Core Massage and Bodywork for Men: Pelvis, Hips, Thighs, Low Back and Abdomen

The Body's Core

"Our session was absolutely amazing - your work is phenomenal, and I love the detail and depth. You have great hands and I trust your touch."

The core is the anchor and foundation of our being in so very many ways: it is the keystone of our bodies in a structural sense; it generates and coordinates power and movement; it contributes to and reflects emotional and psychological states; it is critical to the full range of sexual function and expression; it regulates voiding; it is essential to breathing; it is where several powerful non-physical energy centers reside and operate; and it is central to our sense of vitality, security, and integrity. Its status greatly determines whether we feel safe, comfortable, and 'at home' in our bodies, as well as how well we engage physically with the world we live in. Leaving it out of massage and bodywork sessions does a disservice to those men who wish to explore their bodies and themselves in ways in which there are few opportunities for them to do so. This is especially true for those who are experiencing discomfort, pain, or dysfunction within or relevant to their core.

Section titles on this page are: Definitions and Conceptions of the Core .... The Many Functions of the Core .... Muscles and Connective Tissues of the Core .... The Energetic Core: Concepts, Practices and Core Bodywork .... Mind, Emotions, Stress, Trauma, and the Core .... Sexual Function, Dysfunction, Genital Pain, and the Core .... and  Core Bodywork for Sexual Dysfunction and Genital Conditions, including Pain.

There are "back to top" links to the right of each section title. To see citation sources in the text below, hover your cursor over the citation numbers, or scroll down to the bottom of the page for the full list.

Definitions and Conceptions of the Core

"I'm grateful for meeting you and sharing your work with me and fascination of this important (at least to me) area of the male body and how it really is the core of us in more than one way. I gained a bit more confidence in my maleness, as well as in myself [as a] whole, through working with you. Thank you."

There is no single, universally accepted definition of what constitutes the core.

In its narrowest and most essential sense, the core can be defined as the muscular and connective tissue components that are critical to generating intra-abdominal pressure (internal pressure within the abdominal cavity), which is essential to stabilizing the spinal column in the full range of postures and movements we humans are capable of. These muscles accomplish this by contracting in tandem to squeeze the abdominal cavity from all directions, thus increasing the internal pressure. At the top is the respiratory diaphragm, which sits under the ribcage; wrapping around the midsection is the transversus abdominis muscle and its associated connective tissues, which together function as a wide, dynamic belt; in the back are the multifidus muscles of the lumbar spine; and at the bottom of the core are the muscles of the pelvic floor.

"To find someone with this level of knowledge is like finding gold."

Slightly broader definitions include the muscles listed above plus all other abdominal and low back muscles. Wider still, some consider the core to include the muscles of the abdomen, low back, pelvis, and hips. The most extensive and general definitions include all muscles between the shoulders and the hips; in other words, everything except the legs, arms, and head.

"Thank you for the excellent bodywork session and the information you shared." (physician)

Hsu et al., writing in the Journal of Physical Therapy Science, narrowly defines the core as "the transversus abdominis, multifidus, diaphragm, and pelvic floor muscles" [1], while Willardson, in the Journal of Strength and Conditioning Research, states that "the term 'core' has been used to refer to the trunk or more specifically to the lumbopelvic region of the body" [2]. Akuthota and colleagues, writing in Current Sports Medicine Reports, characterize the core as "a muscular box with the abdominals in the front, paraspinals and gluteals in the back, the diaphragm as the roof, and the pelvic floor and hip girdle musculature as the bottom" [3]. Similarly, Kibler et al. describe the musculoskeletal core in Sports Medicine as "the spine, hips, pelvis, proximal [upper] lower limb and abdominal structures" [4]. Several authors, including Fredericson and Moore [5], state that "the core musculature is composed of 29 pairs of muscles that support the lumbo-pelvic-hip complex." The actual number of muscles depends, of course, on how the core is defined.

The Many Functions of the CoreBack to top

The core provides numerous functions crucial to our well-being, and indeed our very existence, including:

Muscles and Connective Tissues of the CoreBack to top

"Thank you so much! You really go above and beyond in your support. Pretty amazing work, how it unfolds - I appreciate your willingness to be open."

It makes sense from a bodywork perspective to include not just the narrowly defined core itself, but also those muscles and tissues that are highly integrated with it and support its function.Thus, I define the core in a broad sense, and my work may include the muscles and connective tissues in any or all of the following areas: the low back, abdomen, pelvis, inguinal and pubic region, groin, pelvic floor, buttocks, hips, relevant thigh muscles, and respiratory diaphragm. As Kibler and colleagues remind us, "the hips and pelvis [including the pelvic floor] and their associated structures are the base of support for the core structures" [4], and are therefore highly relevant. Likewise, Akuthota and colleagues emphasize that the hip musculature is vital to stabilizing the trunk and pelvis in ways that make the core function more effectively [3]. According to McGill, the buttock, or gluteal muscles (maximus, medius, and minimus) "are also considered to be essential components" of the core [6].

"I cannot express my attitude of gratitude towards you enough. You have been a godsend."

Many muscle groups of the pelvis and hips are arranged in a complex series of fans in several orientations, which together create stability and support as well as enable multiple directions of movement. It cannot be overstated how crucial the pelvis is as the anchor and central link for both the leg muscles coming up from below and the trunk muscles coming down from above. "The core makes the rest of the body more capable" states widely respected biomechanics researcher Stuart McGill [6], and the pelvis is clearly and indispensably its foundation. It is for this reason that the muscles and connective tissues in and around the pelvis are often so central in my core massage and bodywork sessions.

→ Muscles and Muscle Groups

For those who have an appreciation of anatomy and are interested in specifics, muscles and muscle groups addressed in core massage and bodywork sessions can include the rectus abdominis, external and internal obliques, transversus abdominis, pyramidalis, iliopsoas (psoas major and iliacus), quadratus lumborum, all lumbar erector spinae and paraspinal muscles (including the multifidus), gluteals (maximus, medius, and minimus), deep lateral rotators of the hip (including the piriformis), tensor fascia lata, adductors (magnus, longus, brevis, pectineus, and gracilis), hamstrings, rectus femoris (the only one of the quadriceps muscle group that attaches to the pelvis), sartorius, cremaster, and all of the pelvic floor muscles.

→ Connective Tissues

The connective tissues are critical as well. Those that can be especially relevant and useful in core bodywork include the thoracolumbar fascia, which connects three of the abdominals to the spine; the linea alba, which connects the abdominal muscles in the midline, and the breastbone to the pubic bone; the navel, which has fascial connections to several internal structures as well as to the abdominals themselves; the suspensory and fundiform ligaments, which suspend and anchor the penis to the pubic bone; the inguinal ligament; the sacrotuberous ligament; the ano-coccygeal ligament, which anchors the pelvic floor muscles to the tailbone and sacrum; the perineal body, which is the central anchor of the pelvic floor muscles that form the base of the core; the iliosacral and iliolumbar ligaments, and the ilio-tibial (IT) band or tract on the lateral thigh.

The Energetic Core: Concepts, Practices and Core BodyworkBack to top

The core is often viewed from a physical and mechanical (i.e. Western biologic) perspective in which anatomy and function are paramount. This is, of course, an appropriate and very effective way to explore, engage, and address the core tissues — and by far the most common. However, there are several other paradigms or lenses through which our bodies can be viewed and experienced that can be equally appropriate and valuable, including an energetic paradigm.

"I would like the pelvic floor work included again, as I find it so relaxing and transcendent."


"It was like feeling weightless; I've never felt that before. There was a point when I felt like I wanted to cry."

Energetic concepts and practices have been around much longer than Western biologic science and in recent decades have spread rapidly from their mainly Eastern and South Asian roots to the West. Yoga, tai chi and other martial arts, meditation, Traditional Chinese Medicine (TCM), acupuncture, qigong, pranayama, ayurveda, tantra, and bodywork modalities such as shiatsu and acupressure are just some of the many practices that have a strong energetic component or work primarily within an energetic paradigm. Many readers will have heard of, or be familiar with, energy-related terms and concepts such as the solar plexus, chi / qi / ki, meridians, tsubos, the hara, dan tian or tanden, the chakras, and the bandhas. Central to energetic practices are methods of stimulating the body's energy centers and pathways to encourage more opening, activation, movement, and balance - with concomitant improvement in physical, mental, and emotional health.

"I am flabbergasted and desperate to find relief for this issue since it is causing me so much physical and psychological angst. I am certainly now open to explanations and remedies having to do with energetic flows/blockages and emotional/psychological factors and have even found some relief with certain qigong practices. I really appreciated that you take those things into consideration."

male muscle anatomy

The core is central to any discussion of energy since the majority of the body's energy centers and pathways are here. The core generates, coordinates, and distributes energy throughout the body in both a physical, biologic sense and in an energetic sense. The chakras (originating within ancient south asian systems) are one example of these energy centers, with three of them located in the core: in the pelvic floor, the tailbone, and the lower spine. The first, or root, chakra, called mooladhara, is located in the center of the pelvic floor at the perineal body and is usually considered to be where the body's life force (kundalini) resides and springs from. The second chakra, swadhisthana, is found at the tip of the tail bone (coccyx), while the third chakra, manipura, is located in the lumbar spine in the small of the back (at the level of L4 on most men). While the first chakra is central and therefore refers only to itself, the second and third chakras are located along the spinal column and have corresponding physical counterparts on the front of the body (kshetrams): the pubic bone and the navel, respectively. Excellent and thorough descriptions and discussions of all aspects of the chakras can be found in [8] and [9].

The pathways through which energy travels throughout the body have several names, including meridians (from Traditional Chinese Medicine and acupuncture) and nadis (from yoga, tantra, and ayurveda). Many of these begin, end, meet, or pass through the core, and the pelvis and pelvic floor are the nexus through which these pathways connect the upper and lower body.

"I'm more gounded after sessions with you. From a first chakra perspective, that makes sense and I'm noticing it more and more."

Interestingly, recent research has revealed tantalizing associations and correspondences between anatomic features, energy points, and energy pathways. According to Schleip, for example, Langevin has been able to prove a correlation between the energetic pathways called meridians and lines of densification within the connective tissues. In addition, acupuncture points have been found to be located on specific meeting points between connective tissue membranes [7].

Those who are familiar with yoga, martial arts, meditation, and many other practices may already have an understanding of how the concept of energy can be a useful framework through which to conceive of and experience their bodies. For others who may not have considered such concepts, it can be a fascinating and rewarding addition to the standard physical and mechanical paradigm.

"Releasing, opening, an energizing - that's what you do. I always feel altered when I come here, in a good way."

Core bodywork can be a valuable addition to any energetic practice in several ways. All matter, even from a western physics perspective, is energy. Therefore all bodywork sessions — no matter how physically oriented and focused they may be — involve the interaction and exchange of energy both between and within the client and the practitioner. Energy can be defined, understood, and felt in many ways, yet can seem frustratingly elusive and ephemeral to the conscious mind. While there is no one way to sense and work with energy, energetic shifts, responses, and effects are always occurring, however large or small, noticeable or not they may be. Sensitive bodywork coupled with the client's focused interoception (awareness of internal sensations and shifts) can be a useful tool to expand one's ability and facility to tune in and more clearly notice energetic states and shifts that may come into consciousness. Bodywork is also a good way to develop a deeper energetic understanding of the particular tissues and areas of the body being engaged, and an enhanced ability to identify, actively work with, and shift the various energies that are ever-present within us.

"Thank you. That was deeply purifying."

Seekers who study and practice disciplines and systems that are based on energetic principles are often more attuned to energetic presence and shifts, but this way of perception is available to all of us.

Mind, Emotions, Stress, Trauma, and the CoreBack to top

Most of us have experienced butterflies in our stomach in nervous anticipation of an event, have been aware of knots in the abdomen and/or pelvic floor when faced with a dreaded situation, or felt quesy, unsettled, or tense in the muscular core and its contents in response to various situations. These sensations can manifest in several ways: as mild to significant, but normal and transient, reactions to life events; as the gradual and more chronic — or permanent — adoption of defensive and protective postures in reaction to years of mental stress or emotional challenge; or as the short term or long term response to significant trauma.

"Jeff, it's been great working with you. I really appreciate your openness about everything and providing some good constructive feedback to help me navigate all of this. You have been a wealth of information and I thank you again for everything so far."

There is no question that there are myofascial correlates to our thoughts and feelings. Mental stress, anxious thoughts, fears, worries, anger, depression, and a multitude of other emotional and mental states directly affect the muscles and the nervous system in ways which can cause physical tension (e.g. holding, bracing, retraction, restriction, clenching), laxity or weakness, discomfort, pain, and other somatic reactions. While initially these physical responses may be temporary and transient, over time they can become persistent, chronic, and well-established — and tend to maintain themselves despite the fact that they may no longer serve us, reflect who we are, or align with who we want to be.

Ida Rolf long claimed that structure is behavior and vice versa — that is, who we are and how we act is reflected in our physical structure. Similarly, Wilhelm Reich focused much of his research and practice around the concept of character or body armoring — that the physical body organizes itself over time according to our mental and emotional history. Whenever we characterize challenging or painful past experience as 'buried deep inside', it not only refers to deep within our psyche but can also refer to being embedded deeply within our muscles and other tissues, and sometimes frozen or stuck there. Soma (body) and psyche (mind) are indeed tightly bound together and reflections of each other.

"When I was on my stomach I couldn't see what you were doing, but I felt it. I was being shown that there was an [old] trauma being held there. Because of the trauma work I have done in the past I could be aware of this and today the musculature back there is different. By no means is the trauma gone, but it has given me something to work with. I realized how much energy it was costing me to hold on to this, so I will be working on this issue over the following weeks.

When humans became bipeds by adopting an upright posture, our soft and vulnerable bellies — not to mention our genitals — were much more exposed to danger, threat, and injury compared to our closest relatives who remained quadrupeds, and we therefore had to be constantly aware of the need and readiness to take protective action. In today's world, this tendency can sometimes become amplified in reaction to both real or perceived threats of any kind: mental, emotional, or physical. Additionally, social and cultural pressures, as well as conceptions of masculinity, can influence, and restrict, how we experience and use our bodies — including our core. As a result, we adopt and employ subtle (or not so subtle!) postures and movement patterns that reflect our personal history, experience, and beliefs. For example, the abdomen may be chronically tensed and held in; the hips may be in a state of slight or exaggerated flexion; the pelvis may be tilted forward or backward, or have reduced mobility; the thighs may be rotated inward and held closer together; the pelvic floor may be tensed and drawn upward; the genitals may be retracted; the anal sphincters may be overtense or clenched; the butt cheeks (gluteus maximus) may be drawn closer together; the tailbone may be tucked too far underneath; movement of the respiratory diaphragm may be restricted; and the low back may become stiffened.

There are many valid approaches to working with the interface and strong connections between our physical and our emotional/mental selves. Broadly speaking, they can be grouped together and characterized as either top-down approaches or bottom-up approaches (see [10], for example). Psychotherapy is a classic example of a top-down approach, working exclusively through the portal of the mind. Bodywork and other manual or movement therapies represent a bottom-up approach, which works mainly with and through the physical body. These approaches are not at all mutually exclusive, and both can be employed concurrently and to varying degrees. No matter which one is emphasized, benefits can manifest in the other. The bodymind is highly integrated and, in fact, inseparable.

Core bodywork is a useful stand-alone or complementary way to explore, work with, and shift the relationships between the physical, mental, and emotional aspects of ourselves. It is also an effective way to suggest to and remind our tissues, as well as our subconscious and conscious selves, that there can be different, better, and more functional ways of inhabiting our body.

Sexual Function, Dysfunction, Genital Pain, and the CoreBack to top

"I wanted to take this time to thank you for the help you’ve given me. This is the best progress I’ve made in 9 years! You definitely have this figured out and you’re very forthcoming with your knowledge."
(re: erectile dysfunction)

Sexual function is highly dependent on the core, and the pelvic floor component is especially important — yet when sexual pain or dysfunction occurs, the relevance and contribution of these tissues is often overlooked or ignored. Anatomically and functionally, it is clear that the genitals have extensive relationships with the pelvic floor, pelvis, and abdomen — and even to the bottom of the spine.

With its three roots, the penis is well-anchored into the pelvic floor and directly connected to the sitz bones (ischial tuberosities) of the pelvis. In fact, the central root connects the penis to the tail bone (coccyx) and sacrum at the base of the spine via the perineal body, anal sphincters, and ano-coccygeal ligament. From above, the connective tissues of the lower abdomen, including the central linea alba, continue below the pubic bone to form the suspensory and fundiform ligaments that suspend the penis from the front of the pelvis. More broadly, these abdominal connective tissue layers seamlessly merge into their counterparts in the groin, genitals, and perineum.

"I used to experience extreme bouts of prostate and pelvic pain, but ever since I've been coming to see you [over the past 3 years] I've only experienced that once."

The testicles develop within the abdomen and descend from it before birth — not by popping through an opening in the many layers of abdominal wall tissue, but by stretching and elongating these tissues downward with them as they descend. "The layers of the scrotum are [a] continuation of the abdominal wall layers," states Patel [11]. For example, the cremaster muscle, which surrounds the spermatic cord and testicles and forms one of these layers, is an extension and elongation of the internal oblique muscle of the abdomen.

These and other anatomic relationships clearly illustrate how the genitals are well-integrated with, and highly dependent on, the pelvic floor, pelvic, and abdominal components of the core.

→ The Relevance of Muscles and Connective Tissues

The extensive connections and continuations between the genitals and the surrounding core tissues helps explain their highly integrated anatomical and functional relationships. The muscles and connective tissues of the inner thighs, the groin, the pelvic floor, the inguinal area, the pubic area, and the lower abdomen can all trigger or contribute to sexual pain, dysfunction, and the health of the genitals. Trigger- or tender-points in these muscles, for example, can be a significant cause of local or referred discomfort, pain, irritation, or burning in any part of the genitals, including the tip of the penis, penile shaft or base, the urethra, the testicles, epididymis, or anywhere along the spermatic cord. Other mechanisms such as excess tensile or compressive forces exerted by muscles and connective tissues directly on the genital tissues, on the tissues that support them, or on the blood vessels and nerves that supply them can cause, contribute to, or perpetuate genital pain syndromes and sexual dysfunction.

The pelvic floor muscles deserve particular mention as they are critical to sexual function. Among their important contributions: they pump blood into the penis by their contractions and compressions; they are instrumental in trapping blood in the penis via their pull-back force on the penile connective tissues, thus ensuring veno-occlusion (closing of the veins); they provide the propulsive force of ejaculation; they facilitate and enhance sensory awareness and thus increase the capacity for pleasure and heighten erotic charge; they lift the penis upward; they help stabilize the penile shaft and protect it against excessive bending and angling forces; and they stiffen the glans — which has less capacity for engorgement than the main shaft of the penis — via a strong pull-back force on the distal ligament.

→ The Relevance of Nerves and Blood Vessels

The main nerves (pudendal, genitofemoral, ilioinguinal and their branches) and blood vessels (pudendal, testicular, cremasteric and their branches) that supply the genitals travel around, between, and through the abdominal, inguinal, or pelvic floor muscles and connective tissues on their way to the penis and scrotum — and therefore can be susceptible to excess tensile and compressive forces generated by them. Nerves can also be susceptible to the effects of shock from any kind of trauma (e.g. psychological, emotional, or physical trauma such as sexual abuse or assault, bike riding, any direct blow, or surgery), resulting in neural dormancy (neurapraxia). Likewise, blood vessels can develop high tone (constriction) for the same reasons. Scar tissue from pelvic, abdominal, or inguinal surgeries, or from injuries, can also negatively impact nerves and blood vessels. Pain, discomfort, impaired erectile function, altered or reduced sensation, tissue hardening or densification (as in hard-flaccid, for example), and cool or cold genitals are some of the potential adverse effects of restricted blood flow or nerve compromise.

→ And the Respiratory Diaphragm

Many men breathe shallowly, or hold the breath, during long stretches of sexual activity. While this can reflect the breathing mechanism taking a temporary back seat to moments of extreme pleasure, it may not be optimal as a dominant pattern. Full, diaphragmatic breathing contributes to a feeling of aliveness and vitality (including in a sexual sense), keeps oxygen levels high in the blood, shifts the autonomic nervous system in ways that both heighten pleasure and widen pleasure zones, helps to unlock and open us energetically, and helps increase our awareness of the entire body as a full participant, and responder, to all aspects of sexual experience.

Diaphragmatic breathing, pelvic floor awareness and control, and a finely-tuned awareness of arousal levels are important components of ejaculatory control for those men wish to better-manage or resolve their premature ejaculation. These tools are also useful when learning how to separate ejaculation from orgasm (though closely coupled, they are two separate phenomena), which can then be used for various pleasure, energetic, or spiritual goals such as internal or full body (non-ejaculatory) orgasms, multiple orgasms, or using the generation of sexual energy for non-sexual purposes.

Core Bodywork for Sexual Dysfunction and Genital Conditions, including PainBack to top

"Mens pelvic health remains such a desperately underserved community - thank you for showing up and leading this valuable work!"
(physical therapist)

Sexual function depends on number of components of the body working in a complex and highly integrated way, including psychologic processes (mental and emotional) and physiologic systems (vascular, hormonal, neurologic, and myofascial). In addition, lifestyle/behavioral factors (e.g. diet, nutrition, physical activity, obesity, smoking, alcohol and drug use) can have significant effects. Furthermore, many prescription drugs moderately or severely alter or diminish sexual function. Any one of these, but more often a combination, can significantly degrade sexual function. The myofascial component (muscles and connective tissues) is frequently overlooked or dismissed, yet can affect sexual function both on its own, and through its effect on other components such as the vascular or neurologic systems.

In light of the above discussion, and considering that the pelvic floor muscles are "an active sexual organ" [12], pelvic floor and lower core bodywork can play a significant role in addressing many sexual dysfunctions, genital conditions, and pain syndromes — especially when medical evaluations have ruled out infections, other pathologies, and medications as a cause; when symptoms have remained unexplained despite multiple evaluations and tests; or when medical treatments have not had the desired effect. In these instances, core bodywork can be an important, and often critical, component of treatment for any of the following: erectile dysfunction (ED); ejaculatory dysfunction (premature, painful, or delayed ejaculation, perceived ejaculate force reduction, or perceived ejaculate volume reduction); hard-flaccid; flat-lining; penile pain; scrotal, testicular, or epididymal pain; penile or testicular retraction; soft glans syndrome (vasoconstriction); blue balls (vasocongestion); dissociation or dysfunction resulting from sexual abuse or violence; strain injuries from overactive sex; injuries from the use of sex toys; issues related to the use of cock rings; diminished sensation, numbness, or erectile dysfunction from bicycle riding or other activities; painful or difficult receptive anal sex; and post-vasectomy or post-herniorrhaphy (hernia repair) pain.

"This has been hugely integral in my getting better. I'm so happy with the progress I've made in a relatively short period of time.

For those men not experiencing pain or dysfunction, core bodywork can help optimize pelvic floor status, genital health, and sexual function.

Working with genital pain and sexual dysfunction requires a clear grasp of the relevant anatomy, an understanding of the physiology of sexual function, knowledge of pain mechanisms including pain referral, and technical competence. It is also of paramount importance to have good communication skills and be respectful, cognizant of sensitivities and vulnerabilities, and non-judgemental.

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References

1. Hsu S-L et at. Effects of Core Strength Training on Core Stability. The Journal of Physical Therapy Science. 2018; 30: 1014-1018.

2. Willardson JM. Core Stability Training: Applications to Sports Conditioning Programs. Journal of Strength and Conditioning Research. 2007; 21 (3): 979-985.

3. Akuthota V et al. Core Stability Exercise Principles. Current Sports Medicine Reports. 2008; 7 (1): 39-44.

4. Kibler WB et al. The Role of Core Stability in Athletic Function. Sports Medicine. 2006; 36 (3): 189-198.

5. Frederickson M and Moore T. Core Stabilization Training for Middle- and Long-Distance Runners. New Studies in Athletics. 2005, No. 1.

6. McGill Stuart. Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength and Conditioning Journal. 2010; 32 (3): 33-46.

7. Schleip, R, with Bayer J. Fascial Fitness. Lotus Publishing, 2017, p. 42 and 193.

8. Saraswati SS. A Systematic Course in the Ancient Techniques of Yoga and Kriya. Yoga Publications Trust, India. 1981 (2013 reprint).

9. Saraswati, SS. Kundalini and Tantra. Yoga Publications Trust, India. 1984 (2012 reprint).

10. van der Kolk, B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books, 2014.

11. Patel AP. Anatomy and Physiology of Chronic Scrotal Pain. Translational Andrology and Urology. 2017; 6, sppl 1: S51-S56.

12. Raadgers M, Ramakers MJ, and van Lusen RHW, in The Pelvic Floor. Carriere B and Feldt CM, eds. Georg Thieme Verlag, 2006, page 400.

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