Chronic prostatitis/chronic pelvic pain syndrome is a common male genitourinary condition comprising urinary, musculoskeletal, gastrointestinal, and/or psychological concerns with pain as a prominent feature. It is a diagnosis of exclusion. Physicians should use validated patient questionnaires to inventory presenting symptoms and symptom evolution over time. Questionnaires, such as the National Institutes of Health Chronic Prostatitis Symptom Index, can be particularly helpful in monitoring treatment effect on symptoms. Standardized classification systems can prove useful in choosing therapeutic modalities. Treatment should be individualized for each patient and multimodal; it should focus on symptomatic improvement, with a 25% or 6-point reduction in the National Institutes of Health Chronic Prostatitis Symptom Index score being defined as success. Chronic prostatitis/chronic pelvic pain syndrome is a chronic pain condition. Although pharmacologic and nonpharmacologic treatment modalities have variable proven benefit, few are supported by robust evidence. Chronic prostatitis/chronic pelvic pain syndrome does not predispose men to prostate cancer, but it may be associated with male infertility. Physicians should also be alert for its mental health effects on men.
Irwin G. Common Male Genitourinary Issues: Chronic Pelvic Pain Syndrome. FP Essent. 2026;567:7-13.
Case 1. BO is a 34-year-old patient with no significant medical or orthopedic history who presents with a several-year history of chronic intermittent pelvic pain. He has been married and sexually monogamous for more than a decade. Most days per week, he experiences pain after ejaculation, occasional groin or penile pain that radiates to his testicles, and pain on urination. He has never had a urinary tract infection; neither he nor his partner has ever had a sexually transmitted infection.
Definitions, Epidemiology, and Pathophysiology
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) comprises 90% of all prostatitis cases.1 Its prevalence is comparable to that of ischemic heart disease or diabetes, with 2.2% to 9.7% of men experiencing symptoms.2 CP/CPPS has been defined as genitourinary or pelvic pain that persists or recurs over a period of at least 3 of the past 6 months.3,4 The National Institutes of Health (NIH) defines four types of prostatitis (Table 11,4) and classifies CP/CPPS as type III.1 The system further divides CP/CPPS into inflammatory and noninflammatory subtypes based on the presence or absence of leukocytes in expressed prostatic secretions, post–prostatic massage urine, or seminal plasma.1 However, the subtype is rarely determined in the clinic as part of the diagnostic evaluation and is not helpful in guiding treatment.5
Table 1 National Institutes of Health Consensus Classification of Prostatitis Syndromes
| Type | Category | Typical symptoms | Diagnosis | Treatment |
|---|---|---|---|---|
| I | Acute bacterial | Dysuria, urinary frequency, urinary urgency, fever, perineal pain | Clinical examination, urine culture | Antibiotics |
| II | Chronic bacterial | Recurrent episodes of acute bacterial prostatitis–type symptoms without resolution of infection | Urine culture, Meares-Stamey 4-glass test or 2-glass test | Antibiotics |
| III | Chronic prostatitis/chronic pelvic pain syndrome | Urogenital pain or discomfort often accompanied by other genitourinary, gastrointestinal, or psychological symptoms | Clinical diagnosis based on symptoms and exclusion of active urethritis, urogenital cancer, urinary tract disease, urethral stricture, or neurologic disease of the bladder | Determined by predominant symptoms |
| IIIa. Inflammatory subtype | — | Leukocytes present in expressed prostatic secretions, post–prostatic massage urine, or seminal plasma | — | |
| IIIb. Noninflammatory subtype | — | Leukocytes not present in expressed prostatic secretions or post–prostatic massage urine | — | |
| IV | Asymptomatic inflammatory | None | Incidental finding of leukocytes in seminal fluid | None needed |
Information from reference 1 and 4.
Read the full edition
Get immediate access, anytime, anywhere.
Choose a single edition, 1-year or 2-year full-access subscription.
Earn 4 CME credits for this edition.
