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Chronic Pelvic Pain in Men

Chronic pelvic pain syndrome (CPPS) affects 10–15% of men. Tests often come back normal — but that does not mean nothing is wrong. This page explains what causes CPPS, how it is assessed, and which treatments work best.

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. It is also one of the most frustrating. But here is what you need to know: normal test results do not mean we cannot help. The approach to this condition has changed dramatically. With the right strategy, most men see significant improvement.

You're in the right place if...

You have persistent pain in your pelvis, perineum (the area between the genitals and the anus), or genitals lasting more than 3 months — especially if previous treatments have not worked or tests have not 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.

Medical Evidence

AUA Guideline: Diagnosis and Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (2025)

Source:AUANET.ORG

EAU Guidelines on Chronic Pelvic Pain (2025)

Source:

PIF TICK accredited information

The Patient Information Forum is the UK membership organisation and network for people working in health information and support. The PIF TICK is the UK-wide Quality Mark for Health Information.

Author —Published —Last update 23 January 2026Next review 23 January 2027Version —

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This content has been produced for educational purposes and reflects current evidence-based practice. Although GGO Med Ltd is a private urology service, all patient information is compiled with the aim of being accurate, evidence-based, and free from commercial bias. If you feel this content does not meet that standard, we would welcome your feedback — please contact us here.

This is increasingly recognised as a major contributor in most men with CPPS. The pelvic floor muscles 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 muscles.

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.

Learn about pelvic floor physiotherapy →

Over time, persistent pain changes how your nervous system processes signals. This is called central sensitisation (where the nervous system becomes oversensitive to pain signals). The brain and spinal cord 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 (irritable bowel syndrome), fibromyalgia (a condition causing widespread pain and fatigue), 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.

Learn about psychological support →

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 (interstitial cystitis/bladder pain syndrome — where the bladder itself is the main source of pain), where the bladder itself is the primary pain source.

Learn about lower urinary tract symptoms →

Occasionally, specific anatomical issues contribute: nerve entrapment (particularly pudendal neuralgia — pain along the pudendal nerve (the main nerve supplying the pelvic floor and genitals)), 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.

Understanding UPOINT

UPOINT stands for Urinary, Psychosocial, Organ-specific, Infection, Neurologic/systemic, and Tenderness — the six domains we assess and treat.

U — Urinary symptoms

Features: Urgency, frequency, poor flow, incomplete emptying, nocturia (waking at night to urinate)

How we assess: IPSS (a questionnaire that scores urinary symptoms), flow rate, post-void residual (the amount of urine left in the bladder after urinating)

Treatment: Alpha-blockers (medicines that relax the muscles around the bladder and prostate) such as tamsulosin or alfuzosin, anticholinergics (medicines that calm an overactive bladder) if overactive bladder features, behavioural modifications

P — Psychosocial dysfunction

Features: Depression, anxiety, stress, catastrophising, poor coping, relationship strain

How we assess: Screening questionnaires, detailed history

Treatment: Cognitive behavioural therapy (CBT), stress management, mindfulness, antidepressants (which can also help pain directly), couples counselling

O — Organ-specific findings

Features: Tender prostate on examination, elevated PSA, prostatic pathology

How we assess: Digital rectal examination, PSA

Treatment: Quercetin (a natural plant compound with anti-inflammatory properties), 5-alpha reductase inhibitors (medicines that shrink an enlarged prostate) if BPH coexists

I — Infection

Features: Documented current or recurrent UTI, positive cultures from prostatic secretions

How we assess: Urine culture, expressed prostatic secretions culture, two-glass/four-glass test

Treatment: Appropriate antibiotics — but only if infection is confirmed. Empirical antibiotics without evidence don't help.

N — Neurologic/systemic

Features: Pain beyond the pelvis, associated fibromyalgia or chronic fatigue, features of central sensitisation, neuropathic (relating to nerve pain) pain

How we assess: Review of other pain conditions, neurological examination, pain characteristics

Treatment: Neuromodulating medications: amitriptyline (a medicine used at low doses to help with chronic pain and sleep), pregabalin or gabapentin (medicines that reduce nerve sensitivity), duloxetine (a medicine that helps with both pain and mood); management of associated conditions

T — Tenderness (pelvic floor)

Features: Pelvic floor muscle tightness and tenderness, trigger points (a tight, tender spot within a muscle)

How we assess: Digital rectal examination specifically assessing pelvic floor muscles

Treatment: Pelvic floor physiotherapy with a specialist therapist, trigger point therapy, relaxation techniques

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 (medicines that relax the muscles around the bladder and prostate) — such as 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 will be direct: antibiotics only help if there is actual documented infection — which is uncommon in CPPS. Multiple courses without confirmed infection do not work and carry risks (side effects, antibiotic resistance, microbiome disruption).

If you have 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 (a type of antibiotic) 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.

Learn more about psychological support →

Daily low-dose tadalafil (a medicine that improves blood flow — also used for erectile difficulties) 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.

Learn about shockwave therapy →

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.

How pelvic floor therapy works

Pelvic floor physiotherapy for CPPS is not about strengthening — it's about releasing and relaxing chronically tight muscles.

The problem: overactive, not weak

Many people associate pelvic floor exercises with "Kegels" — squeezing and strengthening. For CPPS, this is exactly wrong. The problem is usually muscles that are too tight, not too weak. Strengthening exercises can make things worse.

An overactive pelvic floor creates muscle tension, trigger points (a tight, tender spot within a muscle), and poor blood flow. This causes pain directly and sensitises local nerves.

What treatment involves

A specialist pelvic floor physiotherapist will:

- Internal manual therapy
- — gentle release of trigger points via rectal examination. Uncomfortable initially but should not be severely painful
- External manual therapy
- — work on connected muscles in abdomen, hips, and thighs
- Relaxation training
- — learning to consciously relax the pelvic floor
- Biofeedback
- — biofeedback (a technique that uses sensors to help you learn to control muscle activity), helping you learn what relaxation feels like
- Breathing techniques
- — diaphragmatic breathing (deep belly breathing that helps relax the pelvic floor) promotes pelvic floor relaxation
- Stretching and exercises
- — addressing posture and hip mobility

What to expect

Treatment typically involves weekly sessions for 8-12 weeks, with daily home exercises. Improvement is gradual — don't expect instant results.

The evidence: Research suggests 50–70% of men experience significant symptom reduction with dedicated pelvic floor therapy. One randomised trial showed myofascial (relating to the muscles and their surrounding connective tissue) physical therapy outperformed global therapeutic massage for CPPS symptoms.

Finding a specialist

The therapist needs specific training in male pelvic pain — not all physiotherapists have this expertise. I work with specialist therapists and can refer you appropriately.

"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.

Learn more about prostate and urinary health →

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.

Chronic Pelvic Pain: What to do when Nothing Shows on Tests.

Your Health is Our Priority

Chronic Pelvic Pain in Men

You're in the right place if...

Does this sound like you?

Where do you feel the pain most?

How long have you had these symptoms?

Evidence & Medical Sources5 Sources Verified

AUA Guideline: Diagnosis and Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (2025)

EAU Guidelines on Chronic Pelvic Pain (2025)

PIF TICK accredited information

Have antibiotics helped your symptoms?

On this page

What is chronic pelvic pain syndrome?

The medical classification explained

How common is this?

Symptoms and patterns

Where does it hurt?

Perineum

Suprapubic

Penis & Testicles

Associated symptoms

What makes it worse?

Red flags — seek urgent help

How severe are your symptoms?

NIH-CPSI Symptom Assessment

What causes chronic pelvic pain?

Pelvic floor muscle dysfunction

Central sensitisation (nervous system changes)

Prior infection or inflammation

Psychological factors

Urinary factors

Structural and neurological factors

The key insight

How we investigate chronic pelvic pain

What happens in consultation

Physical examination

What tests might I need?

The UPOINT approach: your personalised treatment plan

Understanding UPOINT

Why UPOINT works

The evidence

Which factors might be contributing to YOUR symptoms?

Treatment options

Lifestyle modifications

Alpha-blockers

Anti-inflammatory medications

Neuromodulating medications

Antibiotics — when appropriate

Psychological therapies

PDE5 inhibitors (Viagra/Cialis)

Emerging treatment: shockwave therapy

Myths vs reality

MYTH: "Chronic prostatitis means I have an infected prostate"

MYTH: "I just need the right antibiotic"

MYTH: "If tests are normal, there's nothing wrong"

MYTH: "This is psychological — it's all in my head"

MYTH: "I need to strengthen my pelvic floor with Kegels"

MYTH: "I'll have this forever"

Pelvic floor physiotherapy: a cornerstone of treatment

How pelvic floor therapy works

Quick check: Does sitting make your symptoms worse?

Living with chronic pelvic pain

Impact areas

Sexual function

Mental health

Relationships

Support and resources

What to expect in Consultation

My approach

Listen carefully

Thorough assessment

UPOINT phenotyping

What happens next

Frequently asked questions

Is chronic pelvic pain the same as prostatitis?

Could this be prostate cancer?

Will I have this forever?

Should I avoid sex or ejaculation?

Can I still cycle with chronic pelvic pain?

Why haven't previous treatments worked?