Pearls & Perspectives: Bringing Clarity to Male Pelvic Pain, with Susan MacDonald, MD

In this episode of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Susan MacDonald, MD, associate professor of surgery in the division of urology at the Penn State Health Milton S. Hershey Medical Center, to discuss the first-ever American Urological Association (AUA) guidelines on male pelvic pain ("Diagnosis and Management of Male Chronic Pelvic Pain [Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain))"—a milestone in understanding and managing chronic scrotal content pain and chronic pelvic pain syndrome.

MacDonald shares how her interest in pelvic pain evolved from her background in reconstructive urology. While training in genital reconstruction, she began to notice recurring patterns in men with overlapping symptoms—voiding issues, testicular pain, and erectile dysfunction—often linked by 1 root cause: pelvic floor dysfunction. Her clinical curiosity and patient-driven need for better care led her to join the AUA guideline panel, where she contributed to shaping practical, evidence-based recommendations.

The conversation explores key takeaways from the new guidelines, including a more judicious approach to antibiotic use—emphasizing a single, limited course only for antibiotic-naïve patients—and the expanding role of pelvic floor physical therapy as a first-line intervention. MacDonald also highlights emerging therapies such as acupuncture, shock wave treatment, and phytotherapeutics, as well as the importance of recognizing psychosomatic and stress-related components of pelvic pain.

She underscores the need for clinicians to perform rectal exams to identify pelvic floor dysfunction, to validate patients’ pain, and to approach management through a multidisciplinary, empathetic lens.

Finally, MacDonald shares her next venture—her new YouTube series, aimed at helping trainees master fundamental surgical skills through concise, accessible video education, reflecting her passion for teaching and the future of digital medical learning.

Chapters
0:56 How MacDonald developed her clinical interest in chronic orchialgia/male pelvic pain
10:35 MacDonald describes her involvement in the AUA guidelines
16:46 The role of antibiotics
22:16 Vasovasostomy for postvasectomy pain syndrome
24:56 Vas reversal vs spermatic cord denervation
30:25 Defining chronic scrotal content pain
38:04 The role of acupuncture
42:28 Practical tips for incorporating guidelines into daily practice