After visiting dozens of doctors and suffering for nearly five years from pelvic pain so severe that he could not work, Daniel Davidson, 57, a dentist in Dalton Gardens, Idaho, finally found a specialist in Phoenix who had an outstanding reputation for treating men like him.
Dr. Davidson, whose pain followed an injury, waited five months for an appointment and even rented an apartment in Phoenix, assuming he would need surgery and time to recover.
Six days before the appointment, it was canceled. The doctor, Michael Hibner, an obstetrician-gynecologist at St. Joseph's Hospital and Medical Center, had learned that members of his specialty were not allowed to treat men and that if he did so, he could lose his board certification — something that doctors need in order to work.
The rule had come from the American Board of Obstetrics and Gynecology. On Sept. 12, it posted on its website a newly stringent and explicit statement of what its members could and could not do. Except for a few conditions, gynecologists were prohibited from treating men. Pelvic pain was not among the exceptions.
Dr. Davidson went home, close to despair. His condition has left him largely bedridden. The pain makes it unbearable for him to sit, and he can stand for only limited periods before he needs to lie down.
"These characters at the board jerked the rug out from underneath me," he said.
In an email, Dr. Hibner confirmed that he had stopped treating men, who he said had made up about 10 percent to 15 percent of his practice. He said his staff was trying to find other physicians for about 100 male patients.
Other men are in a similar situation, unsure of where to turn for help. A number of nerve and muscle problems can cause debilitating pelvic pain syndromes in both men and women, but the problems are more common in women, and gynecologists often have the most skill in treating this type of pain, experts in the field say.
The gynecology board differs, saying that many other types of doctors can treat these ailments in men, according to a spokesman, David Margulies, who heads a public relations firm in Dallas. Board members declined to be interviewed.
The same board reversed itself for another group of male patients last month, however, and said gynecologists would be permitted to screen and treat men who are at high risk for anal cancer.
The board has also informed one patient, who appealed to it directly, that he can continue being treated for pelvic pain by Dr. Hibner — the same doctor in Phoenix whom Dr. Davidson had hoped to see. In an email, which the patient shared with The New York Times, a board official said the intent of its policy was "not to have doctors abandon their current patients like you."
But Mr. Margulies said the permission for that patient's treatment did not mean that the overall policy had changed. He said, "A one-time exception was made for one individual."
A specialty group, the International Pelvic Pain Society, wrote to the gynecology board, requesting that gynecologists be permitted to continue treating men for pelvic pain. The board declined.
The pain society has 300 to 400 members; about half are physical therapists, and 40 percent are obstetrician-gynecologists, said Dr. Richard Marvel, a former president and an obstetrician-gynecologist in Annapolis, Md., who has treated men for pelvic pain.
In an email, the pain society said, "Gynecologists with the appropriate skills, experience and knowledge who choose to participate in the care of men with chronic pelvic pain should not be at risk of losing their board certification, solely because they participate in the care of patients who have a real need, suffer tremendously and have limited options for treatment."
Stephanie Prendergast, president of the pain society and a physical therapist at the Pelvic Health and Rehabilitation Center in San Francisco, said in an email, "I can assure you these gynecologists are better equipped to treat male patients with pelvic pain than most urologists, neurologists, orthopedists, etc."
Pelvic pain is poorly understood and in men is frequently misdiagnosed as prostate trouble. Major nerves and muscles involved are the same in men and women, so some gynecologists began accepting male patients.
Patients say the pain can be excruciating, and constant.
In an interview, one man, 34, who had pain for years before finding treatment that helped, said, "I never would have been an end-my-life kind of person, but if I got run over by a car I wouldn't have been that disappointed."
Treatment may involve physical therapy, daily medication, nerve-block injections, counseling, lifestyle changes and, as a last resort, surgery. It can take months, or longer.
Dr. Marvel said that he had treated 66 men in the last three and half years, and that many had already consulted other doctors. Sometimes the trouble starts with biking; a few patients have been bull riders.
Often he finds that patients have not even been examined properly. Pelvic pain often arises from injured or irritated nerves, and diagnosing it may require sensory testing with pinpricks and cotton swabs in the genital area — a type of exam that many doctors are not comfortable performing, Dr. Marvel said.
Regarding the board's ruling, he said: "I'm a little stressed out about it. Obviously I don't want to lose my board certification." Asked if he would continue treating men, he hesitated, then said: "Well, I mean for now, I plan to still see men if I have men who need the care. But I'm not sure."
He added: "We don't really want to fight with the board. But we do want them to see our position, that we're just trying to help these patients who can't get help any other way."
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