In this episode of Pearls & Perspectives, Amy Pearlman, MD, speaks with Adam Gvili, PT, DPT, a pelvic floor physical therapist and founder of Pelvis NYC, about his personal and professional journey in treating male pelvic floor dysfunction. Gvili shares that from ages 19 to 25, he experienced pelvic floor dysfunction. After seeing multiple urologists, undergoing invasive tests, and trying various medications without relief, he eventually found effective care through pelvic floor physical therapy—though it took several providers before finding the right fit. This personal experience inspired him to enter the field and focus on treating men, a population often underserved in pelvic health. Gvili explains that many patients with pelvic floor dysfunction are young men (20–45 years old), though he also treats patients who have undergone radical prostatectomy. Symptoms range from urinary issues and erectile dysfunction to groin pain, constipation, and tip-of-penis pain. He stresses that pelvic floor therapy for men cannot simply replicate female treatment approaches; instead, therapy should be individualized, patient-centered, and focused on retraining underused or overactive muscles. A major theme of the discussion is the disconnect between urologists and pelvic floor therapists. Both agree that collaboration is essential: urologists should rule out infection, strictures, or anatomic abnormalities, whereas physical therapists help address musculoskeletal and functional issues. Gvili emphasizes that many patients feel dismissed or “gaslit” when their symptoms don’t show up on standard tests, which underscores the need for compassionate listening and validation. On erectile dysfunction (ED), Gvili notes a growing number of young men presenting with ED, often linked to pelvic floor tension, psychological factors, or unrealistic expectations shaped by cultural narratives. He advocates for pelvic PT as a complementary treatment and stresses open communication between providers and patients. He closes by urging young men not to feel shame—pelvic floor therapy can significantly improve quality of life—and encouraging health care providers to stay open-minded about pelvic floor dysfunction, even if the science is still evolving. Learn more about Gvili here Chapters 1:07 Dr Gvili's experience with pelvic floor dysfunction 10:51 Gaslighting and pelvic floor dysfunction 15:00 Dr Gvili on the types of men he treats 19:17 The urologist's role vs the pelvic floor physical therapist's role 28:10 Tip-of-penis pain 34:31 Dr Gvili's "megaphone message"

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