DEAR DR. ROACH: My son was diagnosed with pelvic floor dysfunction (PFD) by a urologist. He went to another doctor who never found anything conclusive. My son has complained of stinging and burning in his urethra, as well as an uncomfortable feeling when trying to sit. He’s on his feet most of the time.

He quit his job because of the problems with this condition. He’s had two MRIs, a cystoscopy and an ultrasound. The problem persists. He uses a hot tub, which offers some relief but not much. According to his doctor, the tests are inconclusive without a diagnosis. Should he seek a new doctor?

• Anonymous

ANSWER: Chronic pelvic pain is found in both men and women, and the diagnosis is frequently delayed for both as well. Patients can suffer for a long time, and both they can also be misdiagnosed.

The underlying cause can be a wide variety of issues, so a thoughtful diagnostic approach is wise. Only a few physicians have the expertise to do a careful physical exam of the pelvic floor, so I refer my patients to specialized pelvic pain referral centers. For men, these centers’ experts may include urologists, surgeons, physiatrists, gastroenterologists and physical therapists.

I can’t speculate on what’s causing his pain. It’s likely that he’s had an evaluation for prostate problems, which is a frequent cause of male pelvic pain. Often, a variety of treatments are recommended.

However, my experience with my few male patients with PFD has shown that a skilled pelvic floor physical therapist provides the most benefit in helping relieve symptoms.

DEAR DR. ROACH: My general practitioner has a problem with helping me relieve my student loan debt. I’ve had a diagnosis of AIDS since 1990, having tested positive in 1988. My accumulation of comorbidities brings an absolute picture to my current condition. Why is it that sometimes doctors take things so personally? I don’t know if my practitioner’s worried that he’ll be put in jail.

• Anonymous

ANSWER: I write many letters for patients, the vast majority of which don’t pose a moral or legal dilemma. Once in a while, a patient asks me to do something I’m not comfortable with. I have two rules: The first is never to commit fraud. The second is to do what I can to help my patient without breaking the first rule.

Jail time for physicians is possible but rare; however, fines and suspension or the loss of a license aren’t rare for those who get convicted of writing fraudulent letters. In your case, it’s absolutely clear that your condition will last for five years or more. Your doctor should be able to write a letter that helps you get into the debt forgiveness program — without a fear of committing fraud.

ToYourGoodHealth@med.cornell.edu.

North America Syndicate Inc.