Chronic Prostatic Pain Syndrome

A headache in the pelvis

Chronic Prostatic Pain Syndrome can be a very frustrating problem. Symptoms are usually non-specific but very troublesome. Treatments can be very protracted and patient end up taking pills for months on end. Lastly, it has a very high chance of recurrence.

Read on to learn more.

What is Chronic Prostatic Pain Syndrome?

Chronic Prostatic Pain Syndrome is a condition whereby a patient suffers from symptoms of Prostate Inflammation for a long period usually months. Other causes of Prostate Inflammation such as Infection and STDs have to be ruled out before a diagnosis of Chronic Prostatic Pain Syndrome can be made. This usually involves urine and /or semen tests.

Chronic Prostatic Pain Syndrome is also known as Prostadynia and Chronic Pelvic Pain Syndrome.

What causes Chronic Prostatic Pain Syndrome?

The exact cause of Chronic Prostatic Pain Syndrome is not well understood. It frequently occurs after an episode of Prostate Infection or Urethritis commonly caused by STDs such as Chlamydia, Gonorrhea and NSU.

What are the symptoms of Chronic Prostatic Pain Syndrome?

The symptoms of Chronic Prostatic Pain Syndrome can be very vague. Symptoms include:

  • a heaviness or dragging sensation in the scrotum
  • pain at the tip of the penis
  • tenderness in the perineum (area between the scrotum and the anus)
  • feeling the need to go to the toilet all the time
  • discharge from the penis
  • discomfort passing urine
  • pain during ejaculation.

What do I do if I think I have Chronic Prostatic Pain Syndrome?

See your Doctor. We will take a detailed history from you and conduct a physical examination. The examination might involve a Digital Rectal Examination (DRE). This is done by the Doctor gently inserting a lubricated gloved finger into your rectum to feel for your prostate. The process itself is not painful. However, you might feel some pain when the Doctor presses on your prostate gland.

We might then need to do blood and urine tests to rule out other causes of your symptoms.

We might also need to conduct a test on the Prostate Secretions. This is done by our Doctor conducting a DRE and massaging the Prostate. This will squeeze some secretions out. You will then be asked to pass urine into a bottle and the urine will be sent for tests. For this tests, please give the Doctor the first catch of urine. This is different from regular urine tests when you are asked to collect the mid-stream.

What is the treatment for Chronic Prostatic Pain Syndrome?

There is no one single best cure for Chronic Prostatic Pain Syndrome.

Our Doctors might choose to prescribe you with a medicine called Gabapentin. This is a medicine that stabilizes the membrane of your nerves. This reduces the nerve signals coming from your Prostate and thereby reducing the symptoms.

We might also choose to prescribe you with anti-inflammatory medicines. This reduces the inflammation of the Prostate and thereby reduces the symptoms.

The treatment for Chronic Prostatic Pain Syndrome might take many months. Do not be discouraged. Keep taking your medicines as advised by our Doctors.

If the pain is caused by a knot in the pelvic muscle, you might have to return for regular DREs to release the knot.

Recently, Electro Shock Wave treatments has been used to treat prostatitis especially Chronic Prostatic Pain. This is a painless procedure where a machine sends Shock Waves into the prostate to reduce inflammation. It however takes at least 6 sessions. This treatment is often provides pain relief from the very first treatment.

Low Testosterone can lead to Erectile Dysfunction.

Testosterone is the primary male hormone in the body. There are many possible causes of Low Testosterone. When the Testosterone is low, a person can also have problem getting an erection.

Read on to learn more.

What is Testosterone?

Testosterone is the hormone in the body that is responsible for all male characteristics. It is produced by the testis.

What is ED?

ED stands for Erectile Dysfunction. It is a medical condition where a man’s erection is unsatisfactory. It ranges from mild ED (able to achieve erection but not full hardness) to severe ED (unable to achieve erection for penetration).

This is different from Premature Ejaculation which is when you have no problems getting hard but ejaculate much faster than you would like to.

How does Testosterone affect ED?

Testosterone is responsible for many sexual characteristic like sexual desire (libido) and erection. A low Testosterone level may lead to ED.

However, many other diseases such as Obesity, Diabetes, High Blood Pressure and High Cholesterol can also cause ED.

How do I know if a low Testosterone Level is causing my ED?

See your Doctor for a Testosterone Test. If your Testosterone is low, it is very likely one of the factors causing your ED.

You may also want to do this AMS (Aging Male Symptoms) Questionnaire. A score of more than 37 means you likely suffer from low Testosterone.

What are the treatments available?

There are several methods to treat low Testosterone including pills, gels and injections.

The most popular treatments for ED are the PDE5 Inhibitors. There are currently 3 brands available, Levitra, Cialis and Viagra.

Can Testosterone Treatment be taken together with PDE5 Inhibitors?

Yes. In fact, these 2 treatments are synergistic and work very well together.

Aside from working very well together to give a strong and hard erection, Testosterone and PDE5 Inhibitors have also been shown to have many holistic health benefits. These include increase in general wellbeing, concentration and energy levels. As well as making the inner lining of your blood vessels more healthy.

Testosterone Treatment. Testosterone Replacement.

What is Testosterone Treatment?

Testosterone Treatment is the replacement of Testosterone into the body.

Who needs Testosterone Treatment?

The majority of people who require Testosterone Treatment are those who suffer from Andropause.

There are also rare diseases that children do not produce Testosterone and require Testosterone Treatment for normal development.

What are the different types of Testosterone Treatment available?

There are currently 3 popular ways of Testosterone Treatment.

Testosterone Gels are painless and easy to use. It is applied twice a day onto the shoulders or thighs. After application you must not bathe or swim for 6 hours to give the gel time to absorb. You must also be careful not to transfer any of this gel onto a female person.

Testosterone pills are taken 2 to 3 times a day. They should be taken with food, preferably slightly greasy food. This is because Testosterone is soluble only in oil. Taking Testosterone pills on an empty stomach might reduce the absorption by up to 50%.

Testosterone injections are very convenient. The latest preparations require only 1 injection every approximately 3 months. The absorption into the body is very constant and there is no need for you to do anything in between the injections.

Are there any side effects of Testosterone Treatment?

Testosterone should NOT be given to someone with Prostate Cancer. Your Doctor will do an examination and blood test for you to rule out Prostate Cancer before giving you Testosterone.

However, Testosterone DOES NOT cause or increase the risk of Prostate Cancer in normal men. In fact, Testosterone treatment has been shown to reduce the level of PSA (Prostate Specific Antigen) which is a marker for Prostate Cancer.

Testosterone might also increase the number of red blood cells in your body. This does not cause any problems unless the increase is tremendous. You Doctor will monitor you red cell count with a blood test.

What are the benefits of Testosterone Treatment?

Testosterone Treatment has many benefits. It increases overall wellbeing, energy levels and concentration levels. It increases libido and helps in erectile function. It helps with weight loss, increase in bone strength and increase in muscle mass. It also helps prevent lifestyle diseases such as High Blood Pressure, High Cholesterol and Diabetes.

What can I expect if I decide to undergo Testosterone Treatment?

Once your Doctor has done the necessary tests and decided that you require Testosterone Treatment, he will discuss with you which method is best for you.

Testosterone Pills and Gels are prescribed for you to use by yourself at home. Make sure you follow your Doctor’s advice carefully.

Testosterone Injections are administered by a trained medical professional.

The 3 monthly Testosterone Injections are given into the Gluteus Muscle (Backside). The Testosterone preparation is very thick and has to be given slowly over several minutes. During the injection you might feel mild discomfort but no pain.

You might feel some discomfort in your backside for 1 to 2 days after the injection.

What follow ups will I need?

Your Doctor might ask you to come back in 6 weeks for your 2nd injection instead of 3 months. This is to increase your Testosterone back to a normal level quickly so that you will start feeling better quicker.

Regardless of which method of Testosterone Treatment you are on, your Doctor will need to repeat a test of your Testosterone Level, PSA and red blood cell level after 6 to 9 months.

Need more advice?

Come down to Our Clinics for a discussion with Our Doctors, or call our clinics for more information:



  1. Dear Dr Tan

    I think I hv this pelvic pain for two yrs now and is usually aggravated by standing or wearing tight pants. Initially thought is prostatitis but seen a number of urologists n done tests that show no signs of prostatitis. Recently condition worsened after i do weight training that targets my lower back muscles. Do you do internal trigger point release of pelvic floor and surrounding muscles (eg levator ani or obturator muscles) or can you recommend a Pelvic Floor Physiotherapist that can assess and treat this condition? Thanks a lot!

    • Pelvic floor trigger points are common. You seem convinced you have levator ani syndrome. You can visit me at Novena Medical Center and we can figure out what can be done for you.

  2. Hi Dr Tan,
    I am 28 years old, I started to have all these problems when I am 25 years old. I have this pain and irritation feeling at the front wall of my bladder everytime. I need to urinate about every hour, need to wait for about one minute or longer before urinating start. Each time, the amount of urine about 100ml or less and the flow is weak. I need to wake up one or two times to urinate at night and the amount is pretty good, its at least 200ml to 400ml.
    Here is what I feel my problems come from. When I masterbate the irriation, pain and the urge to pee feeling increase and it increase more when I lose my errection with or without ejculation. After that, when I urinate, its harder to urinate and I feel like the fluid are blocking the passage. After urinating, the fluid will leaked out. And everytime I ejcualate, is due to the irriation, pain and the urge to pee feeling is too strong.
    I have seen a couple of urologist, they check my prostate but did not say anything about it. I did a Urodynamic Test, the urologist say the amount I can hold is pretty normal. I am going for a cystoscopy soon.
    Is it my prostate or bladder problem?I really like to hear your opinion about my conditions. Thank you.

    • This is onviously a complicated problem. I would not want to make any wild guesses. From what you have described the problem could easily be from the prostate or the bladder or the pelvic floor or the testis.


  1. Men’s Health Clinic Singapore | Men's Health - […] for Men Click here to learn about Blood in the Semen Click here to learn about Throat Gonorrhea Click…
  2. Prostatitis and HIV Symptoms in Men | Men's Health - […] causes of Prostatitis include Chronic Prostatic Pain Syndrome and Abacterial Prostatitis. This can result from an Infection that has…