Episode Details

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.

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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

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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 denervatio