When something changes in the bedroom, a lot of men immediately think, “Is my testosterone low?”

Maybe erections aren't as strong or consistent as they used to be. Maybe endurance has changed. Maybe things work perfectly one day and not so great the next. Or maybe you just don't feel as confident or in control as you used to.

Suddenly, you're wondering if your hormones are dropping, you're getting weaker, or you're simply getting older.

But here's something a lot of men aren't told: sexual performance isn't just about testosterone.

There's More to Performance Than Hormones

Testosterone is important, especially when it comes to sexual desire. But having normal testosterone doesn't automatically mean everything involved in sexual function is working perfectly.

An erection requires several systems to work together. Your brain has to receive the right signals, your nerves have to communicate, blood has to flow where it needs to go, and your muscles have to respond appropriately. Your stress levels, sleep, medications, overall health, and even your pelvic floor muscles can all influence that process.

The pelvic floor is a group of muscles at the bottom of your pelvis that most men don't think about until something goes wrong. But these muscles aren't just responsible for bladder and bowel control. Certain pelvic floor muscles also contribute to erections and ejaculation.

Think of it like a car. You can have a powerful engine, but if another part of the system isn't working properly, the car still isn't going to perform the way you expect.

Your body isn't much different.

And Here's Where It Gets Interesting...

A recent review looked at 13 studies involving 912 men and found that men receiving physiotherapy treatments (including pelvic floor muscle exercises electrical stimulation, and/or biofeedback) had greater improvements in sexual function compared with the control groups.

Think about that for a second. These men were working on a group of muscles that most guys probably don't even realize play a role in their erections.

And it makes sense when you understand what these muscles do. Your pelvic floor muscles can help increase pressure within the penis and contribute to erection rigidity, while also playing a role in ejaculation and sexual function.

But here's the important part: this does NOT mean every guy with erection problems needs to start doing a bunch of Kegels.

Some men may need more strength. Some need better coordination. Others are already holding way too much tension and actually need to learn how to relax.

That's why the goal isn't simply to“make your pelvic floor stronger.”It's getting those muscles to work the way they're supposed to.

And sometimes, that piece of the puzzle gets completely overlooked.

What If Your Pelvic Floor Is Already Working Too Hard?

This is something many men don't realize.

You can actually hold tension in your pelvic floor without knowing you're doing it. Maybe you're sitting at a desk for hours, constantly bracing your abs at the gym, holding your breath when you lift, or clenching when you're stressed.

Think about how easy it is to catch yourself clenching your jaw during a stressful day. Your pelvic floor can develop its own version of that tension.

If those muscles are constantly “on,” the answer may not be to squeeze them even harder. They may need to learn how to relax, coordinate, and then contract when they're actually needed.

Control is more than strength.

Stress Can Be Part of the Picture Too

There's also a reason sexual performance can sometimes change depending on what's happening in your life.

You may notice things work differently when you're exhausted, stressed about work, anxious about performance, or putting pressure on yourself to make something happen.

Sexual function depends on your brain, nerves, blood flow, muscles, and nervous system working together. When your body is constantly tense or stressed, it can become harder to relax and respond the way you want it to.

And then another problem can happen: you notice something isn't working normally, you start worrying about it, and the next time you're in the bedroom you're already thinking,“What if it happens again?”

Now you're trying even harder.

Sometimes trying harder isn't the answer. Better control and less unnecessary tension might be.

So, Is It Really Your Testosterone?

Maybe. Testosterone can absolutely be part of the picture, but it isn't the only possibility.

Erectile difficulties can have many causes, including cardiovascular conditions, diabetes, medications, hormonal changes, neurological conditions, stress, and other health concerns. That's why new or persistent changes in erectile function should be medically evaluated rather than automatically assuming it's your pelvic floor or your testosterone.

But if you've been evaluated and you're still wondering what's going on, your pelvic floor may be another piece worth looking at.

Instead of only asking,“How's my testosterone?”it may also be worth asking,“How well is my pelvic floor actually working?”

Because sexual performance isn't simply about having the highest testosterone level or the strongest pelvic floor possible.

Sometimes it's about having a body that knows when to tighten, when to relax, and how to get all of those systems working together.

And that's a part of men's health that doesn't get talked about nearly enough.

—Dr. Sandy Shulca, PT, DPT
Pelvic Health & TMJ Physical Therapist

This blog is for educational purposes and does not replace individualized medical evaluation or treatment.