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INTRODUCTION

Key Points

  • Pelvic pain in men accounts for about 2 million physician visits annually and 1% of primary care visits.

  • Not all primary care physicians are comfortable with the diagnosis or the management of pelvic pain in men.

Chronic pelvic pain, bladder pain, and prostatitis affect about 2% to 4% of men in the United States and account for about 2 million physician visits each year.1,2 While acute pelvic pain due to infection or trauma can be managed effectively with good resolution of symptoms, chronic pelvic pain imposes a long-term burden on the health care system. Chronic pelvic pain is strongly associated with lower quality of life and decreased functional status.3 The strong relationship of pelvic pain syndromes with other chronic pain conditions such as fibromyalgia, temporomandibular joint pain, and irritable bowel syndrome underscores the role of global pain processing and the need for a multidisciplinary approach to its management. Most patients require long-term, multispecialty care and support to achieve and maintain symptom improvement, regain functional status, and advance quality of life.

The primary care office is often the point of health care access for patients with chronic pelvic pain. Prostatitis accounts for about 1% of all primary care practice visits in the United States, yet many primary care physicians are not familiar or comfortable with managing male pelvic pain.1,4 Sixteen percent of primary care providers reported that they were not at all familiar with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) diagnoses in men, and 48% did not know about the National Institutes of Health (NIH) classification system for prostatitis.4 There is a clear need to better inform primary care providers on the evaluation and management of chronic pelvic pain in men. Primary care providers are on the forefront of diagnoses and have the necessary therapeutic relationships with patients, the ability to offer longitudinal support, and the tools to successfully treat patients with chronic pelvic pain. Because a multidisciplinary approach is often necessary, the primary care physician has the ability to guide appropriate referrals for specialty care and coordinate the treatment plan, thus improving patient satisfaction and outcomes.

GENERAL APPROACH TO PELVIC PAIN IN MEN

Key Points

  • A history and targeted physical exam should be used to elucidate possible causes and symptoms concerning for malignancy, active infection, or trauma.

  • Treatment should be based on organ systems involved, and UPOINT classification can be used to define patient phenotype at presentation.

  • Validated questionnaires should be used to screen and monitor patient progress with treatments.

A comprehensive history and physical exam are essential for the evaluation of patients with both chronic and acute pelvic pain, and often minimal additional testing is needed. Patients may complain of pelvic, suprapubic, penile, perineal, rectal, inguinal, testicular, buttock, or low back pain. Men with chronic pelvic pain may not use the word “pain,” but rather complain of pressure, discomfort, ...

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