Daily tadalafil (Cialis) 5 mg may improve urinary symptoms, pelvic pain, quality of life and erectile function in selected men with chronic prostatitis/chronic pelvic pain syndrome (CPPS). Unlike antibiotics, tadalafil does not treat infection; it works by relaxing the smooth muscle around the bladder and prostate, improving pelvic blood flow and reducing lower urinary tract symptoms.
Does Tadalafil (Cialis) Really Help Chronic Prostatitis (CPPS)?
Yes—for many men, it can. Tadalafil (Cialis) is best known as a treatment for erectile dysfunction. Still, research over the last decade has shown that it may also improve symptoms in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), a long-term condition causing pelvic pain, urinary symptoms and a significant reduction in quality of life.
Unlike antibiotics, tadalafil does not treat a bacterial infection. Instead, it works by relaxing smooth muscle around the prostate and bladder, improving blood flow within the pelvis and reducing urinary symptoms. Clinical studies have shown that many men also experience improvements in pelvic pain, sexual function and overall quality of life, particularly when tadalafil is combined with other treatments such as pelvic floor physiotherapy and lifestyle changes.
Current evidence suggests that tadalafil is most helpful for men who have:
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
- Frequent urination
- Urinary urgency
- A weak urinary stream
- Pain after ejaculation
- Erectile dysfunction alongside CPPS
It is not a cure for CPPS, but for carefully selected patients it can form an important part of a personalised treatment programme.
What Is Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS)?
Chronic prostatitis/chronic pelvic pain syndrome (CPPS) is the most common form of prostatitis, accounting for approximately 90–95% of prostatitis diagnoses. It affects an estimated 2–10% of men worldwide and can occur at almost any adult age.
Despite the name, CPPS is not simply inflammation of the prostate. Modern research has shown that it is a complex condition involving several different body systems.
Possible contributing factors include:
- Increased tension within the pelvic floor muscles
- Irritation of nerves supplying the pelvis
- Changes in how the nervous system processes pain (known as central sensitisation, where the brain and spinal cord become overly sensitive to pain signals)
- Low-grade inflammation
- Problems with bladder emptying
- Psychological stress and anxiety
- Previous urinary tract infections in some patients
This explains why two men with CPPS can have completely different symptoms.
Some experience mainly urinary problems, whereas others are affected predominantly by pain or sexual symptoms.
Common symptoms include:
- Pain between the scrotum and anus (perineum)
- Pain in the penis or testicles
- Lower abdominal pain
- Pain during or after ejaculation
- Burning when passing urine
- Frequent urination
- Urinary urgency
- Difficulty starting urination
- Weak urinary stream
- Erectile dysfunction
- Reduced quality of life
Symptoms often fluctuate, with periods of improvement followed by flare-ups triggered by stress, prolonged sitting, cycling, constipation or ejaculation.
Why Do Antibiotics Often Fail in Chronic Prostatitis (CPPS)?
One of the most frustrating experiences for men with CPPS is receiving repeated courses of antibiotics that provide little or no lasting benefit.
The reason is straightforward.
Most men with CPPS do not have an ongoing bacterial infection.
Instead, their symptoms are caused by a combination of muscle tension, nerve sensitivity, inflammation and abnormal pain processing rather than bacteria.
Antibiotics work by killing bacteria.
If bacteria are not the underlying cause, antibiotics cannot correct the problem.
Several studies have shown that repeated antibiotic treatment in men with long-standing CPPS often provides little additional benefit while exposing patients to unnecessary side effects and contributing to antimicrobial resistance, where bacteria become less responsive to antibiotics over time.
Modern international guidelines therefore recommend identifying the underlying causes of each patient's symptoms and using a multimodal treatment approach, combining therapies that target different aspects of the condition.
This is where tadalafil may play an important role.
How Does Tadalafil (Cialis) Work for Chronic Prostatitis (CPPS)?
Although tadalafil is widely recognised as a treatment for erectile dysfunction, researchers now understand that its effects extend far beyond improving erections.
Its actions on smooth muscle, blood vessels and nerve signalling make it particularly interesting for men with CPPS.
Does tadalafil relax the prostate and bladder?
Tadalafil belongs to a group of medicines called phosphodiesterase type 5 (PDE5) inhibitors. These medicines increase levels of cyclic guanosine monophosphate (cGMP), a naturally occurring chemical that allows smooth muscle to relax.
Smooth muscle surrounds the:
- Prostate
- Bladder neck
- Urethra
- Blood vessels supplying the pelvis
In many men with CPPS, these muscles remain partially contracted.
This increased muscle tone can contribute to:
- Difficulty emptying the bladder
- Urinary urgency
- Frequent urination
- Pain during urination
By relaxing these muscles, tadalafil may improve urinary flow and reduce bladder irritation.
Does tadalafil improve blood flow to the pelvis?
Tadalafil also increases the activity of nitric oxide, a natural molecule that widens blood vessels.
Better blood flow improves oxygen delivery to tissues and helps remove waste products produced during inflammation and muscle activity.
Researchers believe that improved pelvic circulation may reduce tissue irritation and contribute to symptom improvement, although this is unlikely to be the only explanation for its benefits.
Can tadalafil reduce chronic pelvic pain?
One of the most difficult symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is persistent pelvic pain. This pain may be felt in the perineum (the area between the scrotum and anus), penis, testicles, lower abdomen or lower back. Some men experience discomfort only occasionally, while others have symptoms every day that significantly affect their work, exercise, sleep and relationships.
Unlike acute bacterial prostatitis, chronic pelvic pain is usually not caused by ongoing infection. Instead, it is thought to result from a combination of:
- Increased pelvic floor muscle tension
- Irritated or hypersensitive nerves
- Low-grade inflammation
- Altered pain processing within the nervous system
- Emotional stress and anxiety, which can increase muscle tension and pain perception
Because CPPS has several contributing factors, no single treatment works for every man.
Tadalafil may help reduce pelvic pain through several mechanisms.
First, relaxing smooth muscle around the prostate, bladder neck, and pelvis may reduce pressure within the urinary tract and pelvic tissues.
Second, improved blood flow may reduce tissue irritation and improve oxygen delivery.
Third, laboratory studies suggest that the nitric oxide-cGMP pathway may influence the way pain signals are transmitted, although further research is needed to understand this fully.
It is important to have realistic expectations. Tadalafil is unlikely to eliminate pelvic pain completely. Still, many men notice that their pain becomes less frequent, less intense and easier to manage, particularly when it is combined with pelvic floor physiotherapy, exercise and stress management.
Why does tadalafil improve erections in men with CPPS?
Up to 60% of men with CPPS report some degree of erectile dysfunction. This is considerably higher than in men of the same age without chronic pelvic pain.
There are several reasons why this occurs.
Chronic pain
Pain itself reduces sexual desire and makes intercourse uncomfortable. Men who expect pain during or after ejaculation often avoid sexual activity altogether.
Pelvic floor muscle tension
The pelvic floor muscles play an important role during erections and ejaculation. When these muscles remain chronically tight, they may interfere with normal sexual function.
Reduced blood flow
Persistent muscle tension and inflammation may affect blood flow within the pelvis, contributing to erectile difficulties.
Anxiety and reduced confidence
Many men worry that sexual activity will worsen their symptoms. Others become anxious because of persistent pain or fear that something serious has been missed. This anxiety alone can contribute to erectile dysfunction.
Tadalafil improves erections by increasing blood flow into the penis during sexual stimulation. However, in men with CPPS, the benefits may extend beyond erections alone.
Many patients report:
- Greater confidence
- Less anxiety surrounding sexual activity
- Reduced fear of pain after ejaculation
- Improved intimacy
- Better overall quality of life
These improvements often reinforce one another. As pain decreases and confidence improves, pelvic muscles may relax further, helping to reduce symptoms over time.
What does the latest research say about tadalafil for chronic prostatitis (CPPS)?
Interest in tadalafil as a treatment for CPPS has increased significantly over the last decade. Although researchers originally developed it to treat erectile dysfunction, they noticed that many men also experienced improvements in urinary symptoms and pelvic discomfort.
Since then, several clinical studies have evaluated its effectiveness.
The strongest evidence comes from randomised controlled trials in which patients are randomly assigned to receive either tadalafil or a placebo. This type of study provides the highest quality evidence because it reduces bias and allows a fair comparison between treatments.
One of the largest randomised studies included 140 men with CPPS and erectile dysfunction. Participants received either tadalafil 5 mg once daily or a placebo for six weeks.
The results showed significant improvements in men taking tadalafil, including:
- Lower overall symptom scores
- Better urinary symptoms
- Improved quality of life
- Better erectile function
Approximately 51% of men receiving tadalafil achieved a clinically meaningful improvement, compared with approximately 5% receiving placebo.
Although improvements in pain were observed, the difference in pain reduction between tadalafil and placebo was smaller than the improvements seen for urinary symptoms and overall quality of life. This suggests that tadalafil is particularly effective for men whose CPPS includes bothersome urinary symptoms and erectile dysfunction.
Other prospective studies have produced similar findings, with reductions in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the internationally recognised questionnaire used to measure symptom severity in CPPS.
How effective is tadalafil for chronic prostatitis?
Current evidence suggests that tadalafil should be viewed as one component of a comprehensive treatment plan rather than a standalone cure.
It is important to remember that CPPS is a highly individual condition.
Some men experience dramatic improvements within a few weeks.
Others notice only modest changes.
A small proportion experience little or no benefit at all.
The best results are generally seen when tadalafil is combined with treatments that address other aspects of CPPS rather than relying on medication alone.
Who is most likely to benefit from tadalafil (Cialis)?
Tadalafil is not suitable for every man with prostatitis, but research suggests that certain groups are more likely to respond.
You may benefit if you have:
- Chronic prostatitis/chronic pelvic pain syndrome lasting longer than three months
- Frequent urination
- Urinary urgency
- A slow urinary stream
- Pain after ejaculation
- Erectile dysfunction occurring alongside CPPS
- Symptoms that have not improved despite appropriate treatment with antibiotics where infection has been excluded
- Evidence of bladder neck or lower urinary tract dysfunction
Some younger men are surprised when tadalafil is recommended because they associate it only with erectile dysfunction. However, its use in CPPS is based on its effects on urinary symptoms, pelvic muscle relaxation and blood flow rather than age alone.
Who is unlikely to benefit from tadalafil?
Tadalafil is less likely to help if your symptoms are caused by another condition rather than CPPS.
Examples include:
- Acute bacterial prostatitis, where urgent antibiotic treatment is required
- A prostate abscess, which may require drainage
- An untreated urethral stricture (narrowing of the urethra)
- Advanced neurological conditions affecting bladder function
- Severe bladder pain syndrome without lower urinary tract symptoms
- Significant prostate enlargement where surgery may be more appropriate
A thorough assessment is important because several conditions can produce symptoms similar to CPPS but require very different treatments.
How long does tadalafil take to work?
This is one of the most common questions patients ask.
Unlike painkillers, tadalafil does not usually provide immediate symptom relief.
Instead, improvements tend to develop gradually as muscle tone decreases and urinary function improves.
A typical timeline is:
In the first 1–2 weeks, some men notice easier urination and improved erections. At 4 weeks, urinary frequency and urgency often begin to improve. By 6–8 weeks many men experience meaningful improvements in overall symptom scores and quality of life. Only after 12 weeks the maximum benefit has usually become apparent, allowing a more informed decision about continuing treatment.
Clinical studies generally assess outcomes after 6–12 weeks, reflecting the time needed for tadalafil to exert its full therapeutic effects in CPPS.
What dose of tadalafil (Cialis) is used for chronic prostatitis (CPPS)?
For most men with CPPS, the standard dose used in clinical studies is 5 mg once daily.
Unlike tadalafil used for erectile dysfunction "when needed", CPPS is generally treated with daily therapy. Taking the medication every day maintains stable drug levels in the bloodstream, providing continuous relaxation of the smooth muscle around the prostate, bladder neck and pelvic blood vessels.
Daily treatment also allows tadalafil to:
- Reduce urinary symptoms throughout the day.
- Improve pelvic blood flow continuously.
- Support erectile function whenever required.
- Produce gradual symptom improvement over several weeks.
Current research has almost exclusively evaluated 5 mg once daily, and this remains the dose most commonly recommended for men with CPPS.
Should tadalafil be taken every day or only before sex?
For CPPS, daily treatment is considerably more effective than taking tadalafil only before sexual activity.
Many men associate Cialis solely with erectile dysfunction and assume it should only be taken when needed.
However, CPPS is a chronic condition, not an intermittent problem.
Daily dosing aims to:
- Continuously relax muscles around the bladder and prostate.
- Improve urinary symptoms every day.
- Maintain improved pelvic blood flow.
- Reduce symptom fluctuations.
- Support long-term symptom control.
This is why most clinical studies and expert centres use 5 mg once daily rather than intermittent dosing.
How long should tadalafil be continued?
There is no single answer because every patient's symptoms are different.
In general:
- An initial trial of 6-12 weeks allows enough time to judge whether tadalafil is helping.
- Men who experience clear improvements often continue treatment for several months.
- Some men successfully stop treatment once symptoms remain stable.
- Others benefit from longer-term therapy if symptoms return after stopping.
The decision depends on:
- Symptom severity.
- Response to treatment.
- Side effects.
- Whether other treatments have also improved pelvic floor function.
Long-term studies in men with erectile dysfunction and urinary symptoms suggest tadalafil has a favourable safety profile when appropriately prescribed.
What are the side effects of daily tadalafil?
Most men tolerate tadalafil well.
When side effects occur, they are usually mild and improve as the body adjusts during the first few weeks.
Understanding why these side effects occur often helps reduce unnecessary concern.
Why does tadalafil cause headaches?
Headache is the commonest side effect.
Tadalafil widens blood vessels throughout the body, not just those supplying the penis and pelvis.
This temporary increase in blood flow can produce mild headaches, particularly during the first few days of treatment.
Most headaches settle without stopping the medication.
Why does tadalafil cause flushing?
Some men notice warmth or redness in their face.
Again, this effect occurs because tadalafil relaxes blood vessels, allowing more blood to reach the skin.
Flushing is usually short-lived and harmless.
Why does tadalafil cause heartburn or indigestion?
Tadalafil can also relax the muscle between the oesophagus and stomach.
This allows stomach acid to move upwards more easily, causing the following:
- Heartburn.
- Acid reflux.
- Indigestion.
Taking the tablet with food or avoiding large late meals may reduce these symptoms.
Why does tadalafil cause muscle or back pain?
Unlike headaches, muscle aches are thought to occur because tadalafil also affects enzymes found in skeletal muscle.
These symptoms are usually mild, develop within the first day or two and settle spontaneously.
Can tadalafil lower blood pressure?
Yes.
Because tadalafil widens blood vessels, it can produce a small reduction in blood pressure.
For most healthy men this causes no problems.
However, it becomes important in men taking:
- Nitrate medications.
- Certain blood pressure tablets.
- Other medicines that significantly lower blood pressure.
Is tadalafil safe for long-term use?
Current evidence suggests that tadalafil is generally safe when taken under appropriate medical supervision.
Large studies involving men treated for erectile dysfunction and lower urinary tract symptoms have demonstrated good long-term safety.
Unlike some medications, tadalafil does not appear to lose its effectiveness over time in most patients.
Regular review remains important to ensure that:
- Symptoms continue to improve.
- Side effects remain acceptable.
- The diagnosis has not changed.
- No new medications have been introduced that may interact with tadalafil.
Who should not take tadalafil?
Although tadalafil is safe for most men, it is not suitable for everyone.
It should generally be avoided in men who:
- Take nitrate medications for angina.
- Have severe uncontrolled low blood pressure.
- Have experienced a recent heart attack or stroke where sexual activity itself is not advised.
- Have certain rare inherited retinal disorders.
- Have severe liver disease where drug metabolism is impaired.
- Have previously experienced a serious allergic reaction to tadalafil.
It should also be used with caution alongside certain alpha-blockers, as combining these medicines may increase the risk of dizziness due to low blood pressure. Often they can still be prescribed together, but careful dose adjustment and monitoring are required.
Is tadalafil better than antibiotics for chronic prostatitis?
This is one of the most common questions patients ask.
The answer depends entirely on the type of prostatitis.
Many men with CPPS receive several courses of antibiotics despite repeated urine cultures showing no infection.
Modern evidence suggests this approach usually fails to provide lasting benefit.
Instead, treatment should focus on the underlying causes of symptoms rather than assuming bacteria are responsible.
Is tadalafil better than tamsulosin?
This is one of the most common questions patients ask. The answer depends entirely on the type of prostatitis. Many men with CPPS receive several courses of antibiotics despite repeated urine cultures showing no infection. Modern evidence suggests this approach rarely provides lasting benefit — treatment should instead focus on the underlying causes of symptoms rather than assuming bacteria are responsible.
Can tadalafil be combined with other CPPS treatments?
Yes—and this is where tadalafil is often most effective.
CPPS rarely has a single cause, so combining treatments usually provides better results than relying on one medication alone.
Research increasingly supports a multimodal approach, targeting the different mechanisms responsible for pain and urinary symptoms.
Pelvic floor physiotherapy
For many men, pelvic floor muscle tension is one of the main drivers of CPPS.
A specialist pelvic floor physiotherapist can help identify muscles that remain permanently tight and teach techniques to improve relaxation, posture and breathing.
Combining physiotherapy and pelvic floor muscle training (Kegel) with tadalafil may provide greater symptom improvement than either treatment alone because both reduce pelvic muscle tension through different mechanisms.
Quercetin
Quercetin is a naturally occurring plant flavonoid with antioxidant and anti-inflammatory properties.
Several clinical studies suggest that quercetin may reduce pain and improve symptom scores in selected men with CPPS.
Although high-quality evidence remains limited, quercetin is widely used as part of multimodal management because it has a favourable safety profile and may complement other treatments.
Alpha-blockers
Alpha-blockers such as tamsulosin relax the bladder neck and prostate via a mechanism distinct than tadalafil.
They may be beneficial in men with marked urinary symptoms, particularly early in the course of CPPS.
Some patients benefit from combination therapy, but treatment should be individualised to minimise side effects, such as dizziness or low blood pressure.
Lifestyle changes
Simple lifestyle measures can make a meaningful difference, including:
- Regular physical activity.
- Avoiding prolonged sitting.
- Maintaining a healthy weight.
- Limiting caffeine and alcohol if they trigger symptoms.
- Managing constipation.
- Improving sleep quality.
- Reducing psychological stress through relaxation techniques or mindfulness.
Medication alone rarely addresses all of the factors contributing to CPPS.
Do the European Association of Urology (EAU) guidelines recommend tadalafil for chronic prostatitis/chronic pelvic pain syndrome (CPPS)?
The European Association of Urology (EAU) recognises that chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a complex condition that rarely has a single cause or a single effective treatment. Instead of recommending one medicine for every patient, the guidelines support a multimodal approach, meaning that treatment should be tailored to the individual's symptoms and underlying contributing factors.
The EAU recommends first identifying the main drivers of symptoms, which may include pelvic floor muscle dysfunction, lower urinary tract symptoms, chronic pain, psychological stress, sexual dysfunction or, less commonly, bacterial infection.
For men whose symptoms include bothersome urinary symptoms and erectile dysfunction, tadalafil may be considered as part of an individualised treatment plan. However, it should not be viewed as a cure for CPPS or as a replacement for other important treatments such as pelvic floor physiotherapy, lifestyle modification or psychological support when these are indicated.
This reflects an important shift in modern medicine. Rather than searching for one treatment that works for everyone, specialists increasingly combine therapies that
target the different biological processes contributing to CPPS.
Common myths about tadalafil (Cialis) for chronic prostatitis
Myth: Cialis only treats erectile dysfunction.
Fact: Although tadalafil was originally developed to treat erectile dysfunction, research has shown that it can also improve urinary symptoms and quality of life in selected men with CPPS. Its effects on smooth muscle relaxation and pelvic blood flow make it useful beyond sexual function alone.
Myth: Tadalafil cures chronic prostatitis.
Fact: Tadalafil does not cure CPPS. It helps control symptoms and is most effective when used alongside other treatments as part of a comprehensive management plan.
Myth: If antibiotics have failed, nothing else will work.
Fact: This is one of the most common misconceptions. Most men with long-standing CPPS do not have an active bacterial infection. Treatments such as pelvic floor physiotherapy, tadalafil, stress management and targeted pain management may still provide significant improvement.
Myth: Only older men benefit from tadalafil.
Fact: CPPS frequently affects younger men. Age is far less important than symptom pattern. Younger men with urinary symptoms, pelvic pain or erectile dysfunction may also benefit from tadalafil.
Myth: Once you start tadalafil, you have to take it forever.
Fact: Many men use tadalafil for a limited period, while other treatments improve pelvic floor function and symptom control. Others continue treatment longer because they experience ongoing benefits. The duration should be tailored to the individual.
Looking for a consultant urologist specialising in chronic prostatitis (CPPS) in Sussex?
Mr Edward Calleja is a consultant urological surgeon specialising in the assessment and treatment of chronic prostatitis/chronic pelvic pain syndrome (CPPS), male pelvic pain and urinary symptoms. He manages men with persistent pelvic pain, urinary frequency, urinary urgency, pain after ejaculation and prostatitis symptoms using an evidence-based, personalised approach.
As chronic prostatitis (CPPS) rarely has a single cause, treatment focuses on identifying the underlying factors contributing to symptoms. These may encompass pelvic floor muscle dysfunction, lower urinary tract symptoms, nerve sensitisation, sexual dysfunction, and lifestyle factors. Management is tailored to each individual and follows the latest European Association of Urology (EAU) guidance, which recommends a multimodal approach rather than relying on a single treatment.
Depending on the pattern of symptoms, management may include pelvic floor physiotherapy, lifestyle modification, medicines such as tadalafil or alpha-blockers where appropriate, pain management strategies and ongoing assessment to optimise symptom control and improve quality of life.
Frequently asked questions about tadalafil (Cialis) for chronic prostatitis are provided below.
Can tadalafil cure chronic prostatitis?
No. Tadalafil does not cure CPPS, but it can significantly improve symptoms and quality of life in carefully selected patients.
Does tadalafil reduce pelvic pain?
Many men experience a reduction in pelvic pain, although improvements in urinary symptoms are generally more consistent than pain relief.
Does tadalafil work if I do not have erectile dysfunction?
Yes. Tadalafil benefits extend beyond erections. Men without erectile dysfunction may still experience improvements in urinary symptoms and pelvic discomfort.
How quickly does tadalafil start working?
Some men notice improvements within one to two weeks, but most clinical studies assess results after six to twelve weeks of continuous daily treatment.
Can tadalafil improve pain after ejaculation?
Yes. Some men report that pain after ejaculation becomes less frequent or less severe, although individual responses vary.
Does tadalafil reduce prostate inflammation?
There is currently no convincing evidence that tadalafil directly reduces inflammation within the prostate. Its benefits appear to result mainly from smooth muscle relaxation, improved blood flow and effects on urinary function.
Can tadalafil help urinary frequency?
Yes. One of the strongest areas of evidence is the improvement of urinary frequency, urgency and urinary flow.
Can tadalafil improve urinary urgency?
Many men notice that the sudden need to pass urine becomes less severe after several weeks of treatment.
Is tadalafil safe to take every day?
For most healthy men, daily tadalafil 5 mg has an excellent long-term safety profile when appropriately prescribed.
Can tadalafil be taken with antibiotics?
Yes, if antibiotics are genuinely needed for a proven bacterial infection. The medicines work in different ways and do not usually interfere with one another.
Can tadalafil be combined with pelvic floor physiotherapy?
Yes. In fact, many specialists consider this combination to be one of the most effective approaches because both treatments target different aspects of CPPS.
Does tadalafil increase PSA?
No. There is no evidence that tadalafil increases prostate-specific antigen (PSA) levels.
Does tadalafil affect fertility?
Current evidence does not suggest that tadalafil significantly reduces male fertility when used at standard therapeutic doses.
Can I drink alcohol while taking tadalafil?
Moderate alcohol intake is usually acceptable. However, excessive alcohol can worsen dizziness, lower blood pressure and aggravate urinary symptoms.
What happens if I stop tadalafil?
Some men notice their symptoms gradually return after stopping tadalafil, particularly if pelvic floor dysfunction or other contributing factors haven't also been addressed. Others remain stable, especially if they've made progress with physiotherapy or lifestyle changes alongside the medication. Whether symptoms return often reflects how many of the underlying contributing factors have been treated, not just whether tadalafil itself is stopped. Some men with prostate issues experience symptoms through a mechanism distinct from that of other conditions. While some may notice their symptoms return after stopping treatment, others gradually recognise that their condition is complex and involves several factors rather than CPPS alone causing their symptoms. In contrast, others gradually notice symptoms indicating that it is a complex condition involving several factors rather than CPPS causing your symptoms to return. Men's symptoms may return after stopping treatment, while others gradually notice symptoms, indicating that it is a complex condition involving several factors rather than CPPS that causes your symptoms to return. This evidence indicates that it is a complex condition involving several factors, not CPPS, causing your symptoms to be symptom-free after stopping treatment. At the same time, others gradually notice symptoms indicating that it is a complex condition involving several factors, not just CPPS, that cause their symptoms to return. The answer depends on the underlying cause of their CPPS and whether other treatments have addressed contributing factors such as pelvic floor dysfunction.
Consultant urologist specialising in chronic pelvic pain syndrome (CPPS), prostatitis and men's sexual health in Sussex, Brighton, Uckfield, Eastbourne and Hastings
Mr Edward Calleja is a consultant urological surgeon specialising in the assessment and treatment of chronic prostatitis/chronic pelvic pain syndrome (CPPS), pelvic pain, men's sexual health and urinary symptoms. He regularly manages men experiencing pelvic pain, erectile dysfunction, painful ejaculation, urinary frequency, urinary urgency and prostatitis using an evidence-based, personalised approach.
Because CPPS rarely has a single cause, assessment focuses on identifying the underlying factors that contribute to symptoms, such as pelvic floor muscle dysfunction, lower urinary tract symptoms, nerve sensitisation, psychological stress and sexual dysfunction. Management follows the latest European Association of Urology (EAU) guidance and uses a multimodal approach, combining treatments such as pelvic floor physiotherapy, lifestyle modification, targeted medication and pain management where appropriate.
Mr Calleja provides specialist assessment and treatment for patients across Sussex, Brighton, Lewes, Uckfield, Eastbourne, Hastings and the surrounding South East, with a particular interest in complex prostatitis, chronic pelvic pain and male urinary symptoms.
Key points to remember
Tadalafil has become an increasingly important treatment option for carefully selected men with chronic prostatitis/chronic pelvic pain syndrome.
Unlike antibiotics, tadalafil does not treat bacterial infection. Instead, it works by relaxing smooth muscle around the bladder and prostate, improving pelvic blood flow and reducing lower urinary tract symptoms. Many men also experience improvements in erectile function and overall quality of life.
Current evidence suggests that tadalafil works best in men who have urinary symptoms, pelvic pain and erectile dysfunction occurring together. The greatest benefits are usually seen when it is combined with pelvic floor physiotherapy, regular exercise, stress management and other treatments that target the different mechanisms responsible for CPPS.
Although tadalafil is not suitable for everyone and should not be viewed as a cure, it represents an important component of modern multimodal management. It has become a valuable option for men whose symptoms persist despite previous treatments.
References
- European Association of Urology (EAU). EAU Guidelines on Chronic Pelvic Pain: https://uroweb.org/guidelines/chronic-pelvic-pain
- National Institute for Health and Care Excellence. Lower urinary tract symptoms in men: https://www.nice.org.uk/guidance/cg97
- Tawfik AM, et al. Tadalafil monotherapy in men with chronic prostatitis/chronic pelvic pain syndrome. World Journal of Urology. 2022.
- Magri V, et al. Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome.
- Nickel JC. Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.
- Pontari MA. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Current Concepts.
