Painful sex is a real condition. It’s not in your head!You are not alone! Nearly 15 million women suffer from chronic pelvic pain, of which nearly 6.9 million suffer from painful intercourse.Stop! No need to be a silent sufferer. You can get help for your chronic pain.Painful sex is a real condition. It’s not in your head!You are not alone! Nearly 15 million women suffer from chronic pelvic pain, of which nearly 6.9 million suffer from painful intercourse.Stop! No need to be a silent sufferer. You can get help for your chronic pain.
UGAP Pain SyndromePreviously known as POPSS syndrome

Urology

When “chronic prostatitis” is really enthesopathy.

Frequently, urologists are confronted with patients with chronic prostatitis and epididymo-orchitis who do not respond to conventional treatments; their pain is actually due to underlying enthesopathy. In our series, 8 male patients had been mistakenly treated for chronic prostatitis for months, sometimes for years, with several rounds of antibiotics. Seven patients were initially diagnosed and treated as cases of epididymo-orchitis for months with no relief from conventional treatment with antibiotics.

Pain in the testicles and epididymis is actually referred pain from the spermatic cord sitting on an inflamed enthesopathy over the pubic bone. Of note, 2 patients in our series had true bacterial/viral epididymo-orchitis and developed POPSS subsequently.

Abacterial prostatitis

This is a very common condition and nearly 50% of adult males suffer from it. To understand chronic pelvic pain syndrome (CPPS) due to prostatitis, the NIH has adopted a classification system. Type I is acute prostatitis. Type II is chronic prostatitis with bacteriuria localized to the prostate on 4-glass urine cultures. In Type III, 4-glass urine cultures are negative, and these patients were typically treated for months and sometimes years with antibiotics. It has been proposed that symptoms of CPPS Type III may be due to, or associated with, pelvic floor muscle abnormalities which in turn cause pain.

The incidence of non-bacterial prostatitis (CPPS III) is staggering: this category involves 90 to 95% of all cases diagnosed as prostatitis. In the USA this condition affects tens of millions of men at some point in their lives. If it moves from the mild and intermittent phase to the chronic phase, sufferers tend to live lives of quiet desperation. Self-esteem is impaired and the ability to enjoy life is limited.

The paraprostatic sign, described and used by me, demonstrates that the prostate itself is minimally tender due to transmitted pain, but tenderness is marked lateral to the prostate over the inflamed periosteum and attached muscles. Thus I feel that abacterial prostatitis is actually not a true prostatitis; CPPS mimics prostatitis.

Where men feel UGAP pain

  1. Lower abdomen, mimicking appendicitis, diverticulitis and entrapment of the lateral femoral cutaneous nerve (meralgia paresthetica)
  2. Tendonitis (enthesopathy) of the inguinal/groin area, which includes “sportsman’s hernia,” pain radiating to the testis/penis and refractory pain after any surgery in this area
  3. Tendonitis (enthesopathy) of the adductor tendons
  4. Pain and spasms of the pelvic floor muscles, mimicking abacterial prostatitis, interstitial cystitis (causing bladder symptoms) and levator ani syndrome
  5. Perineal pain, for example anal pain, proctalgia fugax (spasms of the anal muscles) and pudendal nerve syndrome
  6. Pain over the tail bone (coccydynia)
  7. Pain over the sitting bones (ischial bursitis)
  8. Pain over the lower back: sacroiliac joint problems and bursitis over the back of the iliac bone (posterior superior iliac spine)
  9. Pain on the sides of the pelvic bone: trochanteric bursitis, piriformis syndrome

Interstitial cystitis

Interstitial cystitis (IC) has been a controversial diagnosis; some doctors believe that it does not exist as a separate entity. Approximately 500,000 to 1,000,000 people are affected by IC in the US, and females account for 88% of sufferers. Pelvic pain is reported in up to 70% of patients with IC and occasionally it is the presenting symptom. The etiology of IC is unknown. Non-responders continue to have suprapubic and pelvic pain with dyspareunia. Several of these patients in our series treated with steroid injections have shown considerable improvement in their pain and dyspareunia and even frequency of urination. This suggests that pelvic enthesopathy plays an important part.