Health Organization for Pudendal Education

Hi all. I would kindly appreciate your opinion.

2 weeks ago I rode my push bike some 700km in two days. Spending 15 hours in the saddle on average per day. About 3-4 days after begun a slow inscidious onset of a dull ache which would pulsate in my penis and only penis. All surrounding anatomy completely asymptomatic.

It then progressed very quickly to a 10/10 pain. Excruciating, agonising sensation of sharp shooting pain with an associated feeling of extreme sensitivity to friction, almost on fire. I would get about 1 hour of sleep a night when it was this bad. Eventually managed to get into the GP who was not much help other than suggesting lidocaine for pain management. I am largely sceptical of GPs however the lidocaine was a life saver. Gives topical relief and when I was at the peak of pain would apply on an hourly basis. I ended up in hospital the next day at 12 am because I was just convinced something was amiss. The degree of pain was just not fitting what physically appeared normal - and I've a fairly high tolerance of pain.

Thankfully in the lastf ew days the pain has decreased to about a 4/10 however remains constant. I am able to go back to work which is great. It still wakes me up however I can now managed a good 6 hrs of sleep. I only need to apply the lidocaine about 2-3 times a day and I am trying to ween off it as much as possible to gauge the degree of symptoms.

My question is this. Do you think I have developed some form of Pudendal Neuralgia? Does the fact that my symptoms have only lasted for about 2 weeks preclude me from this? My understanding is that PN is a chronic condition (3 months+). I'm trying to remain hopeful as the symptoms are getting better but seems to be the same in the last few days. Not sure if this is hopeful or just me in denial still.

I am from Melbourne, Vic, Australia. If anyone is aware of any medical specialist I should be seeing please let me know below.

The psychological trauma at this point in time is much greater than the physical.

Cycling is the biggest thing I have going in my life and the thought of losing the only thing that brings me joy is terrifying.

Please give me your thoughts and thanks in advance.

Roadcyclist.

Roadcyclist,
Welcome and so sorry about all your pain. Good to hear it is calming down some. We can't diagnose for you but there are some Australian physicians listed off the homepage left column - see the list of doctors then Australia. I would suggest staying off the bike until you know what is going on.
Janet

janetm2 thanks for your response and I will for sure get in contact with one of those practitioners as my symptoms still appear to be persistent.

Have kept off the bike as hard as tempting as it has been.

Kind regards,

Roadcyclist

Good luck and if you get a chance let us know how it goes. Hopefully this is a temporary condition.

Hi Cyclist,

Hopefully this will be temporary for you and you will be able to get back to the bike but if you do, it might be a good idea to consider using a specially designed bike seat.
I had a family member who biked across the US with a group of cyclists raising money for a charity and he used a Specialized bike seat that worked really well.

Roadcyclist wrote:My question is this. Do you think I have developed some form of Pudendal Neuralgia? Does the fact that my symptoms have only lasted for about 2 weeks preclude me from this? My understanding is that PN is a chronic condition (3 months+). I'm trying to remain hopeful as the symptoms are getting better but seems to be the same in the last few days. Not sure if this is hopeful or just me in denial still.

I can't say for sure if you have PN. My understanding is that to be considered chronic pelvic pain, then yes, you would have to have symptoms for several months but any type of neuralgia, including pudendal neuralgia can be very temporary. I know someone who has symptoms that come and go based on their activities. The symptoms may flare up for a short time and then go away. There is no exact pattern of symptoms for people with PN.

In addition to checking out the list of Australian physicians on the homepage that Janet mentioned, you may also want to check out the list of PT's.

Violet

Hi Violet

I've seen some of the cycling/touring routes and scenery in the US and I am very envious of your relative . Thank for your suggestion. I've been madly scouring the internet for like minded cyclist's and the Specialized range of saddles seems to be the way to go. I watched a video where my Fizik Arione branded saddle showed to have 0% blood supply to the perineum region after some minutes!

Specialized have now started to offer body-geometry bike fitting services in recent years and I'll look to have that done before I take another pedal stroke. My position on the bike is very race oriented and where I should be putting pressure on my sitbones is actually displaced on my perineum.

In so far as my situation goes I went back to the GP today and he has relayed my fears and has suggested waiting a good couple of weeks before seeing a specialist. He agrees given my history of activity and also the location and array of symtoms that the pudendal nerve is the culprit. He believes that because my symptoms are showing slow but nonetheless progressing signs of improvement the degree of neurological damage is neuropraxia, advising me that there still is hope this this can recover pain free. I'll take any good news I can get and run with it at this point.

I will keep you all posted on my situation as I am sure there will be at least 1 person in the future who will benefit from knowing what my outcome is.

Kind regards,

Roadcyclist.

During those few weeks you are letting things heal and calm down, please consider finding a second hobby you like.....just in case. I promise you that even if you don't get your life completely back how it was before, that you can find meaning and enjoyment in life. So hang in there, take it easy, and pursue your dreams, remembering that if the door closes on them, there can be other dreams.

Violet