Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 24;120(29-30):508-518.
doi: 10.3238/arztebl.m2023.0036.

Chronic Primary Pelvic Pain Syndrome in Men

Julia Franz  1 , Kristin Kieselbach, Claas Lahmann, Christian Gratzke, Arkadiusz Miernik
Affiliations
Review

Chronic Primary Pelvic Pain Syndrome in Men

Julia Franz et al. Dtsch Arztebl Int. .

Abstract

Background: Chronic primary pelvic pain syndrome in men (CPPPSm) can be associated with urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance. Its clinical heterogeneity and incompletely understood pathogenesis make it more difficult to treat. This article is intended to familiarize the reader with basic aspects of the manifestations, pathophysiology, diagnostic evaluation, differential diagnosis, and treatment of this condition.

Methods: This article is based on relevant publications retrieved by a selective search of the literature, including the current guidelines of the European Association of Urology. The features of this disease pertaining to urology, psychosomatic medicine, and pain medicine are illuminated from an interdisciplinary perspective.

Results: Chronic pelvic pain appears to arise through a complex interaction of inflammatory, infectious, neurological, musculoskeletal, and psychosomatic factors. A comprehensive diagnostic work-up should be carried out to evaluate and exclude the numerous differential diagnoses. Treatment strategies are based on the clinical phenotype. Randomized controlled trials have shown that significant relief can be achieved with a variety of drugs and non-pharmacological treatments, selected according to the manifestations of the condition in the individual case. Attention must be paid to treatment-specific adverse effects.

Conclusion: The management of patients with CPPPSm should consist of a comprehensive differential diagnostic evaluation and an individually oriented treatment strategy.

PubMed Disclaimer

Figures

Figure
Figure
Algorithms for chronic primary pelvic pain syndrome in men (CPPPSm) DRE, digital rectal examination; IIEF, International Index of Erectile Function; LUTS, lower urinary tract symptoms; NIH-CPSI, National Institutes of Health Chronic Prostatitis Symptom Index; PHQ-9, Patient Health Questionnaire 9; UPOINT(S) classification, classification according to the following criteria: U = urinary, P = psychosocial, O = organ-specific, I = infectious, N = neurologic/systemic, T = pelvic muscle tenderness, S = sexual.
See this image and copyright information in PMC

References

    1. Fall M, Baranowski AP, Berghmans B, et al. EAU guidelines on chronic pelvic pain Edn Present EAU Annu Congr Amsterdam 2022. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidel... (last accessed on 5 June 2023) 2022 ISBN 978-9.
    1. Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, et al. Prevalence of and risk factors for prostatitis: population based assessment using physician assigned diagnoses. J Urol. 2007;178:1333–1337. - PubMed
    1. Krieger JN, Lee SWH, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008;31(1):S85–S90. - PMC - PubMed
    1. de la Rosette JJ, Hubregtse MR, Meuleman EJ, Stolk-Engelaar MV, Debruyne FM. Diagnosis and treatment of 409 patients with prostatitis syndromes. Urology. 1993;41:301–307. - PubMed
    1. Krieger JN, Nyberg LJ, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–237. - PubMed