Most men don't know they have a pelvic floor, and most doctors aren't trained to look for dysfunction in it. The result: testicles are being surgically removed for pain that's actually neuropathic, at double the rate of a far more effective nerve-sparing procedure. In this episode, Dr. Gabrielle Lyon sits down with Dr. Susan Macdonald, a board-certified urologist, surgical program director at Penn State, and one of only ~30 U.S. specialists treating chronic pelvic pain in men, to discuss: Why "prostatitis" is often the wrong diagnosis, and how rounds of antibiotics mask the real problemThe male pelvic floor anatomy almost no medical school teaches, and how to recognize dysfunction in yourself or a patientOff-label medications (Cymbalta, gabapentin, amitriptyline) that are quietly transforming chronic pelvic pain treatmentWhy erectile dysfunction is rising sharply in teenagers, and the role pornography plays in rewiring young brainsWho actually qualifies for a penile implant, and what the surgery really involves If you've been told your pain is "all in your head," or you're a clinician seeing patients fall through the cracks, this conversation gives you the framework, the language, and the next steps to find real answers. Thank you to our sponsors: Manukora - Go to https://www.MANUKORA.com/DRLYON to save 31% plus $25 worth of free gifts.Timeline - Get 20% off your Mitopure order at https://www.timeline.com/lyonBONCHARGE - Save 15% at https://boncharge.com/ with code DRLYON Explore More from Dr. Gabrielle Lyon Premium Podcast Subscription: Ad-free episodes, key takeaway summaries, exclusive Q&A, and behind-the-scenes content https://foreverstrong.supercast.comWeekly newsletter: Recipes, podcast updates, and practical weekly insights https://drgabriellelyon.com/sign-up/Apply to become a patient: Personalized care with Dr. Lyon’s clinical team https://drgabriellelyon.com/new-patient-inquiry/ Find Dr. Susan Macdonald at: Instagram: https://www.instagram.com/drsusanmacdonald/ X (Twitter): https://x.com/smacdonald_md LinkedIn: https://www.linkedin.com/in/susan-macdonald-506324191/ Connect with Dr. Gabrielle Lyon Instagram: https://www.instagram.com/drgabriellelyon/ TikTok: @drgabriellelyon X (Twitter): https://x.com/drgabriellelyon Facebook: https://www.facebook.com/doctorgabriellelyon Chapters 00:00 - Introduction 01:42 - Meet Dr. Susan Macdonald 03:00 - The high-powered lawyer nobody could help 05:01 - Why testicle pain is 5% of urology visits 07:49 - Men have a pelvic floor (and what it does) 12:46 - How a man knows he has pelvic floor dysfunction 21:30 - Why these muscles are "too tight" in men 26:33 - Chronic pain rewires the brain 29:21 - Stress, trauma, and the mind-body connection 33:29 - Stretching, breathing, and self-treatment at home 36:21 - The medications that actually work (Cymbalta, gabapentin) 44:34 - Muscle relaxers, acupuncture, and the guidelines panel 55:09 - Sexual trauma and chronic pelvic pain 01:00:08 - The "pain plus" diagnostic framework 01:05:23 - The micro-surgical denervation surgery 01:08:36 - Erectile dysfunction in 17-year-olds 01:11:00 - How porn rewires young men's brains 01:18:27 - 40% of men by 40, 50% by 50 01:23:39 - Penile implants: who qualifies, how they work 01:28:10 - Stage 4 cancer at 42 and the pivot to teaching 01:34:17 - Living big with finite time 01:39:00 - Closing message to chronic pain patients If you found this episode valuable, share it with someone who would benefit from it. This episode includes paid sponsorships. The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.
