Clinical Exam: 360° Digital Rectal Exam

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:

• Manukora - Go to https://www.MANUKORA.com/DRLYON to save 31% plus $25 worth of free gifts.
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• BONCHARGE - Save 15% at https://boncharge.com/ with code DRLYON

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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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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.