3 Key Takeaways:
- Comprehensive testing is essential: Pelvic pain diagnosis in men requires multiple tests including physical examination, urinalysis, PSA testing, and imaging studies to identify the specific cause, whether it’s prostatitis, pelvic floor dysfunction, or another condition.
- Digital rectal examination is fundamental: The DRE allows urologists to directly assess prostate health and detect tenderness or abnormalities, with 60-85% of chronic pelvic pain patients showing tenderness during pelvic floor muscle examination.
- Advanced imaging reveals hidden causes: Ultrasound, CT, and MRI scans identify structural problems like kidney stones, cysts, and muscle abnormalities that aren’t detectable through physical examination alone, making them crucial for complex cases.
Pelvic pain in men affects 2-6% of the male population and can significantly disrupt daily life. Unlike a simple injury with an obvious cause, pelvic pain often requires comprehensive diagnostic testing to identify its source. Understanding what tests are done for pelvic pain in men helps you prepare for your urology appointment and ensures you receive the most effective treatment for your specific condition.
Understanding Male Pelvic Pain
Pelvic pain in men refers to discomfort in the lower abdomen, between the navel and pubic bone, that may extend to the groin, perineum, or lower back. The pain can be acute (sudden and severe) or chronic (lasting three months or longer). According to the American Urological Association, chronic prostatitis and chronic pelvic pain syndrome account for approximately 90% of prostatitis diagnoses in outpatient clinics, making it the most common urologic diagnosis in men under 50.
You should see a urologist if you experience persistent pelvic pain accompanied by urinary symptoms (difficulty urinating, frequent urination, burning sensation), sexual dysfunction, or pain during ejaculation. Seek immediate medical attention if you have severe sudden pain, fever with chills, blood in urine, or complete inability to urinate—these symptoms may indicate conditions requiring urgent care.
Initial Diagnostic Tests
Medical History and Physical Examination
Your urologist begins with a detailed medical history to understand your symptoms, their duration, and any patterns or triggers. This conversation covers urinary habits, sexual function, bowel movements, recent infections, medications, and psychological factors like stress or anxiety that can contribute to pelvic pain. A comprehensive physical examination includes checking your abdomen, external genitals, and surrounding areas for tenderness, swelling, or abnormalities.
Digital Rectal Examination (DRE)
The digital rectal examination is a cornerstone diagnostic test for male pelvic pain. During a DRE, your urologist inserts a gloved, lubricated finger into the rectum to examine the prostate gland. This allows the doctor to assess the prostate’s size, shape, and texture, and to check for tenderness, nodules, or swelling that might indicate benign prostatic hyperplasia (BPH) or prostatitis. Studies show that 60-85% of patients with chronic pelvic pain report tenderness upon physical examination of pelvic floor muscles, highlighting the importance of this hands-on assessment.
Urinalysis and Urine Culture
Urinalysis examines a urine sample for signs of infection, blood, protein, or other abnormalities. The test can detect bacteria, white blood cells (indicating inflammation), and red blood cells (suggesting bleeding or stones). A urine culture follows positive urinalysis results to identify specific bacteria and determine the most effective antibiotic. These tests help rule out urinary tract infections as a cause of pelvic pain and distinguish bacterial prostatitis from chronic pelvic pain syndrome.
Advanced Laboratory Tests
PSA Testing
Prostate-specific antigen (PSA) is a protein produced by the prostate gland. Elevated PSA levels can indicate prostatitis, BPH, or prostate cancer. In 2024, the National Institute of Diabetes and Digestive and Kidney Diseases notes that PSA testing helps differentiate between these conditions when combined with other diagnostic findings. However, PSA levels alone cannot diagnose the cause of pelvic pain, as inflammation from any source can temporarily elevate results.
Expressed Prostatic Secretions (EPS)
During the DRE, your urologist may massage the prostate to collect expressed prostatic secretions for laboratory analysis. EPS examination under a microscope reveals white blood cells and bacteria, helping distinguish between bacterial prostatitis (infection present) and chronic pelvic pain syndrome (no infection). The test also assesses prostate inflammation levels and guides treatment decisions.
STI Screening and Blood Work
Sexually transmitted infections, particularly chlamydia and gonorrhea, can cause pelvic pain in men. Your urologist may order STI screening through urine samples or urethral swabs. Complete blood count (CBC) tests check for signs of systemic infection or inflammation, while hormone assays may be ordered if low testosterone or other hormonal imbalances are suspected. These tests help create a complete picture of your overall health and identify contributing factors to pelvic pain.
Imaging and Specialized Tests
Pelvic Ultrasound
Transabdominal or transrectal ultrasound uses sound waves to create images of the prostate, bladder, and surrounding pelvic structures. This non-invasive test identifies structural abnormalities, cysts, abscesses, prostatic calculi (stones), and signs of obstruction. According to research published in the Journal of the American College of Radiology, pelvic sonography is the procedure of choice for evaluating pelvic pain because it’s accurate, less invasive, and less expensive than CT or MRI scans.
CT and MRI Scans
Computed tomography (CT) and magnetic resonance imaging (MRI) provide detailed cross-sectional images of pelvic organs and tissues. CT scans excel at detecting kidney stones, masses, and acute complications, while MRI offers superior soft tissue contrast for evaluating muscles, nerves, and ligaments. Your urologist orders these imaging studies when ultrasound results are inconclusive or when complex anatomical assessment is needed.
Cystoscopy
Cystoscopy involves inserting a thin, flexible tube with a camera (cystoscope) through the urethra to directly visualize the bladder and urethra. This procedure identifies bladder problems, urethral strictures, stones, tumors, and inflammation that may cause pelvic pain. Mayo Clinic recommends cystoscopy when symptoms suggest bladder-related causes or when initial tests don’t reveal a clear diagnosis.
Urodynamic Studies
Urodynamic testing measures how well your bladder, sphincters, and urethra store and release urine. These studies include uroflowmetry (measuring urine flow rate), cystometry (assessing bladder pressure and capacity), and pressure-flow studies. Men with voiding dysfunction or suspected pelvic floor muscle problems benefit from urodynamic testing, which reveals abnormal muscle contractions, obstruction patterns, or nerve dysfunction contributing to pelvic pain.
When Multiple Tests Are Necessary
Pelvic pain often has multifactorial causes requiring a comprehensive diagnostic approach. The European Association of Urology emphasizes that chronic pelvic pain may result from complex interactions of inflammatory, infectious, neurological, musculoskeletal, and psychosomatic factors. Your urologist uses the UPOINT classification system—Urinary, Psychosocial, Organ-specific, Infection, Neurologic, Tenderness of muscles—to guide testing and create targeted treatment plans based on your specific symptom pattern.
Many men with chronic pelvic pain have concurrent conditions. Research shows that men with widespread pain distribution have higher rates of irritable bowel syndrome (34%), migraine headaches (24%), fibromyalgia (13%), and chronic fatigue syndrome (5%) compared to those with localized pelvic pain. This overlap explains why your urologist may order seemingly unrelated tests to understand the full scope of your condition.
Conclusion
Diagnosing pelvic pain in men requires a systematic approach combining medical history, physical examination, laboratory tests, and imaging studies. While the process may seem extensive, each test provides crucial information that helps your urologist identify the specific cause of your pain and develop an effective treatment plan. Early diagnosis and appropriate testing lead to better outcomes and faster symptom relief.
If you’re experiencing pelvic pain, the urologists at St. Pete Urology offer comprehensive diagnostic services using advanced technology and evidence-based protocols. Our board-certified urologists—Dr. Reid Graves, Dr. Nicholas Laryngakis, Dr. Adam Oppenheim, and Dr. Ankur Shah—have extensive experience diagnosing and treating male pelvic pain conditions. Schedule a consultation at our St. Petersburg office by calling (727) 478-1172 to begin your path toward accurate diagnosis and relief.
References
- American Urological Association. (2024). Diagnosis and management of male chronic pelvic pain (chronic prostatitis/chronic pelvic pain syndrome and chronic scrotal content pain): AUA guideline. https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain
- National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Prostatitis: Inflammation of the prostate. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
- European Association of Urology. (2024). EAU guidelines on chronic pelvic pain. https://uroweb.org/guidelines/chronic-pelvic-pain
- Mayo Clinic. (2025). Chronic prostatitis/chronic pelvic pain syndrome. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/chronic-prostatitis-chronic-pelvic-pain-syndrome/
