Male Pelvic Pain: It’s Not Always Prostatitis

Urologists see it all the time. Pain in or near the scrotum, perineum, or penis, frequently made worse by urination or ejaculation.

A diagnosis of prostatitis is made and antibiotics start. Followed by more antibiotics. Prostatitis has been subdivided, bacterial/non-bacterial/chronic/acute, and sometimes classified as urethritis or cystitis.

Perhaps there’s a better way. Dr. Jeanette Potts, an American urologist, suggested as much in her article Male Pelvic Pain: Beyond Urology and Chronic Prostatitis,“Current Urology Rheumatology Review,” v. 12, number 2, 2015, that over the course of many years she came to realize that in many, though certainly not all, “prostatitis” cases, something more was going on.

Thoughtful interview and methodical physical examination can very often reveal pelvic floor muscle dysfunction, Myofascial pain syndromes, Functional Somatic Syndrome/Central Sensitization Syndromes and/or psychosocial distress.

One must be aware that many of these syndromes frequently overlap. Acknowledgement of these conditions and validation of both their physical and psychological distress is paramount to creating trust and confidence in the patient. These are the cornerstones for empowerment and self-care required in the management of chronic pelvic pain.”

Pelvic physical therapy is the cornerstone treatment for such cases and the results are impressive. She makes the point that prostatitis is a real, serious, and treatable malady. However, not all discomfort in the male pelvic region is, indeed prostatitis. Her thoughts on how she battled the urological establishment are linked below.