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Chronic scrotal content pain (CSCP) and chronic pelvic pain syndrome (CPPS) are among the most common urologic chief complaints and also the most frustrating for both patients and providers alike. The differential diagnosis crosses numerous biological domains, including genitourinary, orthopedic (lumbar spine), gastrointestinal, musculoskeletal, infectious, and neoplastic causes. Collecting a complete history and performing a comprehensive physical examination, including digital rectal examination (DRE), to assess pelvic floor tone are imperative in determining the origin of pain.1 Key questions include onset of pain relative to procedures (eg, vasectomy) or musculoskeletal insults, pain with ejaculation or urination, and signs of increased anxiety or life stressors. Despite its high prevalence and frequent implication in pelvic and testicular pain, PFD remains poorly understood. In this study by Zheng et al,2 PFD was identified in 17.6% of CSCP cases. In truth, the true prevalence of PFD is likely much higher, and rudimentary diagnostic tools, such as DRE, provide only limited diagnostic information (often with a strong confirmation bias). This study identified pain with ejaculation as a strong indicator of PFD, matching our experience of this representing the most specific indicator of this condition. Treatment for these patients should be multimodal3 and include not only treatment of the underlying biological triggers (pelvic floor physical therapy, pharmacologic treatment, and procedures such as trigger point injection) but also referral to mental health professionals for anxiety management. Rather than promise a cure, providers should strive to equip patients with a toolbox of treatment options that can be used during flare-ups. Finally, further research is critically necessary to identify the underlying causes at the molecular and cellular level and to begin to improve diagnostic and therapeutic options using approaches informed by rigorous science currently lacking for this widespread and debilitating condition.