Can it affect a man's sex life?
Sexual symptoms are sometimes associated with this condition. For example, there can be ejaculatory pain. In some cases, chronic pelvic pain syndrome can be a clue that there may be ejaculatory duct obstruction, which, for example, could be a treatable cause of chronic pelvic pain syndrome. But those are unusual cases. I have patients who feel better after ejaculation and those who feel worse.
So, ejaculating more can help?
Well, what you need to know is that, in a nutshell, no one knows what to do. There are a lot of theories, and a lot of people have supported different ideas. But I think the safe thing to say is, if it works for you and it's safe, it's all right to do it. So, anything from ejaculating more or less, to drinking wine or not drinking is pretty much dependent upon the patient's response.
How do you manage patients with chronic pelvic pain?
We first rule out things we can identify and treat, like infection or obstruction. Then, if those things are all negative and you have the syndrome, you're left to try to treat experimentally. Based on the patient's history, you may elect to try some things.
I think if you go about it in an open way and tell the patient, "We're going to try a reasonable course for this drug." And if he does get better, even if it's a placebo effect, you could still argue that it's worthwhile because he's better. But I'm not in favor of long-term medications that can have side effects without showing any measurable improvement.
Are there any lifestyle measures that can help?
Riding a bike can cause perineal nerve discomfort, so that's something that can be changed. I try to figure out what's bothering the patient and make suggestions as to correct it. But it's just common sense. Eliminate the causative problems.
