Chronic pelvic pain syndrome

Is common and poorly understood—a fresh approach is needed

A syndrome in men, characterised by chronic perineal and penile pain with varying degrees of urinary and sexual dysfunction, is generally recognised without difficulty by clinicians and often labelled chronic prostatitis.1 As the cause of the most prevalent, non-bacterial, forms of the condition remains unknown, and therefore no definitive diagnostic test exists, the diagnosis has relied on a combination of clinical features, exclusion of other diagnoses (such as bladder outlet obstruction), and the results of investigations, especially the four glass (Stamey) test.2 However, there is no generally agreed clinical definition that brings together the symptomatic features and investigative findings, so it is difficult to make reliable comparisons among the many descriptive and therapeutic studies in 30 years of medical literature—or to draw many conclusions.

None the less, the condition is probably highly prevalent. Urologists and primary care physicians diagnose chronic prostatitis regularly, in adult men of all ages.3 Accurate data on incidence and prevalence are not available, but statistics for the United States indicate that there were more physician visits for prostatitis than for benign prostatic hyperplasia or prostate cancer in 1985. The …