You've had pain for months — maybe years. You've seen doctors, had tests, tried antibiotics. Nothing shows up on scans. Nothing seems to help. You're starting to wonder if anyone actually understands what's wrong.
I do. Chronic pelvic pain is one of the most common conditions I see, and one of the most frustrating for patients. But here's what you need to know: just because tests come back "normal" doesn't mean we can't help. The approach to this condition has changed dramatically — and with the right strategy, most men see significant improvement.
You're in the right place if...
You have persistent pain in your pelvis, perineum, or genitals lasting more than 3 months — especially if previous treatments haven't worked or tests haven't found a clear cause.
Does this sound like you?
Answer these quick questions to see if chronic pelvic pain syndrome might explain your symptoms.
Knowledge check
Where do you feel the pain most?
Select the location that best matches your experience.
Knowledge check
How long have you had these symptoms?
Chronic pelvic pain is defined by duration as well as location.
Knowledge check
Have antibiotics helped your symptoms?
This question helps distinguish between different types of pelvic pain.
Recognise yourself in these questions?
Book a comprehensive assessment. I'll identify what's driving your symptoms and create a personalised treatment plan.
On this page
What is chronic pelvic pain syndrome?
Chronic pelvic pain syndrome (CPPS) — sometimes misleadingly called "chronic prostatitis" — is defined as pain in the pelvis, perineum, or genitals lasting at least three months, without evidence of bacterial infection.
Here's the crucial insight: despite the old name, the prostate usually isn't the problem. The pain comes from a combination of factors — tight pelvic floor muscles, sensitised nerves, and how your brain processes pain signals. This is why antibiotics rarely help, and why a completely different approach is needed.
The medical classification explained
Doctors classify prostatitis into four categories — understanding where you fit helps guide treatment.
How common is this?
Very. Studies suggest 10-15% of men experience chronic pelvic pain at some point. It's one of the most common reasons men under 50 see a urologist — more common than prostate cancer or BPH in this age group. You're definitely not alone.
Symptoms and patterns
Chronic pelvic pain presents differently in different men. Understanding your specific pattern helps us target treatment more effectively.
Common pain locations
Where does it hurt?
Perineum
Suprapubic
Penis & Testicles
Associated symptoms
Pain is the defining feature, but many men also experience:
- Urinary symptoms
- — frequency, urgency, weak stream, incomplete emptying, discomfort when urinating
- Sexual symptoms
- — pain during or after ejaculation,
- , reduced desire
- Bowel symptoms
- — constipation or discomfort with bowel movements
- Muscle tension
- — tight pelvic floor, difficulty relaxing when urinating or having a bowel movement
What makes it worse?
Recognising your triggers can help both diagnosis and management.
Red flags — seek urgent help
These symptoms need immediate medical attention:
- Fever or feeling systemically unwell
- Complete inability to urinate
- Severe sudden-onset pain
- Blood in your urine
These suggest acute conditions requiring urgent care — not typical CPPS.
How severe are your symptoms?
The NIH-CPSI (Chronic Prostatitis Symptom Index) is the validated tool we use to assess symptom severity and track your progress with treatment. Completing this before your appointment gives us valuable baseline information.
NIH-CPSI Symptom Assessment
This 9-question validated questionnaire measures pain severity, urinary symptoms, and quality of life impact. It takes about 2 minutes to complete.
Your score helps us:
- Understand how much symptoms are affecting you
- Track improvement over time
- Compare your response to what research shows
Complete the NIH-CPSI Assessment
Note: This assessment is for information only and doesn't replace clinical evaluation.
What causes chronic pelvic pain?
I'll be honest: we don't fully understand what triggers CPPS in most men. There's no single cause. What we do know is that multiple factors typically contribute — and the combination differs between individuals.
This is increasingly recognised as a major contributor in most men with CPPS. The pelvic floor muscles — the hammock of muscles supporting your bladder, bowel, and prostate — become chronically tight and tender.
Think of it like a persistent tension headache, but in your pelvis. Just as stress makes you clench your jaw or shoulders, many men unconsciously clench their pelvic floor.
The evidence: Studies show 50-80% of men with CPPS have demonstrable pelvic floor muscle tenderness on examination. Targeted physiotherapy addressing this tension is one of our most effective treatments.
Over time, persistent pain changes how your nervous system processes signals. The brain and spinal cord become "sensitised" — they amplify pain signals and interpret normal sensations as painful.
This explains why pain can persist even after any initial trigger has resolved. It also explains why many men with CPPS have other chronic pain conditions — IBS, fibromyalgia, chronic fatigue, migraines. The nervous system has become primed to over-respond.
Why this matters: Treatments targeting nerve sensitisation (certain medications, psychology, stress management) can help "turn down the volume" on pain.
Some men report symptoms beginning after a urinary infection, STI, or episode of bacterial prostatitis. Even after infection clears, the pain system may remain activated.
Important: This "post-infectious" pattern doesn't mean ongoing infection. The infection was the trigger, but isn't the ongoing cause. More antibiotics won't help — we need to address the other factors that are keeping the pain going.
Let me be clear: this is NOT "in your head". The pain is absolutely real. But psychological factors — stress, anxiety, depression, catastrophising — significantly affect how pain is experienced and processed.
Men with CPPS have higher rates of depression and anxiety than the general population. Which came first? Often unclear. Chronic pain causes psychological distress, and psychological distress amplifies chronic pain. Both directions are true.
Why this matters: Addressing psychological factors isn't about dismissing your pain — it's about addressing one of the real contributors to it. CBT and stress management genuinely reduce physical symptoms.
Some men have problems with how they urinate — high-pressure voiding, incomplete relaxation, dysfunctional patterns. These issues can contribute to pelvic symptoms.
There may also be overlap with interstitial cystitis/bladder pain syndrome (IC/BPS), where the bladder itself is the primary pain source.
Occasionally, specific anatomical issues contribute: nerve entrapment (particularly pudendal neuralgia), lumbar spine problems, or previous pelvic surgery or trauma.
These are worth investigating but aren't found in most cases. When present, they may need targeted treatment.
The key insight
Effective treatment doesn't require finding a single cause. It requires identifying which factors are contributing in your case and addressing them all. This is the UPOINT approach.
How we investigate chronic pelvic pain
Investigation serves two purposes: ruling out other conditions that need specific treatment, and identifying which factors are driving your symptoms. I'll be honest — tests often come back "normal". That doesn't mean nothing is wrong; it means the problem isn't something we can see on a scan.
What happens in consultation
The most important diagnostic tool is talking to you. I want to understand:
- Where exactly you feel the pain and how it behaves
- When it started and whether anything triggered it
- What makes it better or worse
- How it affects your life — work, relationships, mood, sex
- Your urinary and bowel function
- Previous treatments and what helped (or didn't)
- Your general health, stress levels, and psychological wellbeing
Physical examination
A thorough examination includes:
- Abdominal examination
- — checking for tenderness, masses, or bladder distension
- Genital examination
- — assessing testicles, epididymis, and spermatic cord
- Digital rectal examination (DRE)
- — feeling the prostate, and
- crucially
- , assessing the pelvic floor muscles for tension and trigger points
The pelvic floor assessment is essential. I'm specifically checking whether your levator ani and obturator muscles are tender or tight — this tells us whether pelvic floor dysfunction is contributing.
What tests might I need?
Most men need basic tests to rule out other causes. Additional investigations depend on your specific symptoms.
The UPOINT approach: your personalised treatment plan
Traditional treatment for CPPS meant giving everyone the same thing — usually antibiotics and anti-inflammatories. The results were poor. Research consistently showed these "one size fits all" approaches didn't work.
The breakthrough was recognising that CPPS isn't one disease — it's a syndrome with multiple contributing factors that differ between individuals. The UPOINT system provides a framework for identifying what's relevant in your case.
Understanding UPOINT
UPOINT stands for Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, and Tenderness — the six domains we assess and treat.
Why UPOINT works
The power of UPOINT is that treatment targets what's actually contributing in your case. Someone with three positive domains needs multimodal treatment addressing all of them. Someone with isolated urinary symptoms might respond to alpha-blockers alone. Someone with significant psychological distress and pelvic floor tension needs CBT and physiotherapy, not antibiotics.
The evidence
Research shows that UPOINT-directed therapy achieves meaningful improvement in 70-80% of men — much better than traditional single-treatment approaches. In one study of 140 men, 75% had at least a 6-point improvement on the NIH-CPSI after 6 months of phenotype-directed treatment.
Knowledge check
Which factors might be contributing to YOUR symptoms?
Think about what resonates most with your experience.
Treatment options
Based on your assessment, we build a treatment plan targeting your specific contributing factors. This usually involves several approaches simultaneously — the evidence shows multimodal treatment works better than any single therapy.
Simple changes can make a meaningful difference:
- Heat application
- — warm baths or heating pad on perineum relaxes pelvic floor muscles
- Avoid prolonged sitting
- — use a cushion, take breaks to stand and move
- Modify cycling
- — consider noseless saddle or temporary break
- Dietary adjustments
- — trial avoiding alcohol, caffeine, spicy foods
- Regular exercise
- — aerobic exercise has evidence for reducing CPPS symptoms
- Stress management
- — yoga, meditation, breathing exercises
Evidence level: Moderate (Grade C recommendation from AUA guidelines)
If you have urinary symptoms (frequency, urgency, poor flow), alpha-blockers like tamsulosin or alfuzosin can help. These relax smooth muscle in the prostate and bladder neck.
Evidence level: Moderate recommendation from AUA guidelines. Most effective for men with significant voiding symptoms. Less helpful if urinary symptoms are minimal.
Side effects: Dizziness, fatigue, ejaculatory changes (reduced or absent ejaculation in some men).
NSAIDs (ibuprofen, naproxen) may provide short-term pain relief as part of a multimodal strategy. Not recommended for long-term use due to GI and cardiovascular risks.
Quercetin — a natural flavonoid with anti-inflammatory properties — has shown modest benefit in some studies and is well-tolerated for longer-term use.
Evidence level: Grade B recommendation (AUA) as part of multimodal approach.
For men with features of central sensitisation or neuropathic pain:
- Amitriptyline
- — tricyclic antidepressant used at low doses for chronic pain. Helps sleep and has pain-modulating effects
- Pregabalin or gabapentin
- — reduce nerve sensitivity. May help if pain has neuropathic features
- Duloxetine
- — SNRI antidepressant with established pain-relieving properties
These take several weeks to work and need gradual dose adjustment.
I'll be direct: antibiotics only help if there's actual documented infection — which is uncommon in CPPS. Multiple courses without confirmed infection don't work and carry risks (side effects, antibiotic resistance, microbiome disruption).
If you've already had several courses of antibiotics without benefit, more antibiotics are unlikely to help. We need to focus on other contributing factors.
If infection is confirmed by culture, appropriate antibiotics (usually fluoroquinolones for 4-6 weeks) are indicated.
Cognitive behavioural therapy (CBT) has evidence for improving CPPS outcomes. It addresses catastrophising thoughts, improves coping strategies, and reduces the psychological amplification of pain.
Mindfulness-based stress reduction (MBSR) also shows promise.
Managing stress and anxiety isn't about dismissing your pain — it's about breaking the cycle where psychological distress worsens physical symptoms.
Daily low-dose tadalafil has shown benefit in some studies, particularly for men with concurrent erectile dysfunction or BPH symptoms. Improves blood flow and may have smooth muscle relaxing effects.
Evidence: Randomised controlled trials (2020-2022) show promise for tadalafil monotherapy in CPPS.
Low-intensity extracorporeal shockwave therapy (Li-ESWT) is being investigated for CPPS. Early evidence suggests it may help some men, potentially by reducing inflammation and improving blood flow.
My view: The evidence is still limited. I consider this experimental at present, but it may be worth discussing if other treatments haven't helped.
Ready to discuss your treatment options?
Book a consultation for comprehensive UPOINT assessment and personalised treatment plan.
Myths vs reality
There's a lot of misinformation about chronic pelvic pain. Let's address the most common misconceptions.
REALITY: Despite the name, 90-95% of men diagnosed with "chronic prostatitis" don't have bacterial infection. The prostate may not even be the source of pain. This is why the condition is now more accurately called chronic pelvic pain syndrome (CPPS).
The name persists for historical reasons, but it's misleading — and often leads to inappropriate antibiotic treatment.
REALITY: If multiple courses of antibiotics haven't helped, more antibiotics won't work. Without documented bacterial infection, antibiotics are ineffective for CPPS — and multiple trials have confirmed this.
The continued prescription of antibiotics for non-bacterial CPPS is one of the biggest problems in how this condition is managed.
REALITY: CPPS is a clinical diagnosis based on symptoms and examination. Normal imaging and blood tests rule out other conditions — they don't mean your pain isn't real or that we can't help.
The key findings in CPPS are often on physical examination (pelvic floor tenderness) and symptom assessment, not laboratory tests.
REALITY: The pain is absolutely real and physical. Psychological factors influence how pain is processed and experienced, but they don't cause it out of nothing.
Addressing psychological factors is part of effective treatment — not because the pain is imaginary, but because stress, anxiety, and how we think about pain genuinely affect nerve signalling and muscle tension.
REALITY: For CPPS, this is exactly wrong. The problem is usually muscles that are too tight, not too weak. Kegel exercises (pelvic floor strengthening) can make things worse.
Pelvic floor therapy for CPPS focuses on relaxation and releasing trigger points — the opposite of Kegels.
REALITY: Most men see significant improvement with appropriate multimodal treatment. Studies show 70-80% experience meaningful symptom reduction with UPOINT-directed therapy.
Some men become largely symptom-free; others learn to manage symptoms effectively. The key is finding the right combination of treatments for your specific situation.
Pelvic floor physiotherapy: a cornerstone of treatment
If your assessment shows pelvic floor muscle tenderness — and most men with CPPS have this — pelvic floor physiotherapy is one of the most effective treatments available. It's also one of the most underused.
How pelvic floor therapy works
Pelvic floor physiotherapy for CPPS is not about strengthening — it's about releasing and relaxing chronically tight muscles.
Knowledge check
Quick check: Does sitting make your symptoms worse?
This helps identify if pelvic floor dysfunction is likely contributing.
Living with chronic pelvic pain
Chronic pelvic pain affects more than just the pelvis. It impacts work, relationships, sex, mood, and overall quality of life. Acknowledging this isn't weakness — it's reality.
Understanding the full picture
Impact areas
Sexual function
Mental health
Relationships
Support and resources
You don't have to manage this alone. Various support options are available.
What to expect at GGO Med
Chronic pelvic pain can be frustrating to manage. Many men come to me having seen multiple doctors, tried multiple treatments, and still suffering. I understand this frustration.
How I work
My approach
Listen carefully
Thorough assessment
UPOINT phenotyping
This isn't a condition where one consultation and one prescription fixes everything. It typically requires ongoing management, treatment adjustments, and patience. But with the right approach, most men achieve meaningful improvement in their symptoms and quality of life.
What happens next
Initial consultation (45-60 minutes): Comprehensive history, examination including pelvic floor assessment, UPOINT phenotyping, and initial treatment plan.
Follow-up (4-6 weeks): Review response, adjust treatments, coordinate with physio/psychology if needed.
Ongoing: Regular reviews until symptoms are well-controlled, then as-needed follow-up.
Frequently asked questions
"Chronic prostatitis" and "chronic pelvic pain syndrome" are often used interchangeably, but CPPS is more accurate. Most men with this condition don't have an infected or inflamed prostate — the pain comes from multiple sources including muscles, nerves, and how the nervous system processes pain.
Chronic pelvic pain is not typically a symptom of prostate cancer. As part of your assessment, I'll check your PSA and examine your prostate to exclude any concerning findings. The pain itself is very unlikely to represent cancer.
Many men see significant improvement with appropriate multimodal treatment. Studies show 70-80% experience meaningful symptom reduction with UPOINT-directed therapy. Some become largely symptom-free; others learn to manage symptoms effectively. The key is finding the right combination for your situation.
Not necessarily. Some men find ejaculation temporarily worsens symptoms; others find it provides temporary relief. Avoiding sex entirely doesn't cure the condition. If sex is painful, we should address this — often through treating pelvic floor tension.
Cycling puts pressure directly on the perineum and can worsen symptoms. If cycling is important to you, consider taking a break to see if symptoms improve, then reintroduce with modifications: noseless saddle, padded shorts, upright position, limited duration.
Most likely because CPPS has multiple contributing factors, and previous treatment only addressed one. If you've had antibiotics but have pelvic floor tension and stress as major contributors, the antibiotics won't help. Effective treatment requires identifying all relevant factors and addressing them together.
The digital rectal examination involves assessing both the prostate and pelvic floor muscles. If your pelvic floor is tender (which it often is in CPPS), this part of the examination may be uncomfortable — but it provides essential diagnostic information. I'll explain everything beforehand and go at your pace.
Chronic conditions take time to improve. Medications may take 2-4 weeks to show effect. Pelvic floor physiotherapy typically needs 8-12 weeks of regular sessions. Psychological approaches also need time. Most men see meaningful improvement within 3-6 months of starting comprehensive treatment — but this varies.
Absolutely. Stress increases muscle tension (including pelvic floor), affects nerve signalling, and influences how the brain processes pain signals. Managing stress genuinely reduces physical symptoms — this is well-established in pain science, not just theory.
Related information
References and guidelines
This page draws on current best-practice guidelines:
- AUA Guideline: Diagnosis and Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (2025)
- EAU Guidelines on Chronic Pelvic Pain (2025)
- Shoskes DA, Nickel JC. Classification and treatment of men with CP/CPPS using the UPOINT system. World J Urol 2013;31:755-760
- Fitzgerald MP et al. Randomized multicenter feasibility trial of myofascial physical therapy for treatment of urological chronic pelvic pain syndromes. J Urol 2013;189:S75-85
- Magistro G et al. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol 2016;69:286-297
Take the next step
Chronic pelvic pain is complex, but with the right approach, improvement is genuinely possible. If you've been struggling with persistent pelvic pain and want a thorough assessment with access to modern multimodal treatment, I'm here to help.
Your next steps
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Comprehensive UPOINT assessment and personalised treatment plan. Same-week appointments available.
Complete Symptom Assessment
Take the NIH-CPSI questionnaire before your appointment for valuable baseline data.
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Speak with my secretary if you have questions before booking. 020 4576 5779
Clinic locations: Chelsea & Westminster Hospital Private Care | Nuffield Health Highgate Hospital
