Erectile Dysfunction as a Longevity Marker with Bill Taylor

In men’s pelvic health, far too many symptoms get reduced to performance, function, or a quick fix. But behind pelvic pain, urinary urgency, sexual issues, or post-ejaculatory pain, there’s often a much bigger story, one that involves the nervous system, breathing, tension patterns, movement habits, and shame.

In my recent conversation with Dr. Umit Erkut we explored how men’s sexual health concerns deserve a much fuller lens, one that goes beyond symptom management and into understanding the whole person. Today, we’re continuing that conversation with another angle, with Scottish physiotherapist, Bill Taylor, a long time men’s pelvic health expert. We’re talking about what men are really dealing with, what gets missed in care, and how better outcomes

begin with better questions.

Welcome back to the vocal pelvic floor, where we explore the intersection of pelvic health, voice, performance, sexuality, nervous system health, and whole person care. I’m your host, Ginger Garner, and today we’re continuing an important conversation around men’s pelvic health. My last interview was with Dr. Umit Erkut who opened the door to a deeper conversation about men’s health, sexual health, pelvic health, and the role of many different things between breathing, nervous system, and…

and learned patterns for recovery. So today, let’s widen that lens a little bit further. And I want to welcome Bill to the show. I am so glad you’re here. Welcome.

Bill Taylor (01:41)

Thanks for having me. Thanks, Ginger.

Dr. Ginger Garner PT, DPT (01:44)

Yeah, absolutely. All right, I got to brag on you a little bit. So everybody listen. This is a little bit about Bill. He is a Scottish physio, physiotherapist with more than four decades of experience and over 25 years specializing in pelvic health. He is widely recognized in the UK and internationally as a leading expert in male pelvic floor dysfunction with a special interest in chronic pelvic pain and the role of manual therapy movement.

⁓ exercise in recovery. Bill is clinical director of Taylor, Taylor physiotherapy in Edinburgh, where pelvic health makes up a large part of his practice. He is also an educator, author, researcher, and currently serves on the boards of both POPG, POGP, sorry, and Prostate Scotland while pursuing doctoral research on movement and exercise and male chronic pelvic pain because he has lots of spare time apparently.

He has served also the Scottish Ballet and Scottish Dance Theatre for over 20 years. He was integral in the development of a full-time physiotherapy service to the National Ballet, after which he continued as a consultant physiotherapist for a number of years. And he continues to work with dancers of all ages and abilities ⁓ in his clinic there in Edinburgh. And he’s also a visiting lecturer at the university there in Edinburgh. Welcome again, Bill.

Bill Taylor (03:09)

Thanks very much. It’s really, I’m delighted to be here. It’s great. Thank you.

Dr. Ginger Garner PT, DPT (03:14)

Yeah, I’ve been waiting for this conversation for a while because we need to well, what I think is a more in-depth ⁓ conversation around men’s pelvic health. And to begin with, it’s such an underserved area. ⁓ I know when I moved into the current urban area that I’m in, it’s the third largest ⁓ city in North Carolina, I made an incorrect assumption that someone else was doing men’s health in this area and that

I didn’t need to also cover that. And then I got here and realized, ⁓ okay, we definitely need to broaden this conversation because it’s not being covered. And I’m getting a lot of referrals and a lot of men who are like, hey, I have these issues, what do I do? So it just makes me really curious. I that was my entry point into realizing that ⁓ yes, women’s pelvic health has been underserved and is still underserved and we don’t have enough therapists, but there’s a whole other, you know,

half the sky here. So I’d love to begin with you, your path into this work. What drew you into men’s pelvic health in the first place?

Bill Taylor (04:23)

Yeah, it seems like yesterday and it seems like a very long time ago at the same time. basically I had just returned to Scotland from where I’d been living in Canada for quite a long time. And I had done quite a lot of work with Diane Lee around pelvic girdle and orthopaedics. And so I was quite comfortable in treating pelvic girdle pain, especially pelvic girdle pain in pregnant women.

And one day a chap walked into the clinic and said, I have prostatitis and I’d really like you to help me with that. And I think I said, well, you need to see a urologist. And he said, well, I’ve seen sex and I’ve had various. And it was kind of like, went, okay, so what do want me to do? He said, well, just have a look at me. So we, I did my usual kind of manual therapy stuff and he got like,

Dr. Ginger Garner PT, DPT (05:09)

Mmm.

Bill Taylor (05:22)

I don’t know, maybe 50 % better after a few sessions. So I was kind of interested and he, think on his third visit, he showed up with a book and he handed me this book and it was called Hedwig and the Pelvis. And it was, I think it was edition three. So I think there’s maybe an edition nine, 10, 11, something like that now. And I read it and I thought, well, that’s interesting. And so I…

found a colleague to help me with how was I going to assess the pelvic floor. I had a chat with a urology friend and a little bit like yourself, I assumed that these men were taken care of by the pelvic health physiotherapy community. Very quickly found out they weren’t. ⁓ In fact, very quickly found out that nobody was taking care of them.

Dr. Ginger Garner PT, DPT (06:18)

Mm.

Bill Taylor (06:20)

So actually I started, so another thing that happened at that time, which is quite hard to imagine, was there was no internet, it was just starting. And the internet allowed men to get together, create platforms where they could share their stories. And I suddenly got phone calls and emails from people saying, you treat pelvic pain.

and you treated this chap and he recommended you so that my guy was getting better. So ⁓ I thought, okay, I can only be honest here. So I started saying to guys, look, I’ve only seen four people, but if you want to come and I’ll have a look. And then I had, think after maybe treating, having a very kind of mechanistic and biomechanical approach to it, after a few months, I thought, you know, this is not how I look at shoulders or knees or elbows or I need to.

broaden my sphere. I need to look at the muscles and how am I going to do that? So I kind of went off on a journey through our special interest group here to learn skill, to build my skill in assessing the pelvic floor, which sounds now easier than it was at the time because I used to rock up to these courses. I would be the only man on the course. And they would look at me with a little kind of

fear and trepidation and think why is he here? But actually they were really quite welcoming. I learned a lot. But one of the things that I learned was I think very early on was that everybody was focused on incontinence. Not many people were interested in pain or dysfunction or the bigger effect that that would have on people’s lives. And certainly nobody was looking at men.

Dr. Ginger Garner PT, DPT (07:52)

Mmm.

Bill Taylor (08:18)

So I kind of, with a combination of pure GP, especially, and then my colleague who was a urologist, I kind of like devised, I just decided, you know what, I have to assess these guys. But at the very beginning, I was super honest and I would, I think I did some that I’d always been used to treating very complex, chronic conditions. And if I did sports injuries or dancers, it was often…

career ending injuries that I was dealing with. So trying to stop their careers being ended. So for me, having the in-depth, very complex conversations was something I was used to. So I used to sit down and say, just tell me your story. Well, it’s very long, I’d say, take your time. And often at the end of the, from the very, very beginning, I used to hear guys say to me, you know, it’s the first time that I think someone’s listened to me. It’s the first time.

that I think have been heard. And I was kind of a bit shocked and a bit surprised and I thought, ⁓ okay. So I then started though, I thought honesty was a good place to start. So I would say to them, so I’ve seen 20 people and I’m getting good results, but it’s really early days. And to be honest, I’m using my orthopedic skills and my clinical reasoning and I’m putting it on top of this pelvic.

area and I’m just treating it a little bit like any other joint in the body. And then I guess my confidence, once I’d seen four and because of the internet and people people kept coming then by the end of the year I think I’ve maybe seen five or six hundred then the next year I’d seen a thousand, fifteen hundred, then two thousand, then three thousand and then four thousand and I guess I started to realize that I had somehow become the go-to person.

for pelvic pain. which was kind of, I thought, wow, okay. So I then started reaching out to movement therapists, Pilates instructors, yoga people, looking at breathing, taking that, just really expanding my skillset and looking at how does this fit? Because there’s an awful lot of, there’s a lot of layers to this, biopsychosocial, sexual, that, you know, it’s a very complex thing, but also,

Dr. Ginger Garner PT, DPT (10:13)

Thank

Mm-hmm.

Bill Taylor (10:41)

A lot of the time, I often used to think it was just about listening. It was about them being heard. And when they felt heard, you were probably 50 % of the way there, certainly towards them trusting and believing you. And I suppose I had been a physio then for 20 odd years and I was used to clinically reasoning very complex cases. And so I just used the skill I had from that.

and applied it to pelvic floor function and dysfunction. It was very interesting because I used to say, when I started to go to other courses, pelvic health courses in the UK, I would say things like, well, I’m not really very interested in incontinence. And everyone would look at me and go, but why not? I said, because I’m really interested in pain, because most of my guys, they’re coming with pain.

Dr. Ginger Garner PT, DPT (11:28)

You

Yeah.

Bill Taylor (11:39)

I said, to be honest, you guys specialize in incontinence, so I can leave that to you and I can deal with the pain. I suppose this just around about five years in, there was a kind of a, was kind of doing this kind of reflective thing one day after about five years of, do I really know what I’m doing? Am I doing good here? ⁓ I had a very busy orthopedic clinic, I thought.

Dr. Ginger Garner PT, DPT (12:04)

snow.

Bill Taylor (12:07)

And I was speaking to one of my patients and I think I must have verbalized this to him, because I don’t know about you, but one thing that happens with pelvic floor patients, pelvic patients is there’s a bit of a deeper connection with them. There’s more of a human thing that happens between you and you can’t stop it. It’s there. I always say to people, if you don’t want that, don’t work in pelvic health because that’s going to happen. And I said to him,

Dr. Ginger Garner PT, DPT (12:21)

Yeah.

Okay.

Bill Taylor (12:37)

you know, I don’t know if I want to keep doing this. And he said to me, you can’t stop. And I said, what do you mean? He said, you can’t stop. He said, you saved my life. No one else was helping me. There’s so many people like me, so many guys like me. You just absolutely can’t stop. And I remember going home and thinking, ⁓ okay then. I guess that’s it. I guess I’m not stopping.

Dr. Ginger Garner PT, DPT (13:01)

you

Bill Taylor (13:04)

And then I think what I did was I started thinking, I started reflecting upon maybe I needed to look deeper into it. I needed to start spreading my knowledge more. I needed to start looking at guys, maybe guys, pelvic floors in a different way. And round about that time, a consultant urologist started sending me

post-prostatectomy patients who were incontinent and who had erectile dysfunction. And I got really interested in that. I got really interested in the whole idea of the kind of mythical nature of the pelvic floor and how it had been given this almost kind of status that made it intangible. people, wasn’t, we didn’t think of it as being

muscles, we didn’t think of it as working as striated muscles would work as muscles would work in the rest of the body. And I started maybe listening more to the guys and thinking, wow, they actually think that the way their pelvic floor works, it’s a bit of a gift from the gods really. It’s kind of bestowed upon them from on high. It kind of arrives when they need it. They stop peeing, they go to pee.

They go to poo, they stop pooing, their erections just appear, they use them, but they don’t actually give them a second thought unless they’re not working. They don’t, if everything is fine, they go for as long as they’re fine without considering it. And then suddenly when it doesn’t work, they’re really at a loss. their journey is that they head off to see a medic

Dr. Ginger Garner PT, DPT (14:38)

Mm-hmm. Mm-hmm.

Bill Taylor (15:00)

and the medics are very kind of almost one-stop shop. Well, actually we’ll give you some Viagra, you take that and you’ll be fine. And they weren’t fine. Or you take some medication for the pain and you’ll be fine and they weren’t fine. Or the other path is, okay, we need to do a whole bunch of tests and those tests became ever increasingly invasive.

Dr. Ginger Garner PT, DPT (15:12)

Mm-hmm. Yeah.

Bill Taylor (15:27)

with ever diminishing returns. And so they were left with oftentimes the very last interaction with a consultant would be, well, I’m not really sure what’s wrong with you, but I think it will probably go away. You’re gonna have to learn to live with it. you know, just maybe I remember at the very beginning, you should just have more sex and you should just masturbate more. And I would think, and my guys would be going but.

Dr. Ginger Garner PT, DPT (15:29)

Yeah.

gosh.

Bill Taylor (15:54)

I don’t want to have sex because it hurts and it doesn’t work right and it doesn’t feel right. And actually I don’t feel very sexy. I don’t feel, I have no, if you have a sore penis or you have ejaculatory pain, you’re not looking forward to that. And so I suddenly started to realize that it was, there was this huge, huge thing that actually just.

Dr. Ginger Garner PT, DPT (15:56)

Right.

Yeah.

Bill Taylor (16:22)

absolutely underpinned their whole journey. You know, it was a bit of an evolution for me because I guess coming from a manual therapy biomechanical background, I think in the first few years I was quite resistant to don’t drag me into the biopsychosocial, ethereal, spiritual side of it. And then I suddenly thought, actually I have no choice really, because if I’m going to treat these men

Dr. Ginger Garner PT, DPT (16:39)

Yes.

Yeah.

Bill Taylor (16:52)

If I’m going to do the best I can for them, I actually have to be, I have to get rid of my baggage. I have to actually drop my barriers down. I have to let them be open to me. And I have to learn to be, you know, listen non-judgmentally and try to give feedback if I think it’s appropriate, put them on a journey. And I learned, I think I learned really quickly as well.

Dr. Ginger Garner PT, DPT (17:04)

Hmm.

Bill Taylor (17:21)

to kind of almost, I did it, I think I probably did it little bit subconsciously. I think I took kind of global trauma precautions. I just assume everybody was traumatized. I just assume everybody was because I thought who am I to decide who is and who isn’t? So if I just assume everyone is, then it’s a safer position to take.

Dr. Ginger Garner PT, DPT (17:36)

You know, yeah.

present.

Yeah.

In the pelvic health community too, that’s a very safe assumption because usually they’ve seen the six urologist or they have seen so many people and they’ve been bounced around that they already have a high level of what’s defined as ⁓ institutional betrayal where the system they go to for safety and protection and answers ends up betraying them and saying, well, just keep going.

Bill Taylor (17:51)

Yeah, yeah.

Yeah.

Yeah.

Yeah,

100%. And I think I say to guys, you know, what happens is you grew up your whole life and that your experience with the medical community is you go along, you tell them a story, they give you a diagnosis, they give you something tangible, either something to take or something to do, or another doctor to do something to you. They put it in a bag, you take it home, you get better. Suddenly you show up and there’s nothing to offer you.

and there’s nothing to give you. the doctors themselves, you know, God bless them. They do their very, very best. But when they come to a point of, when they can’t offer anything, they’re not very good at saying, look, I think I can refer you to someone else. I’ve done everything I can, but actually maybe there’s something, another path for you to tread. Which I have to say now.

all these years later, have, the other day I just suddenly realized I have about 15 urological consults that refer these patients directly to me much, much sooner, probably after one session, maybe two with this consultant when they realize that these guys need to have pelvic health physiotherapy. So that’s been a huge, massive change for me.

Dr. Ginger Garner PT, DPT (19:31)

Yeah,

you know, that context is so helpful because, I mean, you had that particular experience that shaped your trajectory moving forward. You know, you identified that we both had similar experiences and going, wow, okay, that’s a giant gap in care. And then, you you also really described your evolution of how you first entered into doing the work and how it has evolved.

Bill Taylor (19:49)

Yeah, yeah.

Dr. Ginger Garner PT, DPT (19:57)

And I think that’s important for our listeners because they may still not realize like just how broad men’s pelvic health actually is. So if we can talk a little bit about, you know, what men are really coming in with when people hear men’s pelvic health, they think of like incontinence, right? They think of one issue in isolation. They might think of sexual dysfunction if they know a little bit about pelvic, you know, physiotherapy, but the clinical reality is

Bill Taylor (20:16)

Yeah. Yeah.

Dr. Ginger Garner PT, DPT (20:25)

much broader, it’s way more complex. So when men first come to see you, so for the listener who may not realize just how broad it is, when men first come to see you, what are the most common problems that they are actually dealing with?

Bill Taylor (20:39)

So it’s really interesting you say that because for the first 15 years of my pelvic floor practice, I never saw a post-prostatectomy patient. I didn’t see one. So all of my patients were coming with some form of pelvic pain and that could be rectal, perineal, testicular, penile. It could be related to activity. So weightlifting, gym, it could be related to…

maybe and I hate the word porn addiction and I hate that word because I have some things about that because there’s a judgment there. It’s a laden phrase I think but maybe perhaps how they’ve been practicing masturbation and how often and how hard they’ve been doing it that can cause some problems. Then another bunch of there’s often a bunch of guys that ⁓ maybe SSI like anti-depressant

taking guys with SSRI pain and that can, there’s a couple of antidepressant medications that can, if you like seem to trigger pelvic pain in some guys. There’s also another group of medication, finasteride, which is like a hair loss medication. And there’s a bunch of guys that I see that have had some experience in their pelvic floor because of that. But I think at the very beginning, probably 90 % of the…

the guys I was seeing were pain patients of one description of another. Some involved with sexual function dysfunction and some not. If they had a bladder or urinary symptoms, it tended to be urgency rather than incontinence. So they were able to stay dry, but they were going to the toilet a significantly higher number of times in the day than normal. The interesting thing for me, I think at the very beginning was they were all really young.

They were all under 30. They weren’t the group of people that you would think. And certainly, when people used to say to me, so what do you do as a physio? Are you still doing the ballet? Yes. Are you still doing sport? Yeah, I’m doing a bit of sport. Oh, what else do you do? And I say, well, actually I do a lot of pelvic health. Oh, so like women after they have babies, said, no, 100 % of my caseload is basically men. And they would be going.

Dr. Ginger Garner PT, DPT (22:58)

You

Bill Taylor (23:03)

I said, well, because, well, because they’re men, because men have pelvic floors as well. I think, so I think it’s changed. Erectile dysfunction was, is something that I’ve been seeing more in the last five to 10 years, certainly more since COVID lockdown. seems to, it seems to become more of a thing. And I think also,

The other thing is hard flaccid syndrome, was really brought to my attention by by patients themselves. Although I became I became very interested in that because I well, mainly because a lot of the guys were incredibly distraught by the time they came to see me, maybe even more distraught than the pelvic pain patients because they just felt it was completely hopeless. sometimes when they were seeking information on

Dr. Ginger Garner PT, DPT (23:34)

Right.

Bill Taylor (24:02)

you know, on platforms, on patient support platforms, some of that information isn’t always the most positive. And so they would often come in feeling everything was hopeless. I think, yeah, so I think most of my case load still tends to be pelvic pain. Although I think maybe I have about 20 % of my case load is now post-prostatectomy patients. Although interestingly enough, it tends to be the ones who aren’t

who are probably still leaking eight months, 18 months down the road. And I’m really interested in what we’re able to do to treat them differently. I’ve been working on this thing for long time called my performance continuum as opposed to ⁓ do Kegel exercises.

And this is what really got me interested in ⁓ incontinence really was because guys would come in and say, well, I’ve been doing thousands of Kegels for months and nothing’s got better. And from my MSK orthopedic strength and conditioning background, going, well, why are you doing that many? You’re probably over training it and under loading it. And they’d look at me and I would say it and think, so what does that mean? What does that look like?

Dr. Ginger Garner PT, DPT (25:24)

Mm-hmm.

Bill Taylor (25:30)

in pelvic health? How do we change that? How do you make it so that we do load them properly and don’t over train them? I think my guys, my incontinence, post prostatectomy guys think I’m really strange because the first thing I do when they come to see me is I’ll say stop doing everything. Stop all of your exercises right now.

don’t do a single exercise for two days and tell me what happens. And the really interesting thing is they phone me up or they send me a message and they’ll go, yeah, I’ve been dry for quite a bit now because their muscles have a chance to rest. And then I take them back into approach, you know, that kind of over-trained thing. my kind of, my case load at the moment is probably about 85, 95 % men.

Dr. Ginger Garner PT, DPT (26:13)

Yeah.

Bill Taylor (26:26)

and probably about in pelvic health and I think probably maybe 80 % pelvic health, a little bit of MSK still, but not much. But yeah, I think, and I see pretty much anything and everything, know, chronic testicular pain, chronic penile pain, pain with ejaculation, pain with erections. I’m really interested in sexual dysfunction. I’m really interested in…

premature ejaculation. interested in, I had an interesting patient the other day who just couldn’t, ⁓ it was something that I’ve heard before as well with some patients that couldn’t ejaculate inside their partner. And he was very upset about that. And so we did some work around that, which is really interesting work to have, to talk about the brain pelvic floor connection.

Dr. Ginger Garner PT, DPT (27:16)

Yeah.

Right.

Bill Taylor (27:20)

and

what’s happening. And suddenly it becomes, you guys are, they don’t like to talk about this stuff. You know, I said to a guy the other day, said, you you damage your knee playing rugby, you tackle someone, that night in the pub, you’re telling that guy all about your mechanism of injury. You’re telling him how swollen your knee was. You’re telling him you couldn’t walk on it. You’re telling him you stopped that guy making the try so your team won. I said, but.

Dr. Ginger Garner PT, DPT (27:38)

Ha ha ha ha.

Bill Taylor (27:49)

If you go home and your erections are 40 % normally less than normal, you don’t see the guy in the pub go, how are you doing? Well, do know what? Last night I tried to have sex with my wife and my erections were 40 % as good as they normally are. And the pair of you have this conversation, it just doesn’t happen. It doesn’t happen.

Dr. Ginger Garner PT, DPT (28:07)

No, it doesn’t. So that’s why, yeah,

for the listener, think it’s important to understand what some of the symptoms of these things would be so that we can start to normalize this conversation because just like in women’s pelvic health as well, they’re going to have things they just don’t necessarily sit around and talk about because they think they’re just supposed to accept it or that they’re the only one that has it and therefore it’s outside the norm.

Bill Taylor (28:28)

Yeah,

Dr. Ginger Garner PT, DPT (28:30)

Let’s talk a little bit about what the symptoms may look like. I’ve got a list here of things that I hear commonly, and I know they’re probably very common to you, but let’s start with the first one that you mentioned that ⁓ I think many people may not understand what even you’re talking about, but if we could talk about the symptoms of it and then kind of how to move forward, would be hard flaccid syndrome.

Bill Taylor (28:50)

Sure.

Yeah, yeah. So, I mean, hard flaccid syndrome is really interesting condition. I first came across it really by through a patient showing up and saying, I have hard flaccid. And I said, I have no idea what that is. And he, it’s, there’s a lot of internet information about it. And I think we’ve recently, actually I’m sitting here with a paper.

this year just published, Hard-Flaccid Syndrome, a systematic review of etiopathological physiology, clinical presentation and management. And even this paper, which is being written now, we’re still not in a huge agreement. However, I think what we can say, it sits along the line of chronic pelvic pain syndrome kind of dysfunction. And it’s basically a state change in penile tissue. So it’s about a change of how your…

penis feels. It normally feels, the word I would use is turgid, which I mean by that, like semi erect. So it’s not soft and it’s not hard. You can also, it can be wasted in the middle of, a bit like an egg timer in the middle of the penile shaft. There’s also temperature change from the glands to the rest of the penis. The glands often feels cold. There’s a sense of tension that

can be transferred along the penile shaft and into the perineum. It’s a bit, it doesn’t, it feels like you’ve got a semi erection, but there’s not a concomitant arousal state in your brain at the same time. So you’ve got a mismatch between what your brain, what your penis and your part floor is telling you and what your brain is thinking is going on because there’s nothing sexy here.

And I think it’s not particularly pleasant then to have sex and erections often can’t be 100%. And I think, so my kind of take on it is this, is that I think our pelvic floor is a very complex thing. It’s very tied in with breathing. And you’re very aware of that because of your work on voice and connection with your throat and letting your muscles relax. And I think that

know, diaphragmatic, inter-abdominal pressure, pressure system management is really key in these guys because they often are core rigid. They’re often, their breathing is often very shallow and they have a, and it’s like they’ve been told they’re anxious and they just need to relax. And I’ll say, well, you’re probably anxious because your penis doesn’t feel like it’s working right. I think that would make you anxious. Were you anxious before? I don’t feel like I was anxious before, but I’m definitely anxious now.

Dr. Ginger Garner PT, DPT (31:26)

True.

Yeah.

Bill Taylor (31:46)

So it’s kind of, ⁓ I think there’s a vascular component. I think there’s a muscular component specifically in the muscles of the penis, that bulbaspongiosis and ischiocavionosis, which are a little bit separate from the actual pelvic floor muscles themselves. And I think in men, it’s a bit different to women. So women get a condition that I sometimes treat called persistent gentle arousal syndrome.

which I think is a little bit similar to hard flaccid, but not really. And if you look at the anatomy of the clitoris and those muscles, there’s a kind of a similarity there, but a difference at the same time. And it’s to do, think, with, you know, like rectal function is where you have blood going into the penis, but not coming out. And something happens where the coming out part of the blood gets dysregulated. and I think it’s almost a bit like a

A Pervilogous Regulation Syndrome. It’s not just the muscle, it’s not just the vascular system, it’s not just their tension, it’s not just the pressure regulation, it’s all of those things. And it’s very interesting to treat because you can make changes quite quickly, especially in the vascular side of things. was talking to, I was in Norway not that long ago and I was speaking to a lymphatic.

physiotherapist who specialises in lymph drainage and cancer swelling and I was saying to her I said so I have this theory that actually I’ve kind of like I did a lymphatic drainage course because I thought that the lymph wasn’t drained so the the penis wasn’t draining properly so I went on the course and said to the the lymphatic massage person so this is what I want to learn I want to learn lymphatic drainage to the penis and well she looked at me

I hadn’t been looked at that like that for quite some time and I said no listen it’s it’s this is why and she she could understand it a bit but I had this conversation with the the lymphatic physio in Norway and she she was just nodding all the time we see this we see this all the time and we treat guys with lymphadena of their scrotum and lymphadena of their penile tissue and I thought wow so I’ve that

Dr. Ginger Garner PT, DPT (33:46)

Hahaha

Bill Taylor (34:08)

almost kind of reinforce my idea around that. so I think there’s this vascular thing, there’s a muscular thing, there’s sometimes even a neural thing, because there’s the pudendal nerve which supplies the shaft of the penis and the tip of the penis. ⁓ Although I think what happens sometimes in pelvic health as you know, is I sometimes think that pudendal neuralgia is a term that’s thrown around a lot and it’s battered about and I’ve seen in

Dr. Ginger Garner PT, DPT (34:34)

true.

Bill Taylor (34:38)

20 odd years I think I’ve maybe seen three or four true pudendal – It’s a bit like piriformis syndrome, it becomes very trendy, you know, you just label it. Or sometimes I think GPs often will send patients to me saying the patient has a pudendal neuralgia and I think, well, I don’t think so. And it’s a bit like when GPs send patients to you saying they have a frozen shoulder but they have a full range of motion, you know, that kind of idea.

Dr. Ginger Garner PT, DPT (34:45)

Right. Yeah. Yeah.

Mm-hmm.

Right? Yes.

Yeah.

Bill Taylor (35:07)

So I think, yeah, so hard flaccid though is more common than I think we know for sure. And I also have come to think that a lot of guys in the chronic pelvic pain syndrome kind of arena often, if pain is their main problem, they kind of shelf the hard flaccid because it’s not so bothersome as the pain.

And if they don’t have the pain, the hard flaccid is the thing that they come with. And that’s the thing that they present with, if that makes sense.

Dr. Ginger Garner PT, DPT (35:39)

Yeah.

What else do you see that is like, we would call that comorbid, but for the listener, it’s like, what else comes with it, right? For them.

Bill Taylor (35:47)

Yeah. Yeah.

Yeah,

with the hard flaccid guys. So I think there’s a lot of fear avoidance behavior. There’s a lot of anxiety. There’s a lot of not living their life. There’s a lot of not going to the gym and doing what they want to do. There’s a lot of not dating. There’s a lot of not looking for a partner. There’s a lot of…

reflection upon their life about am I going to have a partner, am I going to be able to have children, it is this humongous, like it just turns their whole life on their head. They’ve never had anything that stopped them in their tracks, I don’t think. And I think they often have things like perineal pain, so pain between their rectum and their testicles.

they’ll maybe walk about all day with a sense of clenching in there, a discomfort. It might be uncomfortable to sit. It makes work difficult, especially if they have to be cognitively aware. If they have to actually be engaged in doing incognition, that’s a bit harder. Sometimes if they’re not sitting, then it can be a little easier. Sometimes the sitting’s a problem and going to work can be difficult. So, and I think it can affect…

all aspects of their life and if you’ve got a girlfriend, if they have a partner or a wife and they’re having sex, again that mythical thing, my erections have always worked, they’ve always come when I needed them and they’ve always just done what they’ve needed to do and now they’ve disappeared. ⁓ What am I going to do? And I’ve gone to the doctor and he is going to help me, tell me, give me the right medication and I’ve…

I’ve gone to the top consultant and I’ve left there and he said he doesn’t know what to do. And it leaves them with this absolute feeling of dread that they’re going to be stuck with this for sure. And I think, I often say to them, I’ll say, okay, you have some helpful attention, you have some pain, you have some dysfunction. I said, but really why you here is because you feel miserable and because you feel hopeless. I said, so my job really,

Dr. Ginger Garner PT, DPT (37:48)

Yeah.

Bill Taylor (38:05)

although I’m gonna try and fix your symptoms, my job is can I reduce your misery and can I give you some hope? I said, if we can do those two things, then I said, you’ll be on the way to being mended and on the way to wellness, I think, really.

Dr. Ginger Garner PT, DPT (38:24)

Yeah.

So let’s talk about a few other things because these are very, very common things that I see. And ⁓ if there are other common things that you also see, I’d love for you to talk about those ⁓ as we move, because I want to move towards misconceptions of what men have about their symptoms, but some of the things that they may be experiencing now, like post-void dribble, ⁓ erectile dysfunction, ⁓ painful ejaculation. Can you talk a little bit about those three and what

Bill Taylor (38:47)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (38:54)

they

may feel like just to get them in the door so they’re gonna get help somewhere to know that they don’t have to put up with that.

Bill Taylor (38:58)

Sure.

I think the post-void dribble one’s an interesting one because it’s almost kind of funny. You it’s almost kind of a nuisance. Accept it. Accept it isn’t when it’s happening to you. And it isn’t when you, every time you have a pee and you put your penis back in your underwear, that your underwear is more wet than you would comfortably want it to be. And then you think, ⁓ it’s like so frustrating and a sense of you’re not in control of you.

Dr. Ginger Garner PT, DPT (39:07)

Hmm.

Bill Taylor (39:28)

Because I think the other thing that men do is we kind of imbue and embed our penis with a sense of who we are. when even it’s just this dribbly thing that happens that you think, well, that can’t be that bad. It’s just a little bit of urine. The trouble is if it happens three or four times during the day, your underwear starts to smell. The tip of your penis becomes irritated because of the urine. maybe you’ve started to try and…

dry it with tissue paper and then the tissue paper gets stuck to your penis and then you’re like ⁓ the whole thing becomes something that became really simple where you would just go to the toilet and do a pee, put your penis back in your pants and walk away normally with no consideration has become the guys will tell me things like I try to hold on I start to hold my urine in I start to not go to the toilet

Dr. Ginger Garner PT, DPT (40:05)

Yeah.

Yeah.

Bill Taylor (40:28)

I wait till I’m home and then sometimes I’m even leaking because I’m holding in so much. I think my take on that, I get some decent results with, so bulbospongiosis and ischocavinosis are the two muscles that wrap around the urethra and they are the muscles that once we’ve finished peeing. So I think as well to understand peeing is, I was just talking to a

Dr. Ginger Garner PT, DPT (40:32)

Yeah.

Bill Taylor (40:58)

⁓ space scientist a couple of weeks ago about astronauts and peeing in space and it was very interesting because of course we forget that we need gravity to pee because when we go to pee we stand up our bladder is full sometimes our bladder muscle might squeeze to start the flow of urine but mostly you’re just turning the tap off or opening the tap up in gravity empties so ⁓

But in space that doesn’t happen because so it was very interesting to talk to what the problems they have in space with peeing. But I say to my guys, imagine that your urine runs out and then we have, ⁓ guys have this problem because we have a longer urethra than female urethras. So we have a bit of urethra outside our bladder, a bit of urethra in our prostate, a bit of urethra after our prostate and then urethra in our penis.

So we do have this tube where urine, if it isn’t actually expressed out by those muscles, can sit there. And I think sometimes what happens is we get a bit of mistiming between the bladder opening, the tap opening, the bladder emptying, as maybe, and we don’t tend to use muscles unless we’re in a hurry. If we need to leave the bathroom quickly, we might use detrusor, we might use intra-abdominal pressure. But if we’re just peeing, then…

we normally let that just go and it runs itself naturally. The problem is that we don’t have much concept of exactly how do we pee or exactly how do we make it come out faster. So oftentimes when we try to push the urine out of our urethra to stop the dribble, we actually shut down the bladder and we actually almost trap that urine further up the urethra. And we think, good job, well done Bill.

Dr. Ginger Garner PT, DPT (42:36)

Mm-hmm.

Bill Taylor (42:53)

And then I relax. But when I’ve relaxed, that urine is still there because I haven’t used the muscle to actually express out the urethra. But the nice thing is we can train guys to use the muscles at the front of the penis to milk that out. And we know that because there was some really cool work done by some Australian physios and researchers that you probably know about, Ginger, where they were cuing men.

to use the muscles of the front of the pelvic floor differently from the back. And what they found was that it specifically contracted those muscles that go up the shaft of the penis. So we have this combined thing where we can get guys to be trained to use those muscles to milk the urine out of the urethra. And then they can also do that manually if that, beginning, if that’s not enough. that’s a really nice thing to…

help a man with because it’s one of those things where it’s relatively, it’s a little bit of hard work for them because they have to do the thing that men aren’t very good at. They have to get their brain connected with their penis. They have to, it was a bit like you said that brilliant word at the start of our talk today. You said men tend to be performative and they tend not to be present.

and they tend not to be present in their, much as they would maybe disagree with this, they tend not to be present in their genitals unless they’re having a sexual moment. And if they’re not having a sexual moment, they’re not connected to their penis in any way, or form. So trying to bring their head to this area. And it’s a really simple thing. It always makes me laugh because I don’t think I’ve ever asked

Dr. Ginger Garner PT, DPT (44:29)

to

Bill Taylor (44:48)

a male patient this and they’ve ever said, I don’t know how to do it. And I’ll say, so to make those muscles work, what you have to do is bring your brain to where your penis is. Now, do you know the movement you can make your penis do when it’s erect, where you can make it move up and down? And everyone goes, yep, yep, yep, yep, yep, yep, yep. I’ve never had anyone go, no, no idea. And I’ll say, so let’s try that and see what happens. Now, I’m super lucky in my clinic because I have access to ultrasound imaging.

Dr. Ginger Garner PT, DPT (45:06)

Yeah.

Bill Taylor (45:17)

so I can alter side their pelvic floor muscles and you can do this so that you can see the back and the front separately. So I can see the muscle working and I can show them the muscle working. And even if they, and it’s a very interesting thing because they’ll do it and they say, I have no sense of that. I have no idea what I’m doing. I’ll say, you can, yeah, I can definitely see it. So that too.

Dr. Ginger Garner PT, DPT (45:41)

⁓ Is

that a trans perennial view for you? Yeah.

Bill Taylor (45:44)

Yeah, so trans perennial view . Yeah,

absolutely. And absolutely, took me, because I’m doing some, I’m doing my PhD at the moment, and it took me down this big, dark hole, this big rabbit hole into the idea of like the salient part of the brain and why this was the case, because it’s the subconscious subconscious. And why would we expect you to be connected to this? Because it’s so deep in your brain, it’s meant to work there.

That’s what it’s meant to do. It’s meant to work in that area. It’s not meant to work in your conscious arena, which is why it’s so peculiar to do it.

So I think for me, I’ve been finding some really useful things like teaching guys to milk the urethra, but also because that’s not, it’s a useful tip, but it’s not what they want to do because that’s not how it normally works. It normally works muscularly and it works automatically. So trying to get back to that salient subconscious thing is really what we’re gunning for. So yeah, so that’s one thing. What was the next thing? I can’t actually remember what you asked me about.

Dr. Ginger Garner PT, DPT (46:35)

Mm-hmm.

⁓ erectile

dysfunction.

Bill Taylor (46:48)

⁓ okay. So yeah, it’s a huge thing. think it’s like, you know, ED is just, ⁓ wow. It’s, you know, I think this, I would say this absolutely, that I have learned so much about rectal dysfunction working with post post-epostatectomy patients. I have worked so much about my understanding and the way I think about

Dr. Ginger Garner PT, DPT (46:51)

Yeah.

you

Bill Taylor (47:16)

sexual recovery, sexual rehab ⁓ has completely changed ⁓ for lots of different reasons. think, so what do I think about ED? So ED is this thing where we have, it’s 30 % muscular, it’s 30 % blood and hormones, it’s 30 % sexual arousal, and it’s 10 % we have no idea.

There is something there that is, there’s just a bit of it is unknown. And if you fix the, you know, there’s a lot of guys that the only problem they have is a vascular problem. ⁓ And so they get some Viagra and they’re fine. And that’s it’s done. I mean, my big concern about that is ED is really a big ⁓ marker of men’s general health. So if someone comes with no, if there’s no reason for ED.

Dr. Ginger Garner PT, DPT (48:07)

Hmm.

Bill Taylor (48:11)

I’m always saying to my guys, let’s get you screened medically because it’s the primary sign of cardiovascular change. that’s so we can help guys by saying, look, let’s look down that route because that’s like life and survival as well as the rectal function, 100%. And actually making sure that even if you do live long, the quality of that life is as good as it can be.

Dr. Ginger Garner PT, DPT (48:18)

Yeah.

Yeah, longevity. Yeah.

Definitely.

Bill Taylor (48:36)

So I

think we’re in this as physios, we are in a really privileged position to sort of recognize that, acknowledge that and help support men go on that journey. think, but from an ED point of view, so I see obviously my group of post-prostatectomy guys, I see quite a lot of young guys, the hard flaccid guys are kind of in that group, but they’re maybe on the periphery, they’re a little bit different. ⁓

The erectile dysfunction guys, a lot of the ones I see, if they’ve had, if they’ve been prescribed Viagra and that’s made a difference, oftentimes looking at the muscular component and strength training that can make a big, big difference. One of the things I would say, and I think my approach to sexual rehabilitation is a little bit different.

in that and the often guys come to see me and I’ll say so show me what you’ve been doing and they’ll jump up on the bed and they’ll lie on their back and they’ll bend their knees up and they’ll start squeezing their pelvic floor and I’ll say okay so that’s great well done I said is that how you normally have sex is that what sex looks like for you and they go no and I’ll say okay right I’ll say okay so I’m going to ask you this question and I said so if I if you came to me with a sore knee

and you said to me, I want to run 5k. And I said, jump up on the bed and just squeeze your quadricep, okay? Just keep doing that and just keep squeezing that and just do more and more of it and go away and do that for six weeks and then come back and see me. Do 100 a day and come back and see me. You would look at me like I was not a very good physiotherapist and you’d think, well, this guy doesn’t actually know what he’s doing. I’ll say, so my question to you is, we need to do this kind of.

pelvic floor performance continuum assessment. How do you have sex? Do you normally have sex in missionary position? Do you have sex on your side? Do you have sex on all fours? Do you have sex on your knees? Do you have sex standing up? How is sex for you and your partner? And they’ll kind of look and I’ll say, it might be all of those things. In which case, that’s fine. I’ll say, so my approach to this is I’ll say, okay, so tell me exactly.

Dr. Ginger Garner PT, DPT (50:42)

Mm-hmm.

Bill Taylor (50:59)

What happens when you have sex? Is there some kind of erection? And what I’ve done is I’ve taken strength and conditioning principles and I’ve thought, it a strength problem? Is it an endurance problem? Is it a pelvic problem? Is it a connection problem with hip movement and lumbar spine movement? Because sex involves lumbar spine flexion extension, hip flexion extension, hip abduction, hip rotation.

while you’re doing, while you’re maintaining your erection. I said, so you can’t, I don’t think it turn up to have sex without ever having done those exercises with an erection. You need to get your erection up and running and then you need to strengthen your lumbar spine, your abdominals, your hips together with that erectile moment.

I said, it’s actually really hard to do that. said, I kind of, you know, I have a lot of humor, I think, in my clinic because men, they’re quite uptight and they need to relax. And so I’ll say to them, I always say my funny story, luckily they’ve never really heard it before, so they all think it’s funny. I’ve heard it so many times. I find it hard to find it funny now, but I’ll say.

Dr. Ginger Garner PT, DPT (52:03)

Yeah, yeah.

Bill Taylor (52:19)

It’s not very often that you see someone running down the road masturbating and they laugh and I’ll say, but there’s a good reason for it. Apart from the fact that it’s illegal, apart from the fact that you’d be arrested, it’s actually really hard to do. And then I’ll ask them to reflect a bit and I’ll say, so I want you to reflect back to when you were having sex and you orgasm and everything was fine.

And I’ll and then I’ll introduce the concept of orgasm, which I’ll then go and have a conversation with them about later. Cause I’ll say to them, okay, was there a position that you could not ejaculate in? If you were having sex, did you have to change your position? They go, yeah, yeah, yeah. I could only ejaculate in this position. And I’ll say, okay.

Dr. Ginger Garner PT, DPT (53:02)

and

Thank

Bill Taylor (53:11)

So this ties in with a theory that if you indulge me, I might share with you, but we’ll see. It’s just a theory. I have no evidence for it. ⁓ Yeah. And I’ll say to them, I’ll say to them, so here’s the thing. You’re telling me then for your erection to stay erect, for you to maintain that erect penis to get to the end, to get to orgasm and ejaculation, you had to do something with your posture and your position that allowed that to happen.

Dr. Ginger Garner PT, DPT (53:16)

Okay. We like working theories.

Bill Taylor (53:42)

I said, so can we let that sit there for a minute? I want you to understand that there’s more about this. This is not a penis centric situation. This is pelvic floor muscles, hip muscles, lumbar spine muscles, core muscles, breathing. I said, the arousal thing is nice and that’s good. I said, but it happens up here cortically. But there’s something you’re telling me about your functional integration of your…

Dr. Ginger Garner PT, DPT (53:45)

Thank you.

Bye.

Bill Taylor (54:11)

pelvis, your lumbar spine, all of the muscles, all of the global mover muscles that you have, that’s telling you that your pelvis will not relax enough. And think about this, this is a paradox, relax enough to keep your penis firm enough to allow you to ejaculate sperm up while you’re moving and while you’re stabilizing your hips. So I’ll say, it’s a very, it’s a very, it’s a very complex thing that’s happening, but we take it for granted.

Dr. Ginger Garner PT, DPT (54:40)

True.

Bill Taylor (54:41)

I often say to guys, one of my little funny stories is I’ll say, look, ⁓ in Scotland, men drink gassy beer, they drink lager. And they often drink lager if they have Indian food, so if they have a curry. Now, lager and beer together do not often sit well with your bowels. Which normally means if you go to bed, the lager has irritated your bladder.

The curry has probably irritated your bowels. So at some point, round about two o’clock in the morning, you get up to go to the toilet. And I’ll say, so what happens is you wake up, you don’t put the light on, you stand up. I said, so that’s proprioception. That’s where your joints are in space and what your muscle and your body’s telling you. But you can’t see where you’re going. You walk to the toilet, you get there, you stand at the toilet and you wait for a minute. Then your bladder tap opens and you start peeing.

halfway through your pee, and if you’re lucky, you’re pointing at the toilet pan, if you’re lucky, right? And then halfway through your peeing, your rectum says, ⁓ there’s something in there. Is it solid? Is it liquid? Or is it gas? And then it does this very clever thing where it decides what that is and lets us say it’s gas. It thinks there’s more pressure there, I have to release that pressure. So it lets the gas escape.

but it keeps the feces in, it doesn’t let anything else happen, you’re still standing up, you shut it all down and you walk back to bed and go to sleep. And I’ll say, now we take that for granted, but it’s an incredibly complex thing that’s happening. I said, when we’re coming to deal with erectile function and pelvic floor function, it is a sophisticated, it’s a very sophisticated thing. So I think for me,

as well. So I’ll explain, I think education is really key to me. Like there’s a vascular component, there’s a muscular component, there’s the arousal component and there’s 10 % that we don’t know about. And to say, okay, so then I’ll say to them, look, the muscles that we have in your part floor are striated muscles and that means that the same muscles as your biceps and your triceps and your quadriceps. I said, so we can apply strength and conditioning principles

to them to make them strong. And that means that you can lift your penis up to 40 degrees to the horizontal that makes it more comfortable and amenable to sex. I said then there’s endurance. So you then have to keep it there for a period of time. I then say to them, I’ll say, look, this is my evolutionary part of my story. I’ll say, when we were Neanderthals, we didn’t have partners, we didn’t have wives, we had mates.

and we would mate with a female person and we would normally do that standing up in a state of fear for about three and a half minutes because if we took longer you’d be eaten by a saber-toothed tiger. You had to get in there, you had to deposit sperm and leave. We were sperm depositors, that’s what we did. I said but now we’re different because we’ve taken sex and sex is now attached to commitment and intimacy and pleasure and trust and

Dr. Ginger Garner PT, DPT (57:51)

Thank

Bill Taylor (58:03)

building a family and all of that emotional stuff that it comes with. said, and so much the better, know, so much the better that that’s how it is because we now have this very pleasurable thing that we can look to. I said, but imagine if you’re lasting longer than three and a half minutes, you’re basically a sexual Olympic athlete because you, and then I’ll come back to the point I said, because sex is really an athletic endeavor that involves coordination.

endurance strength I said now that’s just one aspect of course because it can be very perfunctory and it can be very like ⁓ phalo-centric I said but in actual fact oftentimes what it comes to the point where I’ll say to them and you do understand of course that orgasm and ejaculation are not the same thing and they go what do you mean?

Dr. Ginger Garner PT, DPT (58:57)

Mm-hmm.

Hold

on a second, wait, what?

Bill Taylor (59:02)

⁓ What

do you mean by that? And they go, and they let you go, well you had me, I believed everything you were saying and now I think don’t be ridiculous. And then I tell them a story about the Soft Cock Club who are a group of men in America who have been post-prostatectomy, have had neuropraxia, so their peripheral nerves are damaged, they’re never gonna go back and they’re never gonna have

Dr. Ginger Garner PT, DPT (59:13)

Ha ha ha.

Bill Taylor (59:32)

proper, full or even any erections again. But I actually love these guys so much because they were in loving relationships where they wanted to have intimacy with their partners and they discovered that they could reach a sense of sexual and pleasure, orgasm, fulfilment, whatever you want to call it, without ejaculating and without an erect penis. And I thought, wow.

I love that. I truly love that because… So I’ll say to them, so it’s not that I’m saying that’s what’s gonna happen to you, but what I’m saying is, we maybe don’t need to be so performative. Maybe we can be more present. Maybe we can look away from our penis for arousal, pleasure, and all of the stuff that we’re after. And perhaps…

Dr. Ginger Garner PT, DPT (59:59)

Yeah.

Bill Taylor (1:00:24)

If we do that, we put our penis back into the salient part of our brain where it’s not so much about failing because it’s about I failed again, I’ve reinforced that failure, maybe come away from that. So I think I tried to take some of that and put that into my whole kind of assessment and discussion with them to help them understand that there’s more to it than just blood going into a penis.

Dr. Ginger Garner PT, DPT (1:00:35)

Yeah.

Yeah, yeah.

Bill Taylor (1:00:53)

So, I think, and actually I get decent results with the erectile guys. I think sometimes, I think as well, I often say, they’re, think I do something different with them. So if they are heavy weight lifters, I send them to yoga. If they’re yoga people, I send them to do strength and incandescent. I do the opposite thing of the thing that they’re used to. I put something different into their system.

to try to get a different outcome and then see what happens. And I think that it’s been very interesting with the post-prostatectomy guys, especially if you’re using ⁓ trans, if you use trans abdominal ultrasound, so if you scan someone’s tummy above their belly button, you can see both sides of their pelvic floor. And because…

Strength and conditioning principles are such that you might strengthen both sides of the body or you might strengthen one side more than the other. So for example, if you’re doing bicep curls, you might do both biceps at the one time or you might do one bicep and then the other bicep. And I had this thing once, I thought, yeah, I wonder if we need to do that with the pelvic floor. And if we do that, how do we do that? So after using octisone for quite a while, would…

ultrasound tells you that one side is not working as much as the other and then if you do an examination to test the ability the pressure compression on your finger a per rectally you can tell that that is that has less strength than the other side so I then decided with my guys and I decided I wonder what happens if I lie them on their side

Dr. Ginger Garner PT, DPT (1:02:35)

Mm-hmm.

Bill Taylor (1:02:42)

So I lay them on their side and then I then scanned them transparently to see what would happen. And actually if you put them with the weaker muscle uppermost and then you scan them. So let’s say the right side was weak, you laid them on their left side and you scanned them transparently, you got a better contraction on the right sided pelvic floor muscle.

Dr. Ginger Garner PT, DPT (1:02:48)

Okay.

Bill Taylor (1:03:06)

So I would send them away to say, so this is what you’re do for me, okay? So you’re gonna do the contraction on this side, which is a bias towards this side. And then once we’ve done that for of weeks, we’ll flip you back and forward and we’ll do both sides. And then we’ll do some in the middle, which are two together. So we then build this strengthening program that works the pelvic up floor maximally.

Dr. Ginger Garner PT, DPT (1:03:31)

Yeah.

Bill Taylor (1:03:32)

And the other thing I think is, my big thing is I often think we’re doing too many contractions in the sense that if you, so in certain conditions we’re looking for either one RM or 10 RM or seven RM or what is the repetition maximum of that exercise that you can do. And if you scan someone with an ultrasound, you can see them fatigue. You can see the muscle stops working. So you can go, okay, so your RM is six.

Dr. Ginger Garner PT, DPT (1:03:39)

Okay.

yeah, definitely.

Bill Taylor (1:04:02)

So we’re gonna take two off that and you’re gonna work at four, but I want you to be exhausted when you’ve done four. I want those four to be the hardest four contractions you’ve ever done in your life. Your children’s life depend on those contractions. And then once you’ve done four, I want you to have a 30 second rest, then I want you to do another four. And I want you to do that five times, but I want you the next day to take the day off. Don’t do them again. Just take it.

Give the muscle a periodize your training, have some time off. then I’ll also, the other thing I add in is if we’re talking about pelvic, I think oftentimes when we do fast contractions, we don’t do them fast enough. So I often use a metronome so that I can quantify the speed of contraction and I can add percentages on that so they can actually work.

Dr. Ginger Garner PT, DPT (1:04:50)

⁓

Bill Taylor (1:04:59)

for 15 seconds of boom, boom, boom, boom, boom, boom, boom, relax. 45 seconds rest, then give me 15 seconds again, then 45 again, then give me 15 seconds of rest. So to really try to quantify it, to put a number on it so that they can actually see, Bill, I can do 25 seconds now at 60 beats a minute. I’ll go, fantastic, well done, you, that’s amazing. And then they start to build the pelvic.

Dr. Ginger Garner PT, DPT (1:05:03)

Yeah.

Bill Taylor (1:05:26)

side of things as well as separately from the strength and then the endurance is just a time told which is simple but it’s kind of like and then of course what I was speaking about earlier once they’ve got that basic stuff down how do we incorporate that into the functional athletic movements of sex and how does that what does that look like for them and also I think it’s really important from a point of view to say look if I get you back running with a sore knee I don’t just say go and run 10k

Dr. Ginger Garner PT, DPT (1:05:44)

Yeah.

Bill Taylor (1:05:56)

So I say to you, listen, if you want, if the penetrative component of sex is absolutely so important to you, then we know perhaps you might last two minutes. So leave that for the last two minutes. Don’t use it at the beginning. I said, do you know what I’m gonna say? I’m gonna say, so this is not a failure. This is an opportunity to revisit intimacy with your partner in a different way.

Dr. Ginger Garner PT, DPT (1:06:13)

Yeah.

Mm-hmm.

Bill Taylor (1:06:26)

Think

about what this could be. How has sex been for you recently? And they’ll normally say, well, it’s been getting not so good because this has been happening for a while. And I’ve been just pretending and I’ve been showing up and I’ve been performing, but my performance has been diminishing. the other thing that happens, of course, right across the board is you’ll say, sex is the most intimate thing you can do with someone. And yet,

We hardly ever talk about it. We hardly ever say, so darling, how was that for you? How was that? How was our connection tonight? Did that go down well? I said, so this is an opportunity to say to your partner, look, my penis is not working properly. I wanna be intimate with you.

Dr. Ginger Garner PT, DPT (1:06:58)

Yeah. Yeah.

Yeah, exactly.

Mm-hmm.

Bill Taylor (1:07:23)

What other things are you interested in doing? What can we do? I said, because that gives your penis a workout from an arousal point of view, not necessarily from a muscular, vascular point of view. And it starts to build the connection again between parasympathetic or the relaxed place you need to be to have sex. Connect that with your whole pelvic floor function. So.

Dr. Ginger Garner PT, DPT (1:07:47)

Yeah. Well, so

I have one more question before we kind of shift into, because you have brought up so many good points about, and like with, you know, Umit’s episode of talking about breath holding, know, diaphragmatic dysfunction, those being so important to, you know, with premature ejaculation, there’s also painful ejaculation. So can you take a few minutes and talk to the listener about what that, what

Bill Taylor (1:08:02)

Yeah.

Mm-hmm. Mm-hmm.

Yeah.

Dr. Ginger Garner PT, DPT (1:08:15)

could precede that? What does that end up looking like so that they know when to go and get help?

Bill Taylor (1:08:21)

It’s an interesting thing, isn’t it? Because when they come to see us, they’ve often had this for quite some time and it’s often been developing over a period of time. And it might…

Dr. Ginger Garner PT, DPT (1:08:33)

And it often starts with

like musculoskeletal issues that feel so distal to that.

Bill Taylor (1:08:35)

Yeah, yeah,

it’s like really interesting because they’re often talking to you with a cleansed jaw. They’re often not breathing diaphragmatically or laterally costally. Their ribs don’t move. They just, I’ll often say to them, I’m very impressed how you’re able to make air move in and out your body without any structural change of your trunk. I said, I’m not quite sure how you’re managing it, but it’s impressive.

Dr. Ginger Garner PT, DPT (1:08:44)

Hmm.

Yeah.

Bill Taylor (1:09:04)

So I think absolutely. They often have maybe perhaps, I’m trying to think of the kind of three groups of people that I’m thinking of like weightlifters, for example, weightlifters that are maybe lifting exceptionally heavy weights. So people that are maybe training for strongman competitions, people that are powerlifters where they’re using Valsalva with a closed glottis and a noise to increase interabdominal pressure. maybe they’re, so they’re,

their intention is to get as heavy as they possibly can without any concern to what they’re feeling in their pelvic floor. And then I think, so I say, maybe this is, I’ll tell you my little theory about what I think happens with these guys, right? I think that it goes back to childhood. And I think that actually we are, we’re born and we’re in nappies and we can pee and poo wherever we want with abandon.

And if we’re running around without our nappy on and we pee on the floor, it’s really funny. Everyone laughs. And then we get potty trained. Okay? So that trained word is really important. We then go to school and when you’re at kindergarten or when you’re in nursery school, you’re allowed to go and pee and poo whenever you want. The toilets are free, you go, you wander, you come back. You go to primary one, but you understand, you start to understand that peeing and pooing is something private.

and something that you is maybe a little bit, there’s some stigma, but you don’t know what stigma is and you don’t know what shame is. And even if you yourself or poo yourself, well, it happened, but you you’re young and so people accept it. You then go to primary one and you’re still allowed to go. Primary two, so you’re kind of about, in Scotland, primary two you would be six or seven. And so you can ask to go to the toilet and…

Dr. Ginger Garner PT, DPT (1:10:35)

Mm-hmm.

Bill Taylor (1:10:57)

they let you go, but there’s a little hesitation, which is the first time you think, oh, is there something wrong with me asking to go? Then you get to seven or eight and maybe your bladder hasn’t settled down as much or maybe your bladder works in a different way. And you start, ask and it’s, do you really have to go with a judgment laden response? then you get to 11 and 12, then you’re just a nuisance.

Dr. Ginger Garner PT, DPT (1:11:04)

Yeah.

Totally, yeah.

Bill Taylor (1:11:27)

then you’re disturbing the class. And then in the male world, what happens is you ⁓ start masturbating and you find porn. And porn is, porn can be really problematic, know, in the way it portrays sex and the way it portrays women and the way that, you know, young men will probably watch it purely for a visual stimulation without really any

assessment of whether it’s good bad or where it sits in society or what it is and I think what then happens is you start talking to your pals and there’s an awful lot of misinformation again about sex and if you’re super lucky and you have parents that say to you let’s talk about sex and this is what sex is about and sex is about respect

and sex is about respect for yourself and for someone you decide to sleep with and it’s about thinking about stuff and also talking about stuff. I used to always say to my kids, although I used say to them, look, if you’re not big enough to talk about it, you’re not big enough to do it. I said, that’s the only thing I’ll say to you. If you can’t talk about it, don’t do it because you’re not ready to do it. Okay. So I think what happens, but of course,

Dr. Ginger Garner PT, DPT (1:12:40)

Yeah, so good.

you

Bill Taylor (1:12:52)

Boys will be boys and they have these horrible conversations and I think you know there’s a whole thing with the Manosphere at the moment and Instagram and all of the horrible things that are happening that I say boys will be boys in the sense that they tend to want to appear a certain way, they tend to want to fit in, you don’t want to be different, you don’t want to stand out from your peers and I think even if you encourage your children to do that they still they sometimes find that hard to do especially maybe in the sporting arena.

Dr. Ginger Garner PT, DPT (1:13:00)

Right.

Bill Taylor (1:13:22)

you know, where everyone’s a jock and everyone’s like, everyone’s like, wah, you know, it’s tough and all the rest of it. And they have conversations where they say things like, yeah, so women take a long time to orgasm, so you have to start practicing lasting longer. So guys then start masturbating and edging and waiting and holding off and doing that for a considerable amount of time for lots of different reasons. And then also what they see,

Dr. Ginger Garner PT, DPT (1:13:24)

Yeah.

Bill Taylor (1:13:51)

As I often, I remember I had a patient who was 26, who was a virgin and had never had sex, had never really had any, because of a cultural upbringing, had never really had the teenage kind of fumbles, the kind of two young people exploring sex at that age and both on the same page, you know, like with being respectful.

Dr. Ginger Garner PT, DPT (1:14:13)

you.

Mm-hmm. Yeah.

Bill Taylor (1:14:20)

doing that journey, you know? And he hadn’t

had that. And I remember saying to him, can I ask you a question? Where have you learned about sex? And he looked a bit sheepish and I said, look, I’m gonna guess you learned about sex from porn. And he said, yeah. And I said, right, okay. I said, so porn isn’t sex, okay? Porn is nothing like sex. I said, so whatever you’ve learned, whatever you’ve seen, whatever you’ve learned, forget all of it.

Dr. Ginger Garner PT, DPT (1:14:48)

Yeah.

Bill Taylor (1:14:48)

And he kind of looked at me went, ⁓ what will I do? And I said, well, okay, that’s great. I said, you’re in the right place. I’m going to give you this book, which actually I think is a wonderful book. It’s called The Wonder Down Under and it’s called The User’s Guide to the Vagina. It was written by two Scandinavian gynaecologists. And I’ll say, so you’re going to take this book and you’re going to read it. I said, and then I have another book written by an American urologist, Silverstein called The Penis Book. And then you’re going to read that.

Dr. Ginger Garner PT, DPT (1:14:52)

⁓

wow.

Bill Taylor (1:15:18)

then you’re gonna swap it with your girlfriend, your fiance, and you’re both gonna have read them. And then I said to him, I’ve got this idea, because he said, ⁓ what happens in my culture is once I’m married, we’re meant to consummate the marriage kind of almost in the same building that the party’s happening in. And I said to him, okay, I said, right, that’s fine. said, and…

I said, I’m gonna just say this perhaps and you can take my advice or not, but you come to see me with rectal dysfunction. I’m not sure that you need that added stress. I said, so I’m gonna speak from my position, not from the position of your culture, and there’s no judgment here at all other than that. Perhaps we need to do this thing where we take it slower for both of you guys and that you’re both okay with that, but you have to have a conversation with your wife that…

Dr. Ginger Garner PT, DPT (1:15:53)

Totally.

Bill Taylor (1:16:14)

that’s what’s going to happen. And it was amazing really because I think about three or four months later I walked into my treatment room and there was a couple sitting there and I recognized him and I hadn’t met her and this was his wife and they had just come in to say we just wanted to come and say thank you because we had we basically you had given us you had kind of made it okay for us to go a different path.

Dr. Ginger Garner PT, DPT (1:16:42)

Yeah.

Bill Taylor (1:16:42)

you

gave us an option. And I think, you know, as a Perfect Health Physio, we are in this amazingly privileged place where people bring the most intimate things of their soul, really, you know, to the table. And we have a great responsibility to step up to that, I think, and give us…

Good an answer as we can. I’m not saying it’s the best answer, but we give as good an answer as we can based on our experience and what we know and what we feel.

Dr. Ginger Garner PT, DPT (1:17:17)

So Bill, I want to thank you for doing something that’s incredibly important. One, you’ve been talking about these very specific issues that I think the listener now is going to more fully understand what to identify and that they can be helped. So there is hope.

The other thing that I really wanted to bring out that you mentioned was this whole idea about the stigma surrounding pelvic health, sexual health, and how this concept of masculinity can become almost toxic in some ways where it’s not just hurtful. And many times we talk about it in terms of how it’s harmful to women, but I don’t think we often talk enough about how it is equally harmful to men too. ⁓

Bill Taylor (1:18:01)

I

Dr. Ginger Garner PT, DPT (1:18:02)

Thank you for bringing that up.

Bill Taylor (1:18:02)

think that’s absolutely true. think that the patriarchy harms both men and women. It’s almost like a non-gender thing. It stands above all of that. And I think sometimes we don’t see that clearly. think masculinity, it refers to really the set of traits. We’ve got behaviors, roles, expectations that society really associate with being male. And I would go so far as to say,

Dr. Ginger Garner PT, DPT (1:18:12)

Yeah. Yeah.

Bill Taylor (1:18:29)

impose on men because society is disappointed if you don’t act like a man. You know we have it in the gay community where if you’re at all feminine it’s not you’re almost considered a little bit less because you’re not you’re not acting like a man whatever that means. I think you know we’ve got traditional cultural masculinity we’ve got strength, toughness, independence, self-reliance, emotional control, provider, protector, all of that stuff but I think I think

Dr. Ginger Garner PT, DPT (1:18:57)

Yeah.

Bill Taylor (1:18:59)

It’s interesting because there’s been the whole thing with Louis Theroux and his documentary about the Manosphere and the whole issue around that. And I actually think, I’m going to say this because I have three kids and my two are around about 30 and one’s about 21. And all of them have a different view about masculinity that is really enlightening, I think. And they have this more, especially my 21 year old who

Dr. Ginger Garner PT, DPT (1:19:23)

and

Bill Taylor (1:19:28)

plays sport and is at university and is bit of a jock and all of that stuff. has this, it’s like, they have more emotional awareness and expression. They’re much more help seeking when it’s needed. They’re much more caring. And not even that, I ask him that, but he’ll tell me that he’s helped a friend. He had a friend in distress and that friend came to him and he then went out of his way to support that friend and on his journey. And I think, you know, I think there is hope.

There is hope. I think, you know, masculinity isn’t the same as being male biologically, is it? There’s not one single way of behaving. It’s shaped by culture, upbringing, religion, faith, peer groups, personal values, all of those things. And I think masculinity sometimes, it can be a bit of a barrier, if the way it is, because you think you have to, it can either support

Dr. Ginger Garner PT, DPT (1:19:57)

Yeah.

Thank you.

Bill Taylor (1:20:26)

or it can, I think, hinder recovery depending on how it’s expressed. I think it’s, yeah, I think so. It’s like, you know, I think, I tend to, the one thing that guys don’t often want to do is talk and talk about the kind of the condition they have or the experience they’ve had. And so I think one of my big things that I’ve worked really, really hard at in my practice is to,

Dr. Ginger Garner PT, DPT (1:20:33)

Yeah.

Bill Taylor (1:20:55)

I my hands, I talk far too much. So one of the things I do is I actually sit on my hands and don’t speak and just listen. And if I want to speak, I take one hand out from under my leg to speak. And when I’m finished, I stick it back in so that I actually just give, hold the space for the man in front of me to say whatever it is that he thinks he needs to say.

Dr. Ginger Garner PT, DPT (1:21:05)

Yeah.

you

Bill Taylor (1:21:22)

And I think also be aware sometimes, be aware that sometimes they might not want to say anything that day. That might not be the day for saying something, but you have to have some patience and some understanding that maybe the next time they might say something. this is them, you’ve built some patient therapist alliance, but their whole experience in life is not to show weakness, is not to show vulnerability.

is not to show that they’re not in control, which of course is exactly what pelvic floor dysfunction does to you. It takes away your control. It makes you completely vulnerable. It makes you, you said a really interesting thing that really resonated with me. It’s a very, very lonely journey, pelvic floor pain. You feel that you’re the only man in the world that’s ever got it.

Dr. Ginger Garner PT, DPT (1:22:00)

So true.

Yeah.

And. ⁓

Yeah.

Bill Taylor (1:22:20)

And unless you go to, and sometimes, you know, there’s some patient platforms that can be incredibly supportive from a resource point of view, but sometimes the patient platforms and the support networks, maybe the people that are on those platforms have been unable to get good help, have been unable to access help. And so they’ve been there for a very long time and they’re not improving. And so some of the guys that go on,

Dr. Ginger Garner PT, DPT (1:22:38)

Mm-hmm.

I see that a lot.

Yeah.

Bill Taylor (1:22:49)

initially, while initially it can be really helpful, it can actually in the long term be quite detrimental because they’d start to believe that they’re not going to be better. And you know, it kind of breaks my heart slightly because I almost want to like somehow morph myself onto those platforms and lay my hands on all these guys that are not getting any better and say, let me help you, let me, there is definitely help here,

Dr. Ginger Garner PT, DPT (1:23:10)

Mm-hmm.

there is hope,

So as a boy mom of three, some of the things that we were talking about with the stigma and masculinity, but also very much breaking away from that, it’s almost like breaking that generational curse of saying, no, I don’t have to operate under that antiquated definition of what a man is anymore. And I can operate on my own terms according to how I feel and how I want and what my needs are. So for anyone listening,

Bill Taylor (1:23:29)

Yeah. Yeah. Yeah, Absolutely. ⁓

Dr. Ginger Garner PT, DPT (1:23:43)

who may be struggling silently, who’s maybe suffering under that stigma that they can get out from underneath, or that idea of what masculinity is, I want to end on something very practical and hopeful. So what would you want men listening to right now to know if they are dealing with pelvic pain, urinary symptoms, sexual dysfunction, or just feeling too embarrassed to ask for help?

Bill Taylor (1:24:07)

Sure. I think this, I think almost in a way, and I’ll use some masculine terms here, we need to reverse engineer this thing, okay? We need to actually say, look, this is just, this is, just because it’s your pelvic region, just because it’s your genitals, just because it’s your pelvic floor, it’s still part of you as a person and you and your body. And it’s muscular and it’s neural to do with the nerves, it’s to do with breathing. There’s a real…

biomechanical kind of explanation for why things are happening. It doesn’t mean you’re broken, definitely you can be helped. And there are people out there that want to help you. There are physiotherapists around the world that want to help you. We have also, I think this is really important, we have got really much better at helping you. We’ve got really, really much better at helping pelvic floor dysfunction. We’re not there yet.

Dr. Ginger Garner PT, DPT (1:24:58)

Thank

Bill Taylor (1:25:04)

We’re still on a journey. We’re still learning things all the time. We’re still, we, you know, I think this, oftentimes what you’re told is that it’s in your head, that you just need to relax. I would say it’s not in your head. I would say that relaxing helps everything right across the board. If we can down-regulate our body systems, then that’s a great thing. I don’t know though, I have…

Dr. Ginger Garner PT, DPT (1:25:18)

Mm-hmm.

Yes.

Bill Taylor (1:25:32)

ever met a pelvic floor patient with pain or dysfunction that having been told to relax has that worked? Because it’s way harder than that. It’s like if I said to you, it’s that thing I was talking about, about the thing being subconsciously in your brain. You know how to relax your elbows, you know how to let your arms go, you know how to relax your shoulders, you know how to relax your jaw, you know how to breathe. And in actual fact, those things are really, really useful for pelvic

Dr. Ginger Garner PT, DPT (1:25:40)

tired.

Totally.

Bill Taylor (1:26:02)

floor pain patients, start somewhere that isn’t where your pain is. Start somewhere away from your body and let that whole thing soften and melt. I think find something, if you can find, know, tell a friend, tell someone that you’re close to, share it. It would be very interesting how many, the number of times that I have felt floor patients that will say, I thought I was the only one until I told a couple of my mates and turned out two or three of them had the same thing.

but no one wanted to mention it. There is an incredible pelvic in ⁓ men speaking to men and sharing their vulnerability in a group. But it doesn’t actually have to be a man. If you have a close female friend, you have someone that you can really trust, that you think is going to be, is not going to judge you, is not going to try to say, you should do this or you should do that. Everyone loves advice. Everyone…

Dr. Ginger Garner PT, DPT (1:26:32)

Yeah.

Bill Taylor (1:27:01)

Everyone loves to tell you, my friend had that, that’s what they did, fixed them. I think every single person’s different. I would say though, I think my big message is there’s always hope. There is always something that you can do to be in a better place. I think that pelvic floors are very sophisticated, but they’re very plastic and they can change and recover. And I think that… ⁓

You know, don’t feel…

try to or try to not think that somehow you’re failing, that somehow it’s your fault, that somehow you caused this, that somehow somebody’s going to laugh at you when you show up with your condition, that it makes you less of a man because it absolutely doesn’t. And in actual fact, I’m going to say that, you know, standing up for ourselves and taking ownership of our bodies and our

Dr. Ginger Garner PT, DPT (1:27:45)

Yeah.

Bill Taylor (1:28:05)

our modern masculinity, if you like, is a really positive thing to do for sure.

Dr. Ginger Garner PT, DPT (1:28:09)

Yeah, yeah.

That’s such ⁓ an incredible message. And what I appreciate so much about this conversation, Bill, is that it really helps continue and deepen the conversation in other previous podcasts. So listeners, if you haven’t listened to Dr. Umit Erkut’s ⁓ interview, go back and listen to that. We’ll drop that into the show notes. But it’s the reminder that ⁓ we need bigger conversations about this, that men’s pelvic health is not fringe. It’s not some rare…

condition. ⁓ It’s not too awkward to talk about. It’s real. It’s common. It’s deeply human. It deserves skilled, compassionate, whole person care. So just really thank you for bringing your perspective and for the work that you’ve done and for the work that you’re doing. And if it was that easy to relax, then we wouldn’t need to get our doctoral degree since we all this extra time. But it is that complicated and it does deserve.

Bill Taylor (1:28:47)

100%.

100%. 100%.

Dr. Ginger Garner PT, DPT (1:29:12)

that level of attention. So for everyone out there listening, there is hope and there’s so much that can be done. ⁓ Bill, can you tell everybody where they can find you?

Bill Taylor (1:29:21)

Sure, I’m on Facebook under Bill Taylor and I’m at Bill Taylor on Instagram, 3311, I think. And I’m also at Taylor Physiotherapy and I’m happy for people to reach out if they have questions or anything comes up from this talk that they want to ask me about. Yeah, totally, I’m here. So just do it.

Dr. Ginger Garner PT, DPT (1:29:42)

Thank you so much. Everyone, thank you for listening to this episode of the vocal pelvic floor. If this has been helpful, please share it, subscribe, leave a review. And until then, I will see you next time.