Chronic pelvic pain in men: neurological and pelvic floor contributions

Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects around 8% of men, significantly impacts quality of life and is a frequent presentation in sexual health clinics. Its multifactorial pathophysiology includes pelvic floor muscle overactivity, neurological contributions and central sensitization. This case-based review illustrates how recognizing nociceptive, neuropathic and nociplastic mechanisms supports multidisciplinary, patient-centred care. Four clinical cases are presented. Two highlight the medical management of CP/CPPS in genitourinary medicine settings, demonstrating the value of an early explanation of the pelvic pain–anxiety feedback loop, pelvic floor relaxation strategies and judicious use of α-adrenoceptor blockers and/or low-dose tricyclic antidepressants. Two further cases illustrate pudendal and genitofemoral neuralgia, demonstrating the role of neurodynamic assessment and neural mobilization; they show substantial improvement with pelvic floor down-training and load management. Across all cases, outcomes improved most when interventions addressed high pelvic floor tone and were delivered within a multidisciplinary team framework.