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A holistic biopsychosocial management approach for cis-gender males with chronic pelvic pain syndrome attending sexual health services: a retrospective case review
  1. Paddy J Horner1,2,
  2. Emma Connor3,
  3. Sara Williams3,
  4. Jessica Butterly4,
  5. Megan Crofts1
  1. 1 Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  2. 2 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  3. 3 Bristol Medical School, University of Bristol, Bristol, UK
  4. 4 Physiotherapy Department, St Michael’s Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Paddy J Horner, Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; paddy.horner{at}


Objectives Chronic pelvic pain syndrome (CPPS) in men is a condition associated with significant morbidity which is typically managed in sexual health services. We introduced a modified biopsychosocial approach for managing CPPS in men, reducing use of antibiotics and evaluated its application in a retrospective case review.

Methods Patients attended for a full consultation covering symptomology, onset and social history. Examination included urethral smear and assessment of pelvic floor tension and pain. A focus on pelvic floor relaxation was the mainstay of management with pelvic floor physiotherapy if required. Prescribing of antibiotics being discontinued if no evidence of urethritis at first consultation. The main outcome was change in the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score (which patients completed at each attendance); significant clinical improvement was defined as a NIH-CPSI score reduction of >25% and/or ≥6 points.

Results Among 77 consecutive patients diagnosed with CPPS between April 2017 and December 2018, the mean NIH-CPSI score at the initial visit was 24.1 (11–42). Antibiotics were prescribed to 38/77 (49.4%) and alpha-blockers to 58/77 (75.3%). Overall, 50 (64.9%) patients with a mean initial NIH-CPSI score of 25.4 (11–42) re-attended a CPPS clinic. Among these, the average NIH-CPSI score at the final CPPS clinic appointment declined to 15.9 (0–39) (p<0.001); 34/50 (68%) men experienced significant clinical improvement. Men who attended only one CPPS clinic compared with those who reattended had a shorter duration of symptoms (18 (1–60) vs 36 (1–240) months; p=0.038), a lower initial NIH-CPSI score (21.7 (11–34) vs 25.4 (11–44); p=0.021), but had attended a similar number of clinics prior to referral (2.9 (0–6) vs 3.2 (0–8); p=0.62).

Conclusions The biopsychosocial approach significantly reduced the NIH-CPSI score in those who re-attended, with 68% of patients having a significant clinical improvement. The first follow-up consultation at 6 weeks is now undertaken by telephone for many patients, if clinically appropriate.

  • genital diseases, male
  • prostatitis
  • sexual health

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  • Contributors PJH developed the modified biopsychosocial approach with input from MC and JB. PJH and MC conceived the study idea. EC and SW extracted the data from electronic patient records and PJH, EC and SW analysed the data. EC and SW wrote the first draft of the evaluation with input from PJH. Subsequent drafts were produced by PJH followed critical review by all authors. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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