How to cite: MacDonald S. “Approach to the Male with Chronic Urogenital Pain.” September 19, 2025. Accessed Mar 2026. https://grandroundsinurology.com/approach-to-the-male-with-chronic-urogenital-pain/
Summary
Susan MacDonald, MD, Associate Professor of Urology, Penn State Health, Hershey, Pennsylvania, provides a concise, experience-based overview of how to evaluate and manage men with chronic urogenital pain, including chronic orchialgia and chronic pelvic pain syndrome (CPPS). Dr. MacDonald emphasizes diagnostic precision, realistic patient communication, and evidence-based therapeutic strategies.
Dr. MacDonald outlines the overlap between chronic testicular pain, bladder pain, and CPPS, stressing that patients often exhibit multiple overlapping symptoms, including perineal, ejaculatory, and voiding pain. She explains that pelvic floor dysfunction frequently underlies these syndromes and that recognizing high-tone pelvic floor muscles through proper examination techniques is critical.
Central sensitization and altered brain connectivity in CPPS are discussed, with supporting data from the Multidisciplinary Approach to Pelvic Pain (MAPP) network, highlighting that these patients experience pain at higher thresholds, similar to those with fibromyalgia. Dr. MacDonald advises using validated questionnaires such as the Genitourinary Pain Index and sexual function indices to document symptom patterns and guide management.
Therapeutic recommendations include structured pelvic floor physical therapy, dedicated anti-inflammatory courses, and neuromodulators such as gabapentin, amitriptyline, or duloxetine. For chronic orchialgia, microsurgical denervation of the spermatic cord, and orchiectomy can be considered. Dr. MacDonald emphasizes that testicular removal should be reserved as an absolute last resort.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Susan MacDonald, MD, is an Associate Professor in the Department of Urology at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania. Dr. MacDonald specializes in urethral reconstruction, prosthetic urology, graft and flap creation, and microsurgical dissection.
