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The Complex Interplay of Chronic Pelvic Pain and Psychological Distress in Men: A Holistic View
Dr. Susie Gronski, PT, DPT
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Our bodies are remarkable ecosystems where every part plays a crucial role in our overall well-being. So when distress hits our most intimate regions, its effects ripple throughout our entire being, affecting not just our physical state but also our psyche and emotions. The significance of our genitals goes far beyond their basic function; it’s intertwined with our identity, our sense of safety and survival.
Consider this study by Van der Velde in 2001, showing the intricate relationship between stress and pelvic muscle tension. This study observed how the pelvic muscles react instinctively, often before conscious thought, when faced with perceived threats. It’s a testament to how deeply our body's protective mechanisms intertwine with our emotions.
According to the International Association for the Study of Pain, Chronic Pelvic Pain Syndrome (CPPS) is “the occurrence of chronic pain when there is no proven infection or other obvious local pathology that may account for the pain. It is often associated with negative cognitive, behavioral, sexual or emotional consequences, as well as with symptoms suggestive of lower urinary tract, sexual, bowel or urological dysfunction.” It is commonly a diagnosis of exclusion.
In such cases, men are often misdiagnosed as having “Chronic Prostatitis”, however, international findings reveal that less than 10% of male pelvic pain cases are due to a bacterial infection of the prostate. The problem remains that many men will still receive several rounds of unnecessary antibiotic treatment despite the absence of a prostate infection. 1,2 Chronic prostatitis and prostatodynia are outdated diagnoses for this population. The current guidelines recommend using Chronic Pelvic Pain Syndrome or Primary Prostate Pain Syndrome instead of Chronic Prostatitis.
Delving into the psychological impacts reveals a challenging cycle for men grappling with CPPS—constantly navigating anxiety, stress, and persistent discomfort. Studies have highlighted the direct correlation between perceived stress levels and the ensuing pain and disability over time; “the more stress patients perceived during the first 6 months after a healthcare visit, the more pain and disability were reported after 12 months.” 3
But what exactly is stress in this context? It’s not just an emotional strain; it’s a complex amalgamation of conscious and non-conscious emotional and physical bodily protection responses that are innately programmed to look after us, necessary for our survival, and also challenge and build our resilience. Ongoing physical and emotional stress, as experienced by those with CPPS, triggers fear, frustration, and maladaptive responses, perpetuating a cycle of bodily protection responses that exacerbate the situation.
The cascade of stress infiltrates the body’s chemical and behavioral processes, perpetuating pro-inflammatory responses and impacting overall health. Chronic stress triggers involuntary muscular guarding, fuels inflammatory responses, and affects gut health, often amplifying pain sensitivity and discomfort.
The social aspects woven into pelvic pain are profound. The level of support from partners or spouses, access to accurate health information, and societal perceptions all play a role in shaping an individual’s pain experience. Lack of understanding, dismissive attitudes from healthcare providers, and negative clinical encounters further deepen feelings of hopelessness and frustration. It has been said that, “social support is often of prognostic value for recovery in patients with musculoskeletal pain.” 4
Amidst this intricate web of distress, there’s hope. Our bodies possess incredible adaptive capabilities. Understanding pain, exploring movement, engaging in cognitive and emotional approaches, re-engaging in meaningful activities, and reflecting on our experiences build resilience, fostering self-efficacy and supporting our bodies to “unlearn” over-protective responses, ultimately reducing pain. Acknowledging the intricacy of pain and embracing its multifaceted nature are pivotal in the journey toward recovery. This demands a shift—from merely focusing on alleviating symptoms to feeling empowered to guide our own health journey.
Pelvic pain isn't just a physical ailment; it's a complex interplay of physiological, psychological, sociocultural factors, and more. Recognizing this complexity and nurturing a supportive, empowering environment is fundamental in traversing this challenging terrain, offering a path toward healing and renewed well-being.
About the Author
For over a decade, Dr. Susie Gronski has been a leading expert in men's pelvic and sexual health. As a Licensed Doctor of Physical Therapy, Certified Pelvic Rehabilitation Practitioner, AASECT Certified Sexuality Educator and Counselor, and author of "Pelvic Pain: The Ultimate Cock Block," she has made significant contributions in this field. Dr. Susie is the founder of an interdisciplinary clinic focused on men's urosexological care. To learn more about her and her team, visit drsusieg.com.
1 Collins, M., Stafford, R., O’Leary, M., & Barry, M. (1998). How common is prostatitis? A national survey of physician visits. The Journal of Urology, 159(4), 1224-1228.
2 Magistro, G., Wagenlehner, F., Grabe, M., Weidner, W., Stief, C., & Nickel, J. (2016). Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. European Urology, 69, 286-297.
3Riegel, B., Bruenahl, C., Ahyai, S., Bingel, U., Fisch, M., Lowe, B. (2014). Assessing psychological factors, social aspects and psychiatric co-morbidity associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men - A systematic review. Journal of Psychosomatic Research, 77, 333-350.
4 Nijs, J., Roussel, N., Paul van Wilgen, C., Köke, A., & Smeets, R. (2013). ‘Thinking beyond muscles and joints: Therapists' and patients' attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment.’ Manual Therapy, 18(2), 96-102. doi:10.1016/j.math.2012.11.001
Please note: This article is made available for educational purposes only, not to provide medical advice. The views expressed in this article are those of the author, which do not necessarily represent those of Curable or other contributors to the Curable site.