block for painful scrotum?

[nerven]

hi.
my scrotum is burning for years. meanwhile i have been no life. it is a weird condition that my mind and body feels like paralyzed. i cannot do something productive and have quit a job. i depend on past savings and parents. i am 31 now. i talked to an anesthetician and he said he can do it. he talked about something about sacro-iliac nerve but i am unsure. i searched and see that pudendal nerve branches to dorsal and scrotal nerve so it should be about pudendal nerve. i will see him again. any information and advice would be helpful.

[Violet M]

I'm sorry this has made your life very difficult.

This link has an excellent description of innervation of the scrotum.

http://emedicine.medscape.com/article/82983-overview

According to the article, "The scrotum is innervated anteriorly by the ilioinguinal and genitofemoral nerves, while the posterior portion of the scrotum is innervated by the perineal branches of the pudendal nerves."

So you could try blocks of the pudendal nerve, ilioinguinal nerve, and genitofemoral nerve. Obviously you would need to do each of these nerve blocks at a different time to see if one of them provided temporary relief. This would help your doctor diagnose which, if any, of these nerves is affected.

Violet

[nerven]

thank you for your answer.
burning part is only the skin. do you know anything about the skin nerves, i.e. are the glans and scrotum skin nerves branch differently?

[Violet M]

The scrotal skin is innervated by the perineal branch of the pudendal.

http://pmj.bmj.com/content/63/741/521.full.pdf

According to the following scholarly article, the glans penis and frenulum are innervated by a branch of the pudendal nerve called the dorsal nerve, and the frenulum is also innervated by the perineal branch of the pudendal nerve.

http://www.ncbi.nlm.nih.gov/pubmed/10037378

Since pain can be referred and there may be overlap in some of the innervation it can be tricky to diagnose exactly which nerve and which branch of the nerve is involved, and whether the nerve is the primary source of irritation or whether there is another source of irritation.

Do you have the option of trying physical therapy from someone trained in treating pudendal neuralgia?

[nerven]

Thank you for your findings.
Pain doesn't vary according to external factors, it is completely internal, constant, goes off sometimes and then comes back eventually. There is no visible sign.
I doubt that physical therapy would work in this case. Do you still recommend?

[Violet M]

It seems like it would be worth it to at least have an evaluation by a PT to see if the pelvic floor is involved at all -- or if there are any mechanical issues contributing to your symptoms. But I don't know that much about your history, etc. You have to follow your own instincts.

Violet