The Rest Of The Muscles

This week I received a statement from the physical therapist.  On it was her official diagnosis: “levator ani spasms.”  This is the first time I had seen her diagnosis, but I have never seen the term “levator ani” before.  So, as usual, I decided to look it up.

I found a medical web site that described the muscle in extensive detail.  The site said that the levator ani consists of three components:

  • Pubococcygeus
  • Iliococcygeus
  • Puborectalis

The description also included a diagram of the muscles.  The pubococcygeus and puborectalis look like they are more towards the front and I can’t really tell the difference between them by looking at the pictures.  The Iliococcygeus, however, looks more like a separate muscles and is located more towards the back.

So this was a good discovery.  The pictures showed muscles exactly where I feel them.   When I am doing the exercises at the physical therapy office, I feel it tighten mostly behind my anus and up my pelvis.  When I relax, I feel it in the same place.  So, I am pretty positive that I am using the correct muscles now.  I am focusing on the right muscles and I am learning to control them.  It is all coming together.  I really think that I must be on the cusp of some really good progress.

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Posted by on April 11, 2014 in Sex


Inner Relaxation

I wrote in my previous post that recently I have been focusing more on the muscles I feel back in my pelvis rather than the ones farther forward.  These are still part of the pelvic floor and now seem to be the ones that are staying tense when I try to relax.

Despite my focus on exercising and relaxing them, when I performed the exercises at the physical therapy office and we measure my relaxation, I still was not able to get them to relax quickly.  After I tensed them, they would relax in stages, not smoothly, and then, at the end, relax very slowly to the level that the physical therapist wanted to see.  For that last week, getting these muscles to relax fully and quickly has been my focus.

As I worked on this, I started to realize that there was some sort of inner tension that I was causing and holding on to.  It is a subtle feeling that I have a hard time describing.  I am still not quite sure what muscles are involved, but the tension feels like there is a net inside my body pulling up on my pelvic floor and pulling in on my stomach and back – like a big straw sucking everything up into my chest.  When I let this tension go, it feels like my internal organs are sinking down in my body.  I feel heavier on the inside, but also more free and relaxed.  When I keep this tension relaxed, I can relax my pelvic muscles much more quickly and effectively.

As a side effect, when I relax that internal tension I find it more difficult to contract my pelvic floor.  It feels heavier and stiffer.  This seems a little bit strange to me, but I guess I am doing all of the work with my pelvic floor muscles rather than getting help from some other ones.  I guess that means I am also getting a better pelvic floor muscle workout, and a better workout should also mean better progress.

The next time I went to see the physical therapist, I concentrated on relaxing this tension while I was doing the exercises.  I could feel the difference while I was doing them, and the physical therapist noticed that I was relaxing more and relaxing more quickly and commented on how much better I was doing.  In the past, my tension number when I was relaxed was in the 6′s, but this time I was able to get some numbers down in the 4′s.  These are much better results than I have ever been in the past.

So I am seeing more progress.  One of the difficulties I have will trying to address my premature ejaculation is a real lack of measurable milestones.  Unfortunately, PE doesn’t seem to improve incrementally.  It seems like you either get it, or you don’t.  As a result, I need to find other metrics to track my progress, and one of those metrics is identifying tension and successful relaxation.  With this metric, just made another big step forward.

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Posted by on March 30, 2014 in Sex


Muscle Focus Moving Back

At my first physical therapy working session, I had a discussion with the physical therapist about which muscles were part of my pelvic floor.  Based on my ability to contract my muscles at the time, she suggested that I focus on the muscles towards the front for doing my Kegel exercises.  I followed her suggestion for several weeks while doing the exercises.

After doing the biofeedback for a couple of weeks, we noticed that not only was my muscle relaxation very slow, but it happened in stages.  After I contracted them and then tried to relax, they would relax initially for a short period of time, then nothing would happen, and then they would start to relax again. The physical therapist had me try several things to get the muscles to relax more quickly, but nothing seemed to help.

At home, as I focused on the relaxation phase of my Kegel exercises, I realized that I was still holding on to tension in the back of my pelvic floor, in muscles that feel like they run vertically in the back of my pelvis.  I started to focus on tensing and relaxing those muscles, and immediately I could feel that my entire pelvic floor was relaxing more quickly and completely.  At my next visit to the physical therapist, using the biofeedback she was able to verify that I was able to relax much more quickly.

So now I think I have found all of the muscles in my pelvic floor.  In the past, I didn’t have any idea that all those muscles were involved in sex.  Now that I know, I am practicing controlling and relaxing them more effectively.

This is the next piece in the puzzle….

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Posted by on March 21, 2014 in Sex


Pelvic Electroshock Therapy

In my previous post, I mentioned that my pelvic muscles seem stubbornly stuck at a tension level of 10.  At times, I can get it down to 4 or 3, but it always climbs back up.  The physical therapist said that because the muscles are used to being tight, they don’t like to relax, so we need to jolt them out of this pattern.  She suggested trying something new.  Since Kegel exercises help my pelvic floor to relax, she suggested that stimulating the muscles might help to relax them even more.

For my biofeedback sessions, I have an electrode about two inches long and half an inch in diameter that I stick in my rectum.  When I squeeze my pelvic floor muscles, the muscle tension creates an electrical current in the sensor that indicates how much tension is in the muscle.  For the new therapy, she said that we would reverse that process.  The unit would create electricity in the sensor and the sensor would cause my muscles to contract.  Electroshock therapy for the pelvic floor (my term, not hers!)

I was a little bit hesitant.  Every outcome of this exercise that I could think of was unpleasant.  When she turned it on, I could picture my anus constricting and tightening so much that I screamed and writhed in pain.  Kind of like an anal taser.  I pictured stomach and abdominal cramps worse than food poisoning and the flu together.  Fried from the inside out, like an egg in the microwave.  The physical therapist, however, assured me that it was going to be nothing like that.  So at the end of the session, she connected another little device to the sensor that was already in my rectum.  When she turned it on, the sensation in my anus was something between a tingling and 1000 little pin pricks.  It went up and down in 10 second intervals.  It wasn’t painful, but it wasn’t remotely pleasurable.  She said it would go for 10 minutes.

It was kind of hard to endure at the beginning.  When it would first start to ramp up again, it was a little painful until it became more like a tingling feeling.  Eventually, I realized that if I relaxed as much as possible, I could avoid the initial painful feeling.  Eventually, I tried to crank it up a little, but apparently my ten minutes was up, and the device turned off.

I really couldn’t feel anything different.  That was the last thing we did and the physical therapist moved on to another patient, so we didn’t measure again either.  I’m not sure how much benefit I got from it.

That night, my wife and I had sex.  I did OK, but not great, so I didn’t notice any real improvement, and certainly nothing  different from after my previous appointments. I’ll report back next week and see what the physical therapist says.  Maybe I’ll try to crank up the stimulation earlier.

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Posted by on March 17, 2014 in Sex


How To Give Up???

I am disappointed that I have not been making as much progress on my premature ejaculation as I would like or that I expected.  I have been in the pelvic floor physical therapy now for several weeks, but my PE just doesn’t seem to be getting any better.  In fact, it may actually be getting worse.  There have been several times since I started the physical therapy that I have come almost immediately after we starting having sex, like before I started working on my PE altogether.  This isn’t what I expected and certainly not what I wanted.

I was feeling frustrated and disappointed with my progress, so I sat down to write a blog about “When to give up”.  When should I quit and stop trying to improve out sex life?  When does this become an obsession?  When does the work on my PE start to have a negative impact on my life and on our sex life?

Of course, as I started to think through the answers to those questions, I realized how stupid they are.  Deciding to stop working towards a goal only makes sense if your life is already working well in that area, but you just want more, or you are working to do something that is not central to your life.  Suppose, for example, you played a sport in college and did very well, but you didn’t get picked to be a pro.  You want to make it to the pros, so you work out, play semi-pro, and go to pro camps hoping to get selected.  At some point you have to realize that you are not going to make it to the pros.  You have to give up.  However, you are already accomplished, you have a job that pays the bills, and you have other relationships.  Sticking with the goal of getting to the pros is unnecessary and can have a negative impact on the rest of your life.

Working on my PE is different.  Our sex life is already bad (or at least not that great), so I’m not giving up anything to work on it.  It’s going to be disappointing if I do nothing, so we might as well work on it.  We can try to make it as natural and passionate as we can, but if I finish too soon and my wife is left unfilled and unsatisfied, who cares how exciting it was at the start?  Fortunately, none of the things I have tried has cost very much so far, so I’m not wasting our money.  Ultimately, there hasn’t been a true cost to me to try to address my PE.

After thinking this though, I realized that at this point, the question isn’t “When do I give up?”.  The question is “How do I give up?”  There is no reason for me to stop doing what I have been doing.  The only limit I see is that eventually, I may run out of new ideas to try.  Either way, I will still be trying and still working on it.  As long as I am having sex (which I hope will be for the rest of my life), I will be working on my PE.  I may not ever get the results I want, but I am going to keep working at it.  I really have nothing to lose.


Posted by on March 16, 2014 in Sex


Back On A Sex Schedule

We are back on a schedule for sex. Sometime early last fall, my wife and I were talking about my premature ejaculation and my wife made the comment “The problem is that you need to have sex on a regular basis.  We should plan it and put it on the calendar.  That way we make sex a priority in our marriage and we are sure that you have a chance to practice.  If it is important, we need to schedule it.”

I was kind of amazed.  We tried this about two years ago and had some brief success; however, it didn’t last very long.  At the time, my wife was not into it and didn’t like the idea of having set times to have sex, so after a couple of weeks, we stopped the schedule.   (I didn’t report about it because it was kind of depressing and I couldn’t get myself motivated to write.)  My wife didn’t remember our previous effort, but since she suggested it this time, I was all on board!

Since it was her idea, I let her dictate the terms.  In our previous effort, I set up a sort of rotating schedule. She simplified it and suggested we set aside Friday, Sunday, and Tuesday nights to have sex (with other nights optional), and that we plan our schedules around it.  Our regular activities are on other nights, and we don’t plan anything on sex nights unless we’ve talked about it and planned a make-up night.

It has been at least six months now, and we are still sticking with the schedule.  It is working out quite nicely, actually.  She is ready, willing, and engaged and often reminds me of it early in the day.  I know when to expect it and when I will get dedicated time with my wife.  We’ve been very busy lately, so the schedule allows us to be intentional and proactive about spending time together and connecting sexually.  It’s been really good for us.

So the schedule seems to be working really well for us right now.  I don’t know how long we will stick to it, but so far so good.  Sex is important to our marriage.  We schedule other important activities, and now we schedule sex too!

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Posted by on March 7, 2014 in Sex


Pelvic Floor Status

Here is a status update on my pelvic floor.  At my first biofeedback physical therapy session, the feedback sensor measured my pelvic floor at a 15.  I could barely relax and get it to 11.  The physical therapist said that she wanted to see 3s. Last time I was in, I started off at around 10 and after one set of Kegels, I was down to around 3 to 4, a vast improvement. The problem is that as I lie there, the number creeps slowly back to 10.  After trying several things, we found that I could keep the number near 3 if held my back arched (rotated my hips forward).  As a result, the physical therapist thinks there is still something with my lower back or abs that is creating the additional tension in my pelvic floor.  She gave me some abdominal stretches to do.  Time will tell if they work.

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Posted by on March 7, 2014 in Sex


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