Chronic prostatitis and CPPS: pelvic floor physical therapy in NYC
You were told you have prostatitis. You took antibiotics, maybe more than once. The pain is still there. If that sounds familiar, you’re not alone, and there may be a reason the treatment hasn’t worked.
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Medically reviewed by Dr. Adam Gvili, PT, DPT, on November 2, 2026
Prostatitis vs. CPPS
“Prostatitis” means inflammation of the prostate. Some cases are caused by a bacterial infection and need antibiotics. But most men diagnosed with chronic prostatitis don’t have an ongoing infection at all. Doctors call this chronic prostatitis / chronic pelvic pain syndrome, or CPPS.
In CPPS, the pain is real, but the cause is often not the prostate itself. Tight, tender or overactive pelvic floor muscles are a common part of the picture.
Does this sound familiar?
- Pain in the perineum, testicles, penis, lower belly or lower back
- Pain during or after ejaculation
- Burning when you pee, or needing to go often, with normal urine tests
- Symptoms that come and go, and flare with stress or long periods of sitting
- Several rounds of antibiotics with little or no lasting change
When to see a doctor first
See a doctor promptly if you have fever, chills, blood in your urine, or you cannot pass urine. These need medical care. If you haven’t been evaluated by a doctor for your symptoms, we’ll recommend that alongside physical therapy.
What the guidelines say
The American Urological Association’s 2025 guideline on chronic pelvic pain in men includes pelvic floor physical therapy as a treatment option for men who have pelvic floor muscle tenderness. The same guideline also advises against repeated antibiotics when tests show no infection.
We work alongside urologists. Physical therapy doesn’t replace medical care; it addresses the muscle side of the problem, which medication often doesn’t reach.
How we evaluate CPPS
1. Free 15-minute call. Tell us about your symptoms and what you’ve already tried. We’ll let you know if we’re the right fit.
2. First visit (45 minutes). Your physical therapist will:
- Take a full history of your symptoms, tests and past treatments
- Assess the muscles and soft tissue of your lower abdomen, perineum and pelvic floor, including an internal exam if you’re comfortable with it
- Explain what they found and your plan before you leave
The pelvic floor is a group of muscles that sit inside the pelvis, so the most accurate way to assess and treat them is directly. If it would help, your therapist may suggest an internal exam: one finger, in the rectum, always at your comfort. We explain each step before we do it, check in with you throughout, and you can pause, stop or say no at any time. Most people expect it to be uncomfortable and are surprised by how manageable it is.
What treatment can involve
- Hands-on release of tight or tender pelvic floor muscles, internally and externally
- Retraining your pelvic floor to relax and coordinate
- Breathing and movement work
- Guidance on sitting, exercise and managing flare-ups
- A home program from your first visit, so you can keep progressing on your own
Your team
Dr. Adam Gvili, PT, DPT, Founder. Every visit is 45 minutes, one-on-one, with your own physical therapist.
Dr. Joseph Mendoza, PT, DPTPelvic Floor Physical Therapist
Dr. Sam Vargas, PT, DPTPelvic Floor Physical Therapist
Frequently asked questions
Because in most cases, the prostate isn’t the problem. Around 90% of prostatitis cases aren’t caused by a bacterial infection. They fall under chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS), where tight, overactive pelvic floor muscles around the prostate are often part of what’s driving the pain. That’s often why antibiotics don’t bring relief, even when tests come back clean. We assess those muscles directly and treat them.
That’s a question for your doctor. We don’t prescribe or stop medication. If you’re unsure, ask your urologist about the AUA’s guideline on male chronic pelvic pain.
For many men, yes. Stress increases pelvic floor tension, and flare-ups often follow stressful periods. Part of treatment is learning to recognize and release that tension.
Not everyone is affected, but many men are. Tight pelvic floor muscles can cause pain during or after ejaculation, weaker erections, or trouble maintaining them, and the fear of pain can make intimacy stressful on its own. As the muscles learn to relax, these symptoms often improve along with the pain. If sexual symptoms are part of your picture, tell us, and we’ll address them directly as part of your plan.
No. You can book directly. If you’re already seeing a doctor, let us know who they are. We’ll keep them in the loop, because the best care happens when your whole team is working together.
We’re an out-of-network practice. We’ll give you a superbill to submit to your insurance for possible reimbursement. A superbill is a medical receipt with procedure codes that shows your insurer what happened during your session. If your insurance needs supporting documentation, we’ll send it promptly. What you get back depends on your plan.
Going deeper: CPPS
Why CPPS is often misdiagnosed
Its symptoms look a lot like an infection, so antibiotics are usually the first treatment. But most cases aren’t infections at all. When cultures come back normal and the symptoms don’t go away, a common cause, tight and overactive pelvic floor muscles, often goes unrecognized.
CPPS and pain after ejaculation
Your pelvic floor muscles contract during ejaculation. When they’re already tight or tender, that contraction can trigger pain that lasts for minutes or even hours afterward.
CPPS and urinary symptoms
An overactive pelvic floor can make it harder to start urinating, weaken your stream, or leave you with a constant urge to go. These symptoms often improve as the muscle tension is treated.
What to bring from your urologist
Recent test results, a list of medications you’ve tried, and any imaging reports. These help us see what’s already been ruled out, so we can focus on what hasn’t.
Related reading: male pelvic pain and urinary frequency and urgency. You can also see all the conditions we treat.
Talk to a clinician first
Start with a free 15-minute call. Tell us what’s going on and ask anything. No commitment.
Or call (929) 590-3445. Talk to a clinician first. No referral needed.