This is a very open, honest and frank account of my pelvic pain and its aetiologies (catalysts) and what ( I feel ) has triggered it again. As a therapist with the knowledge and experience in treating male  patients suffering with Chronic Pelvic Pain Syndrome (CPPS) and Chronic Prostatitis (CP) my ‘flare ups’ are of particular interest to me.

My pelvic pain started in my mid 20’s with rampant infections epididymitis and orchitis that left me with only one testicle. 12 years on and my pelvic pain is something that I would have considered to be well and truly under control..
For me my pelvic pain is an early warning system that indicates when my responsibility/stress/anxiety/pressure (call it what you will) bucket is filling up close to bursting point. There is a limit to the amount of responsibility, pressure and stress we are able to manage at any given time. Holmes and Rahe devised a stress scale in the late 60’s that highlights this (here). At the time of writing this my score on the scale came to 325! Holmes and Rahe believe that any score over 300 raises the odds by 80% of suffering with stress induced illness. Read the article and check your own score.

Reflecting back on the last 6 months it is clear to see I have not helped myself one iota. Life carries on around us I often catch myself thinking if I can only just get a, b, c, d and e sorted then I will be able to get on with my life…

“For a long time it had seemed to me that life was about to begin — real life. But there was always some obstacle in the way. Something to be got through first, some unfinished business, time still to be served, a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life.” – Fr. Alfred D’Souza
This are a list of the major changes in my life over the last 6 months, it doesn’t include everything otherwise we would be here for a very long time:

Infertility and Operation – Having a varicocele embolization in the summer to increase my fertility (which was at zero prior to the op) was the start. Multiple tests, scans and follow up appointments were wearing me down. My wife was fertile and I was losing faith in my ability to be the husband I wanted to be. Drastic lifestyle changes were still not producing the necessary goods for baby making. Normal forms of sperm were at 0% (norm is 3-4%), total number of sperm was at 2.8 (norm is 33-46) and progressive sperm was 23% (norm was 31-34%) 3 months after the varicocele op and my results were off the charts. I was fertile – Normal forms of sperm were 7%! Total number of sperm was 54.4 and progressive sperm was 39%! Later that month we finally fell pregnant. I was beside myself with joy, it had actually happened. But, I also felt the weight of responsibility that comes hand in hand with pregnancy and impending fatherhood.

Study – I have been studying towards numerous qualifications including my teaching certificate and multiple pelvic pain related treatments. I graduated this summer in my 5th certificate in only 3 years. My final exams are this March and I cannot wait!

New business – The Pelvic Pain Clinic has been a longstanding ambition of mine, with 5 years waiting for the right opportunity for this era to begin. Writing the website content over the last 2 months, waiting for the delayed launch (it was put back 3 weeks) and now promoting /advertising it, as well as tweeting and posting etc. on social media channels is a job in itself.

Current business – This year we have had the highest turnover of staff at the clinic my wife and I run. Multiple pregnancies (4 in total, after having had none the previous 6 years!) and therapists moving out of the area due to a change in personal circumstances added extra pressure to our schedule. Covering shifts, interviewing new hopefuls and training up of new staff who had made the cut all piled on the pressure

Moving house – Back in September we agreed on the purchase of a house which had ‘no chain’ What a crock of s**t, it is January now and the purchase is still being held up. What should have taken 6-8 weeks is now approaching 20 weeks! We need to get in and make some changes to the building in time for our little one’s arrival.

Christmas time – I, like most of you I am sure, ate foods we wouldn’t normally eat. I drank drinks I wouldn’t normally drink (one year I will learn that snowballs are just not nice!) and on both of these subjects I consumed more than was truly necessary. But it’s Christmas after all. New Year’s Eve was a late night, it was a great night with very, very good company. However the companion I woke up with on New Year’s Day was not pleasant (no, I do not mean my wife here, she’s beautiful), the general malaise and ache in my groin was not welcome. It was not the start to 2016 I had dreamed of.

Baby scare – The day after Boxing Day we ended up in hospital because my wife was bleeding. Leaving my sister in laws house (who had lost a baby at full term 5 years ago!) had me passing bricks. We waited for what seemed like hours just to be seen. We finally left the hospital at 12.45 am with the ‘all clear’ after having had numerous scans and exams to ensure baby was all good. Ever since then I have felt like I am on tender hooks, anxious and nervous about what might happen!

Change in routine – Not swimming, running, meditating or doing yoga. I lead a busy life (in case you hadn’t noticed) and keeping fit and healthy is what keeps me sane(ish).I helps to keep my stresses at bay and my pain under wraps. My regular exercise routine was shot, I simply didn’t have the time to dedicate to myself (fatal mistake). Coming off my bike (the one time I managed to get out over Christmas) left me with a sprained wrist and no skin on my right knee (sigh!). Another barrier to returning to regular exercise!

Symptoms – A feeling my bladder is smaller than it was and that the urine inside it is slightly acidic and abrasive like spikey cactus juice. A fluttering in my perineum, small twitches and contractions that felt more the like the skin of a drum being played. An ache deep in my one remaining testicle (I can’t lose another one!). A sensation like a boa constrictor was residing behind my pubic bone which squeezed and tightened when sat hunched over a desk or driving. An itchy perineum (not rectum this time) and junction of the base of my testicles that was unbearable when sat for too long. Plus the ability to heighten all of these symptoms simply if I focused on them. It is like playing peek a boo with pain! Thankfully this flare up has not elicited burning on or after urination or ejaculation (these are symptoms I am also far too familiar with dear reader).

Having had a number of infections in the past (in my groin/pelvis) I know this is not one. The pain shifts around, it waxes and wanes and is elusive. It is not highly focal, it has not brought on fevers, chills and the general malaise associated with infection (I still felt melancholy). So what is the genesis of this episode? My lifestyle and the subsequent changes, increased stress levels, anxiety and additional pressure have diverted me from my usual routine. Getting back on track with a regular exercise routine, eating and drinking more conscientiously (instead of grabbing a few beers to relax and ordering take away when I don’t have enough time to cook etc.) and spending time doing things that make me laugh and feel alive again (not alcohol fuelled) are key to reducing and managing MY pain. That is not to say this formula will work for all those who suffer with CPPS and Prostatitis. But, it will make you feel in control of life again and that is key to recovery.

I would love us chaps to be more like our sisters, mothers, aunts, girlfriends, wife’s and any other women in our lives. It should be ok for us to discuss our concerns, worries and health conditions. It should not be deemed manly to manage (or not) and cope (or not) by ourselves, with only Dr. Google or forums as our guide. Honesty and openness holds the door to recovery wide open and allows us to find the necessary support and guidance towards recovery.
As Bob Hoskins used to say in a UK ad for British Telecom – “It’s good to talk” Be open and honest with yourself, what’s the worst that could happen. Don’t wait for it to get better. Be pro-active, make changes and take control again.

“Pain just doesn’t show up in our lives for no reason. It’s a sign that something in our lives needs to change” Mandy Hale

Karl Monahan

Karl is a sports and advanced clinical massage therapist with the qualifications, experience and knowledge in the treatment of male pelvic pain and in particular Prostatitis and Chronic Pelvic Pain Syndrome (CPPS). He has worked in men’s health since 2006 and has succesfully been treating male pelvic pain since 2009. He is the owner of The Pelvic Pain Clinic, London.

PS: I dedicate this article to our gorgeous little boy who we met all too briefly this weekend. Multiple anomalies meant that we had to terminate the pregnancy early. This article was finished just before we had to go into hospital for the procedure. As I write this final paragraph I am not feeling much at all, I am just numb!
God bless your beautiful little soul, you will always be in our thoughts and actions. Rest in peace little man, rest in peace xxx

The post Why My Pelvic Pain Has Flared Up Again! – Dedication first appeared on the The Pelvic Pain Clinic website

Testimonials From Clients

“Having suffered with Pelvic Pain to the point where I had to be hospitalised for a number of nights. Karl has a great understanding and level of empathy with his patients. Appreciating exactly how they feel and what they are going through”

To read blog posts from my patients about their successful recovery from their chronic pelvic pain and chronic prostatitis experiences, in their own words click here


Please find below a sample of some of my patient testimonials from over the years. I have not included them ALL here. Instead I have picked a handful of those that demonstrate a wide range of my skill sets, outcomes and patient opinions. I would therefore hope that you are able to gauge how I approach my methods of treatment. If you have any questions regarding any of these comments below or would like to know more about my treatment please contact me here

My aim is to take every individual patient I see and treat them as individuals. If I am not achieving this then I believe I am letting down that patient. It is therefore imperative that my approach is bespoke and tailored. Failure to do so is likely to result in an unsuccessful outcome.

From those testimonials listed below I hope to give you a flavour of what you can expect if you come and see me as a patient.


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