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 problem
The male pelvic floor anatomy almost no medical school teaches, and how to recognize dysfunction in yourself or a patient
Off-label medications (Cymbalta, gabapentin, amitriptyline) that are quietly transforming chronic pelvic pain treatment
Why erectile dysfunction is rising sharply in teenagers, and the role pornography plays in rewiring young brains
Who 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:
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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
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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.
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