gathering age.
If we were in the process of being eaten by
a lion, we would tighten up those softest places, our abdomen,
our pelvic floor, Woodard said. Today, Wall Street deal making
and psychopathic bosses are bigger threats to his patients than

(06:55):
big cats, he said, But the body handles stress the same.
Bodies don't know that our current threat is different than
being eaten by something with teeth. Richard Lee, a urologist
in Manhattan, says there are two main drivers of those
who come in with stress related pelvic floor dysfunction. Are
you type A and are you in a high stress

(07:15):
job where you have to perform at a high level
at all times. He treated a middle aged corporate lawyer
who came in with urinary symptoms dribbling and feeling the
urge to pee frequently, as well as penile pain. He's
super wound up. He's on his firm's managing committee. He's
hitting it on one thousand cylinders. Lee said, he goes
on vacation and it's like, all of a sudden, I'm

(07:37):
peeing fine. Anxiety at work is to some degree table stakes.
Sometimes if I get yelled at in a meeting, I'll
feel my pelvic floor get tight. Landon said, my body
reacts before my mind understands that I'm anxious. After a
few months of PT, he said, he is better at
managing his physical stress is a regular at yoga class

(07:59):
and his symptoms free. Yet some men live with their
pain for decades, embarrassed by their symptoms or unaware that
they're treatable. A trader who is thirty four getting up
every forty five minutes to pee, thinking I guess this
is normal now, or thinking in my twenties sex used
to be like this, but I guess I'm getting older.
Woodard said his initial sessions often involve a lot of

(08:20):
education about what normal actually is for men. Yes, your
body goes through changes, but not at thirty five. You
should still be able to urinate properly and have sexual function.
Just find well into your older years. Pelvic floor dysfunction
has many causes, Gavilli said, including trauma or masturbating too
hard or often. He works with men with post vasectomy pain,

(08:43):
trapped nerves, penile trauma, and gay men wanting to have
anal sex comfortably. Stress is not always a factor. It
can also be tight b guys that have this pain,
he said. Still, access to pelvic floor physical therapists willing
to treat men remains extremely limited. Both Kavilli and Klein
began to specialize in pelvic floor problems after they had

(09:04):
their own health issues and grew frustrated by the lack
of available care for men. Pelvic floor board certification is
still within the women's health specialty under the American Board
of Physical Therapy Specialties the Credentialing Body. Fewer than two
thousand physical therapists are currently certified to treat pelvic floor dysfunction,
according to data from the American Physical Therapy Association. By contrast,

(09:27):
in twenty twenty, there were over three hundred twelve thousand
licensed pts in the US according to the Federation of
State Boards of Physical Therapy. Most of the trained pelvic
floor therapists are women, while many men prefer to be
treated by male pts. The specialization is also an additional
post graduate course for pts, requiring twelve to eighteen months

(09:49):
to credential, with around ninety hours of additional instruction costing
one thousand to two thousand, five hundred dollars. When men
join the training, there could be additional complications. They made
you bring a partner because you weren't always able to
practice on the model and the class, Klein said. Men
with pelvic floor dysfunction said that when they first sought

(10:09):
physical therapy for it, most of the clinics they called
only treated women. Mark fifty nine and retired struggled with
bladder control for months after having his prostate removed when
he was diagnosed with cancer, I found a ton of
places that could help me with PT if I was
a woman because of childbirth, he said. There were signs
of progress. In twenty nineteen, after some pushback, the Academy

(10:32):
of Women's Health changed its name to the Academy of
Pelvic Health, and a change to the name of the
ABPTS certification has been proposed. Male specific pelvic floor training
is now offered and a male Pelvic Health Certificate track
is expected to launch in twenty twenty six. The urology
community is also starting to take pelvic floor therapy for

(10:53):
men seriously and refer patients an overactive or tight pelvic
floor won't show up on an X ray, MRI or ultras.
As a result, many men with pelvic floor dysfunction are
diagnosed with non bacterial prostatitis, a kind of industry catch
hall for pelvic pain with no good explanation and without
a simple solution, or told they have ed men in

(11:14):
their twenties who had never experienced issues getting an erection
before the onset of their symptoms. Frequently come into pet
with prescriptions for viagra and sialis, but physical therapy for
the pelvic floor can still be very expensive to access,
and many private providers are out of network. While Klein
accepts insurance through his larger practice group, Woodard charges upwards

(11:35):
of four hundred dollars an hour, though others in his
practice charged less, he still runs a month long wait list.
Alex twenty seven, was working for a top financial consulting
firm when he started experiencing painful cramps in his groin.
Sometimes he felt it in his penis, sometimes in his perineum,
sometimes his upper thighs. He was working long hours, sitting

(11:56):
at a desk for most of the day. He wasn't
sleeping well. Doctors didn't have answers. It was a pretty
dark time, he said. I freaked out that my sex
life was completely over. He started to worry he might
not be able to have children. Reading Reddit forums on
pelvic pain and prostatitis, he noticed a lot of very
depressed guys, even expressing suicidal sentiment. It is common, specialists

(12:20):
said for men with penis problems and pain to fall
into a pattern of catastrophic thinking, one exacerbated by the
degree to which those problems are under reported. While most
men in their lifetime have felt some kind of pelvic
area pain, many men are horrified to say these things
out loud or seek help. Woodard said when he tried
to organize a support group for his patients, no one

(12:42):
wanted to go, but men who have suffered from pelvic
floor dysfunction said, finally talking about their problems changed everything.
I just think that there are probably millions of men
out there that don't even know they have a pelvic
floor and probably take a lot of blue pills when
they don't necessarily have to. Mark, the retire who struggled
after prostate surgery said, hopefully talking about it will make

(13:03):
it less taboo, because it was extremely hard to get
health care, said Matt thirty three, a trader at a
large hedge fund. I was really afraid to do anything
in the bedroom because I was worried there would be problems,
said John twenty two, a recent college graduate. It's important
for people to know that it gets better. Some men
have even been referred by friends after disclosing their symptoms,

(13:26):
part of what Petas described as a generational shift led
by younger, perpetually online clients who are showing more willingness
to advocate for themselves and more comfort and their masculinity.
After physical therapy, Landon talked to a few friends about
his symptoms. A few of them were like, this happened
to me too. I still do stretches every day. He said,

(13:46):
he has no idea how many more men on his
trading floor were lying about having back pain. People are
a lot more comfortable with back pain and saying my
back hurts than saying my ballsack hurts.