Does Chronic Pelvic Pain Affect Male Fertility?

Male chronic pelvic pain (CPP) is well-known to be associated with sexual health impairments including, but not limited to, pain limiting sexual activity, premature ejaculation, erectile dysfunction. In addition to potential interference in sexual activity due to pelvic pain associated alteration in libido and function, does CPP affect sperm health? According to a systematic review and meta-analysis published this year, semen parameters are impacted in men who present with chronic pelvic pain. 12 studies were utilized, including nearly 999 cases and 455 controls. Semen parameters studied included seminal plasma volume, sperm concentration, total sperm count, motility, vitality, and morphology. Men diagnosed in the studies with CPP or chronic pelvic pain syndrome (CPPS) met the NIH criteria for the condition.

The results of the analysis indicate that sperm concentration, percentage of progressively motile sperm, and morphologically normal sperm in patients with CPP/CPPS were significantly reduced when compared with controls. Semen volume was higher in the CPP pain group than in controls, and the results suggested no significant difference in sperm total motility, sperm vitality, and total sperm count. How do these factors affect fertility? The authors point out that semen parameters are "the mainstay of male fertility and reproductive health assessment" and and that the percentage of morphologically normal sperm is an indicator of male fertility potential. While the sperm concentration was identified to be lower in male patients who have CPP, the semen volume being elevated may affect these numbers. Sperm motility, being necessary for fertilization, would logically be a factor in potential impairment of fertility.

The authors discuss the possibility that an inflammatory response associated with chronic pelvic pain, or an autoimmune response against prostate specific antigens factor into the alterations in semen analysis observed in men who have chronic pelvic pain. While the issue of fertility and pelvic pain is controversial, and not entirely understand, we can hypothesize about local factors affecting pelvic and sexual health, as well as autonomic nervous system implications mediated by the chronic pain state. As science aids in the understanding of the mechanisms affecting semen parameters, pelvic rehabilitation professionals will continue to address the potential causes of the dysfunction: nervous system dysfunction such as anxiety, depression, hormonal regulation, and neuromuscular pain states that may affect local blood and lymph flow (and therefore affect cellular nutrition and removal of waste products of cellular metabolism). If you are interested in learning more about male anatomy, sexual dysfunction, pelvic pain, and incontinence, come to the Male Pelvic Floor Function, Dysfunction, & Treatment continuing education course in Tampa in October!