How to cite: Burton, Rochell (Shelli). “Male Pelvic Pain: Case Study.” Grand Rounds in Urology. Published November 11, 2025. Accessed Mar 2026. https://grandroundsinurology.com/male-pelvic-pain-case-study/
Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Senior Editorial Director, Grand Rounds in Urology, and Urology and Pelvic Floor Nurse Specialist, University of Pennsylvania, Philadelphia, Pennsylvania, Adjunct Professor of Surgery, Division of Urology, Perelman School of Medicine, Emerita, introduces Rochell (Shelli) Burton, APRN-BC, Vanderbilt University Medical Center, Nashville, Tennessee. Nurse Burton presents an interesting case involving a thirty-one-year-old male long-distance cyclist with chronic pelvic pain, treated with targeted botulinum toxin therapy.
The patient experienced persistent perineal and hip discomfort, associated with performance and levator ani muscle tension, erectile difficulty related to pain, and diminished quality of life. Prior management included prolonged physical therapy, anti-inflammatory agents, and muscle relaxants, with limited relief.
After multiple failed interventions, including trigger point and nerve blocks, Nurse Burton evaluated the patient for potential botulinum toxin injection. The procedure was performed in-office under local conditions with patient consent and counseling about possible temporary pelvic floor weakness. Injection sites were mapped according to muscular landmarks, using a stepwise injection technique across identified trigger points.
Post-procedure, the patient reported improvement within days, including restoration of sexual function and sustained pain reduction. Six months later, he remained stable, requiring no further injections. Ms. Burton emphasizes the value of concurrent physical therapy, psychological support, and individualized management. The case highlights the clinical utility of botulinum toxin injections for selected men with refractory pelvic floor myalgia when conservative measures fail.
