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Pelvic pain in men with negative STI tests 

Men can experience pelvic pain even if tests for sexually transmitted infections (STIs) come back negative. This page explains how pelvic floor muscle tension and anxiety may be contributing - and what you can do to manage the symptoms.

When to get urgent help

Get urgent medical attention if you experience any of the following: 

Blood in your urine or semen
High fever or chills
Vomiting
Sudden or severe pain
Difficulty passing urine or complete urinary retention

What causes the symptoms if it’s not an STI? 

If your tests for chlamydia, gonorrhoea, or urethritis are negative and you still have discomfort in your penis, testicles, or lower abdomen, this could be due to pelvic floor muscle tension, rather than infection.

The pelvic floor muscles support the bladder and bowel and play a key role in controlling urination and ejaculation. These muscles also surround the base of the penis, scrotum, and anus. When tight or tense, they can cause:

  • a feeling of pressure or aching in the lower tummy
  • pain at the tip of the penis
  • testicular pain
  • discomfort between the testicles and anus (perineum)
  • increased need to urinate or difficulty starting to urinate

What is the pelvic floor?

The pelvic floor is a group of muscles found at the base of your pelvis. In men, they form a sling-like support for the bladder and bowel and help control how you urinate and ejaculate.

These muscles also wrap around the urethra (the tube that carries urine through the penis). If they are too tight or go into spasm, they can irritate surrounding nerves. This might make pain feel like it’s coming from the penis, testicles, perineum, or even the thighs or lower stomach.

What causes the muscle tension?

Stress and anxiety can cause unconscious tightening of the pelvic floor muscles. You may not realise it, but your body can hold tension in this area in the same way people hold stress in their shoulders or jaw.

This involuntary tightening can cause:

  • burning or aching pain in the penis or pelvic area
  • a need to urinate more often
  • pain when urinating or ejaculating
  • a sense that the bladder hasn’t fully emptied

These symptoms often increase anxiety, which then leads to even more muscle tension. This creates a pain–tension–anxiety cycle.

If I have these symptoms, how can I manage this?

Many men find that symptoms improve once they understand that pelvic pain isn’t always caused by infection — and that muscle tension can be treated. 

Here are some things that can help: 

  • pelvic floor physiotherapy
  • stress management techniques such as mindfulness and CBT
  • avoid straining during bowel movements
  • taking regular breaks from sitting
  • using a warm compress on the lower abdomen or perineum
  • using over-the-counter pain relief like ibuprofen

Other frequently asked questions (FAQs) about male pelvic pain  

It’s unlikely. Our tests for STIs and urethritis are very accurate. If results show no infection or inflammation, symptoms are often due to muscle tension or irritation of pelvic nerves. 

Yes. These are common conditions in men under 50 with persistent pelvic pain but no infection. They often overlap with pelvic floor dysfunction and can last for months. Treatment focuses on symptom relief rather than antibiotics. 

Practice deep belly breathing, mindfulness, use heat therapy, do gentle stretches, and avoid sitting for too long. 

Pelvic floor dysfunction may be the cause if: 

  • your symptoms worsen with stress or anxiety
  • pain is felt in different areas (e.g. penis, testicles, perineum, or lower abdomen)
  • tests for infections like chlamydia, gonorrhoea, or urethritis are negative
  • there is no clear injury or medical cause
  • you notice relief after relaxation or gentle stretching

A pelvic health physiotherapist can assess your symptoms and help confirm the diagnosis. They may look at posture, breathing, and how your muscles respond during a physical exam.

Treatment depends on the underlying cause, but may include: 

  • pelvic floor physiotherapy – specialised exercises and techniques to release tight muscles and improve function
  • cognitive behavioural therapy (CBT) – a talking therapy that helps manage the pain–tension–anxiety cycle
  • pain relief – over-the-counter medicines like non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
  • warm compresses – heat packs can help relax pelvic muscles and reduce pain
  • lifestyle changes – including reducing sitting time, improving posture, avoiding straining when using the toilet

No. With proper support and therapy, most people experience symptom relief within weeks or months.

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