Health Organization for Pudendal Education

Posted: **Fri Nov 22, 2024 9:14 pm**

Hello,

I’m reaching out to share my complex journey with chronic pain and seek advice from others who may have similar experiences. Over time, I’ve experienced various symptoms affecting multiple areas:
• Perineum pain, particularly at the base of my scrotum, with a slight burning sensation.
• Chronic scrotal pain.
• Pain at the back of my thigh.
• An aching sensation in my heel.
• Pain behind my knee, where the hamstring and calf connect, especially when crouching.
• Pain at the tip of my penis, primarily on the right side.
• Loss of sensation in certain areas.

I’m an active individual, going to the gym daily, and I’ve wondered if my high pain tolerance has contributed to the progression of these issues. I’m at a point where I’m considering surgery as my quality of life is deteriorating and I can’t fathom things getting worse then where they are currently.

I’ve been diagnosed with bilateral pudendal neuralgia, pelvic floor dysfunction, and bilateral neuropathy of the posterior cutaneous nerve of the thigh. I’ve also been on medication for about six months, including gabapentin and baclofen.

Considering surgery has been on my mind, but I wonder whether addressing my pelvic floor dysfunction first would be more effective, or if both should be tackled at the same time. I’ve consulted with various specialists, including Dr. Michael Hibner, who suggested Botox as a treatment option. However, I’m uncertain about the best course of action.

I’ve also consulted a doctor in Russia, Dr. Organes Dilanian, who, alongside a team of specialists, identified scar tissue. This finding has added to my uncertainty, as I’ve been told by others that scar tissue isn’t visible through an ultrasound.

Given my ongoing symptoms and the mixed information I’ve received, I’m feeling lost about the next steps. I’m eager to hear from others who might have faced similar challenges or have suggestions on how to navigate these complex issues. Any advice or shared experiences would be greatly appreciated.

Symptoms:
- Pain in the tip of the penis (predominately a dull ache on the right side and hurts to the touch)
- Discomfort
- intermediate pain in the side and back of the thighs
- Scrotal pain
- intermediate pain during defecation (stabbing pain)
- Loss of sensation in the tip of the penis

Current medication:

- Gabapentin 1500 mg/day
- Baclofen 30mg/day

Diagnosis:

- Pelvic floor dysfunction and myofascial syndrome
- bilateral pudendal neuralgia
- bilateral posterior cutaneous nerve of the thigh neuropathy

Best of health to everyone

Posted: **Fri Nov 22, 2024 11:27 pm**

Hello,

I'm sorry to hear you are on this journey. I can relate to your love for being active as weightlifting is what got me into trouble.

I'm not sure what the best course of action would be for you, but I do have a couple of questions and ideas that might help you with your decision. What type of surgery are you considering? If you are considering pudendal nerve decompression surgery, you would want to be quite certain you have pudendal nerve entrapment (PNE) and not just pudendal neuralgia before going ahead with surgery.

Betterdayscoming wrote: ↑Fri Nov 22, 2024 9:14 pm I’ve also consulted a doctor in Russia, Dr. Organes Dilanian, who, alongside a team of specialists, identified scar tissue. This finding has added to my uncertainty, as I’ve been told by others that scar tissue isn’t visible through an ultrasound.

Was the scar tissue identified by Dr. Dilanian's team discovered via ultrasound? If so, you could consider an MRI too if you haven't already done one. I had MRI's of the lumbosacral area and the lumbosacral plexus. It's important to rule out anything obvious in those areas. You can now get an MRI of the pelvis that enhances the images of the nerves and can sometimes show scar tissue/entrapment of the pudendal nerve. I don't know where you live but if you go to our website at pudendalhope.org and from the homepage go to the list of doctors you can find Hollis Potter's contact info in the US doctors and find out if there are any doctors near enough to you who use her MRI protocol. If you already have scar tissue, having surgery could potentially cause more scar tissue. Does your doctor have a plan to prevent more scar tissue from forming and just re-entrapping the nerve? Some people tend to form more scar tissue than others.

Even MRI's don't always show an existing entrapment so it's important to have pudendal nerve blocks before considering PNE
surgery. How you respond to nerve blocks can indicate whether you might have an entrapment. You may want to read the Nantes Criteria for determining if you have a nerve entrapment.
https://www.pudendalhope.info/wp-conten ... iteria.pdf
I don't agree with the criteria 100% but it is sort of a guide for helping you to determine whether to have surgery. Entrapments often present as unilateral pain.

Since you have a diagnosis of pelvic floor dysfunction, I'm assuming you've been evaluated by a pelvic floor physical therapist? If so, did they find any contributing factors such as sacroiliac joint dysfunction, pelvic misalignment, or hypermobility? If your pelvis isn't stable, the ligaments can press on the pudendal nerve and entrap it. This might not show up on an MRI or ultrasound. When they do a rectal exam and press on the pudendal nerve at the ischial spine is there tenderness there? That can be a sign of nerve entrapment. Does internal myofascial release help or does it irritate the nerve more? One of the ways I decided I had a nerve entrapment was that internal work caused a major flare-up of the nerve instead of calming down the muscles.

Sorry for so many questions. I am not trying to get you to answer them here, but just throwing them out there as things you would want to consider before heading into surgery. Another question you want to ask yourself is whether your pain and life are so bad that you are willing to risk getting worse with surgery or Botox. Usually people do fine with treatment but there are some slight risks involved and you need to know what those are from your doctor before you go ahead with treatment.

Wishing you the best with your decision.

Violet

Posted: **Mon Nov 25, 2024 6:54 am**

Hi Violet,

Thank you so much for taking the time to write such a thoughtful reply. I’ve been following this forum for over a year now, just reading everyone’s stories, and I finally decided it was time to share mine and ask for advice. I also want to say how much I’ve appreciated your replies over the years they’re so full of care and thoughtfulness, and it really shows how much you want to help. It means a lot to me and, I’m sure, to everyone else here.

To answer your questions:

The type of surgery I’m considering is transgluteal decompression with Dr. Aszmann. It feels like a big step, but the scar tissue they found has been a major push for me. Dr. Dilanian’s team seems pretty confident that scar tissue is involved, and after dealing with this for eight years (I’ve had symptoms since 2016), I can’t ignore how much worse things have gotten. I’m 24 now, and the idea that pelvic floor spasms or myofascial issues could have caused scar tissue compressing my nerve really resonates with me. I’ve read that surgery becomes less successful after the ten-year mark, and with my symptoms getting exponentially worse over the past two years especially in the last eight to ten months I feel like I need to act now if it’s the right option.

Yes, the scar tissue was identified via ultrasound, and I also had an EMG with Dr. Dilanian’s team. The EMG confirmed nerve-related issues, which adds to my belief that surgery might help. I also had an MRI of my pelvis and lumbar spine, but nothing significant showed up there. I’m not familiar with variations of pelvic MRIs, but I’ll definitely look into Hollis Potter’s protocol as you suggested thank you for pointing me in that direction!

I understand the concern about surgery potentially causing more scar tissue, and it’s something I’ve thought a lot about. I do trust Dr. Aszmann he has a strong reputation and is known for his expertise—but I haven’t had a chance to discuss the specifics of the surgery with him yet. I’ll be sure to ask about how he plans to manage the risk of scar tissue formation when I meet with him.

Regarding pelvic floor dysfunction, I’ve been diagnosed with it, but I haven’t worked with a pelvic floor physical therapist yet. Ironically, I was supposed to have my first appointment tomorrow, but my therapist got sick, so it’s been rescheduled for next Monday. I’m definitely looking forward to it. Honestly, I’ve avoided pelvic floor therapy for a while because it wasn’t something Dr. Dilanian’s team emphasized, and I’ve read a lot of mixed success stories about it. Part of me feels like my issue isn’t that simple, and with how long this has been going on, I’m worried that therapy alone won’t be enough. That said, I know I need to explore every avenue, and I’m keeping an open mind going into this appointment.

As for internal myofascial release or anything like that, I haven’t tried it yet, so I can’t say if it helps or makes things worse. A lot of the questions you raised about contributing factors like pelvic misalignment, SI joint dysfunction, or hypermobility are things I plan to discuss with the physical therapist when I see them.

And please don’t apologize for asking so many questions! I actually really appreciate how thorough you are it shows how much you care, and it’s helping me think through everything I need to consider. This whole journey has been overwhelming, and having someone like you guide me with such thoughtful questions means so much.

Thank you again for your kindness and support. I’m sure I speak for everyone here

Posted: **Tue Nov 26, 2024 7:14 am**

I'm sorry to hear you are going through this at such a young age -- not that it's good at any age, but you have so much of life to look forward to. I sincerely hope you find a treatment that works for you. Dr. Aszmann has a good reputation from what I have read so I expect he will be able to advise you well. Does he require diagnostic pudendal nerve blocks before doing surgery? I don't know of many people who got permanent relief from them, but they can be a valuable diagnostic tool to confirm your diagnosis. New guidelines by some major organizations are showing that there is no evidence for using steroids in them.

Regarding PT, I think sometimes just the thought of being assigned a bunch of exercises, which is what often happens, is not appealing. I don't think pudendal neuralgia is something that calls for a lot of exercise. But it would make sense to at least be evaluated by a PT who knows what they are doing just to be sure you haven't overlooked something. But I agree, if you have been battling this for several years now and you are getting worse, you don't want to waste a lot of time on PT unless it's obviously helping right away. I knew pretty quickly that it wasn't helping and I moved on to surgery.

Since you've already had MRI's and the ultrasound did show scar tissue, I'm not sure I would spend a lot of time and effort on another MRI if everything is pointing to a nerve entrapment, especially since it sounds like you don't live in the US and it would be really hard to travel here for a specialized MRI.

Hope to hear some good news from you before too long.

Violet

Posted: **Wed Dec 04, 2024 5:01 am**

Betterdayscoming,

Have your doctors imaged both your lumbar spine and your pelvis (which would show your sacrum)? I asked because spine issues in these areas can create waist down symptoms like you have and it may be good to rule them in or out before considering PN surgery. I am sorry you have been dealing with these issues for so long and at such a young age.

Stephanies

Posted: **Fri Oct 09, 2026 2:33 am**

Hello Violet,

I hope you’re doing well. It’s been a long time since we last spoke. I lost access to my account, and I’ve spent that time actively working on my health.

I did about a year of physio, and it genuinely helped. I improved noticeably over time, and there were stretches where I felt almost pain-free for days at a time. Other periods I’d feel good for a couple of weeks, but there was always some lingering pain, short spurs of stabbing pain in the back of my thigh or discomfort in my scrotum but overall I was doing quite well. Flares happen here and there still.

This month, though, I’ve had a couple of flares, and they’ve really taken a toll on me. My foot pain gets much worse when my symptoms are active, which shows me the two are connected. I’m now seriously considering surgery.

What makes this decision hard is that when I’m not flaring, my quality of life is pretty good, and I’m not really thinking about my pain. I go to the gym daily, I can deep squat without any problem, and I can sit for hours. Sitting is honestly not an issue for me at all.

My flares can last for a few days but usually a couple of weeks.

During flares, my symptoms include:

Pulsating pain in my penis that comes and goes (only during flares)
Decreased sensation in my penis. This had gotten worse over time and then slowly improved, but whenever I flare, I notice the sensation drop again
Scrotal pain
Pain in my right heel
An aching pain on the right side of my penis, which is where my ultrasound showed significant scar tissue
Pain behind my thighs, under my buttocks
Stabbing pains in the back of my thigh

Most of my pain is on the right side, or at least much worse on the right. I do have all the same pain on the left as well, except for the foot pain, including pain in the back of my left thigh and in my scrotum.

My biggest fear isn’t the surgery itself. It’s having my sacrotuberous ligament cut. I understand Dr. Aszmann partially severs it, but I’d really like to preserve it completely if that’s at all possible.

I also want to say how grateful I am for Dr. Aszmann. My experience with him has been flawless. He’s an incredibly compassionate and knowledgeable doctor. At one point, when my symptoms were improving and I was having good stretches, he advised me to hold off and keep a pain journal. Not long after, my pain got much worse, and I found myself leaning heavily toward surgery again.

I know this was a long message, so I’ve summarized my questions below.

My questions:

Is it possible to have pudendal nerve decompression without cutting the sacrotuberous ligament at all?
Would a transischiorectal approach change anything, particularly in terms of preserving the ligament?
Based on my symptoms, is there any way to tell where the entrapment is likely located?
If the entrapment site can’t be pinpointed, is the transgluteal approach the best option since it gives access to the entire nerve?
Does the transgluteal approach provide full access to Alcock’s canal?
I drive about 30,000 miles (50,000 kms) a year for work and currently have no pain when sitting. Once the incision has fully healed, is sitting pain after surgery likely to come only from the surgical site, or could the surgery itself cause ongoing sitting pain?
Who do you consider the best surgeons for this procedure based on the forums and my symptoms?

Also if you know anybody who's had similar symptoms to me I'd love to touch base with them as well.

Thank you so much for your time, as always. I’m truly grateful for all the work and effort you put into this forum, and I hope everyone here is doing well.

Warm regards,
Betterdayscoming

Posted: **Fri Oct 09, 2026 9:53 pm**

I don't know if this helps but for most people cutting the ligaments involved isn't a problem. Its only during surgery they will be able to say for certain, if entrapment is present but if you are going for surgery, I'd advocate releasing the nerve as much as possible to try and get the best possible result. Its also impossible to be certain where the entrapment is prior to surgery as the pain can be distal to the site of compression.

There are risks but its uncommon to get worse, particularly with an experienced surgeon. I would ask what they feel the risk of complications in your case. Only you can decide whether the potential benefits outweigh the potential risks. It sounds as though you have tried other forms of treatment and they haven't been ultimately effective. Physiotherapy can only relax your pelvic floor, it cannot decompress a nerve so you should factor in what and whether all other conservative methods have failed. The other thing to consider is you may get a better result from treatment you've already tried, after surgery.

You may want to ask which surgery approach is best, or potentially what this particular surgeon offers. Not every surgeon does every possible approach but I understand most offer laparoscopic, whilst some still favour the transgluteal approach and some offer both approaches.

A nerve block is usually a helpful indicator of surgical success and whilst I very much knew surgery was my only option from the start, I think the only question you need to ask yourself is what your quality of life currently. Many people said to me, what happens if I got worse. I could only make my decision based on my circumstances at the time.

Also, for me pain killers were a complete waste of time and I don't really consider trying to mask a problem, actual treatment. In fact I would call it gaslighting.

Good luck, keep fighting.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Hello Violet,

I hope you’re doing well. It’s been a long time since we last spoke. I lost access to my account, and I’ve spent that time actively working on my health.

I did about a year of physio, and it genuinely helped. I improved noticeably over time, and there were stretches where I felt almost pain-free for days at a time. Other periods I’d feel good for a couple of weeks, but there was always some lingering pain, short spurs of stabbing pain in the back of my thigh or discomfort in my scrotum but overall I was doing quite well. Flares happen here and there still.

This month, though, I’ve had a couple of flares, and they’ve really taken a toll on me. My foot pain gets much worse when my symptoms are active, which shows me the two are connected. I’m now seriously considering surgery.

What makes this decision hard is that when I’m not flaring, my quality of life is pretty good, and I’m not really thinking about my pain. I go to the gym daily, I can deep squat without any problem, and I can sit for hours. Sitting is honestly not an issue for me at all.

My flares can last for a few days but usually a couple of weeks.

During flares, my symptoms include:

Pulsating pain in my penis that comes and goes (only during flares)
Decreased sensation in my penis. This had gotten worse over time and then slowly improved, but whenever I flare, I notice the sensation drop again
Scrotal pain
Pain in my right heel
An aching pain on the right side of my penis, which is where my ultrasound showed significant scar tissue
Pain behind my thighs, under my buttocks
Stabbing pains in the back of my thigh

Most of my pain is on the right side, or at least much worse on the right. I do have all the same pain on the left as well, except for the foot pain, including pain in the back of my left thigh and in my scrotum.

My biggest fear isn’t the surgery itself. It’s having my sacrotuberous ligament cut. I understand Dr. Aszmann partially severs it, but I’d really like to preserve it completely if that’s at all possible.

I also want to say how grateful I am for Dr. Aszmann. My experience with him has been flawless. He’s an incredibly compassionate and knowledgeable doctor. At one point, when my symptoms were improving and I was having good stretches, he advised me to hold off and keep a pain journal. Not long after, my pain got much worse, and I found myself leaning heavily toward surgery again.

I know this was a long message, so I’ve summarized my questions below.

My questions:

Is it possible to have pudendal nerve decompression without cutting the sacrotuberous ligament at all?
Would a transischiorectal approach change anything, particularly in terms of preserving the ligament?
Based on my symptoms, is there any way to tell where the entrapment is likely located?
If the entrapment site can’t be pinpointed, is the transgluteal approach the best option since it gives access to the entire nerve?
Does the transgluteal approach provide full access to Alcock’s canal?
I drive about 30,000 miles (50,000 kms) a year for work and currently have no pain when sitting. Once the incision has fully healed, is sitting pain after surgery likely to come only from the surgical site, or could the surgery itself cause ongoing sitting pain?
Who do you consider the best surgeons for this procedure based on the forums and my symptoms?

Also if you know anybody who's had similar symptoms to me I'd love to touch base with them as well.

Thank you so much for your time, as always. I’m truly grateful for all the work and effort you put into this forum, and I hope everyone here is doing well.

Warm regards,
Betterdayscoming

Posted: **Sun Oct 11, 2026 2:49 am**

Hello Betterdayscoming,

I'm sorry to hear you are still on this difficult journey. I will give you what information I can and hopefully it will give you some ideas.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am My questions:
Is it possible to have pudendal nerve decompression without cutting the sacrotuberous ligament at all?

Yes, Dr. Bautrant used to do this using the transischiorectal fossa approach. I don't know of any surgeons who are still using that approach but the laparoscopic approach, which many surgeons are using now, gives the option of either cutting just the sacrospinous ligament or cutting both the sacrospinous and sacrotuberous ligaments. You can read more about it in Dr. Tibet Erdogru's article.
https://www.pudendalhope.info/wp-conten ... rdogru.pdf

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Would a transischiorectal approach change anything, particularly in terms of preserving the ligament?

Yes, it would preserve the sacrotuberous ligament but I don't know of any surgeons using that approach as I mentioned above. My understanding is that it is one of the more difficult pudendal nerve decompression approaches to perform.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Based on my symptoms, is there any way to tell where the entrapment is likely located?

I can't say for sure. That would be a question for an experienced surgeon. Have you had any nerve blocks at either the ischial spine or in Alcock's canal? Your response to those blocks could give a clue as to whether you have entrapment at the ischial spine or in Alcock's canal, or whether you even have pudendal nerve entrapment. By response, I mean temporary pain relief from the anesthetic for a few hours for diagnostic purposes. Since you have symptoms in the penis area there could be dorsal nerve root involvement but your symptoms are also in the scrotal and under the buttocks area so it sounds like it would be more widespread than just the dorsal branch of the pudendal nerve so would likely also involve the perineal branch. My symptoms were primarily from the perineal branch but the main trunk of the nerve was entrapped at the ischial spine and in Alcock's canal. Some of your symptoms are atypical for pudendal nerve entrapment, which doesn't necessarily rule out pudendal nerve entrapment because there are some cases of PNE where the person has no pain with sitting, but you have some right heel pain and back of the thigh pain which could indicate some involvement of other nerves such as the posterior femoral cutaneous. This would be something to ask the surgeon about.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am If the entrapment site can’t be pinpointed, is the transgluteal approach the best option since it gives access to the entire nerve?

Not necessarily. The laparoscopic approach seems to be showing good results, based on a fairly recent publication. https://pubmed.ncbi.nlm.nih.gov/38942945/ As discussed in Dr. Erdogru's publication above, laparoscopic approach can access entrapments in Alcock's canal and the ischial spine which are the most common points of entrapment. It also may be less likely to cause as much scar tissue as the transgluteal approach since it is not as invasive. This could be an advantage if you are prone to forming scar tissue, as evidenced by your ultrasound that shows some scar tissue. This is just my understanding though -- you would want to ask your potential surgeon these questions.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Does the transgluteal approach provide full access to Alcock’s canal?

Yes, according to Prof. Robert's description at the top of page 8 of this article.
https://www.pudendalhope.info/wp-conten ... Robert.pdf

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am I drive about 30,000 miles (50,000 kms) a year for work and currently have no pain when sitting. Once the incision has fully healed, is sitting pain after surgery likely to come only from the surgical site, or could the surgery itself cause ongoing sitting pain?

There is no way to predict with certainty what the results of your surgery will be, but most people don't have a worsening in sitting pain after surgery. If you are worried about incisional pain from the transgluteal approach, you may want to consider the laparoscopic approach.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Who do you consider the best surgeons for this procedure based on the forums and my symptoms?

I can't endorse a particular surgeon but I can say the laparoscopic approach is becoming more widely used and seems to be having good results based on this meta-analysis. https://pubmed.ncbi.nlm.nih.gov/38942945/
I honestly don't know of any "bad" PNE surgeons. Many of the surgeons will do an online consultation, so you might want to consider talking to several of the PNE surgeons and having them answer your questions.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Also if you know anybody who's had similar symptoms to me I'd love to touch base with them as well.

Sorry, I can't think of anyone with your exact symptoms. Since penile pain seems to be one of your primary concerns, you could do a search in the upper right corner to find posts on this forum from guys having that same issue.

Wish I could answer your questions better but hopefully you will be able to find a surgeon who can give you satisfactory answers. I have only heard good things about Dr. Aszmann. I don't know what particular approach he would use in your case but since you have some possible scar tissue already, it might be important to ask how he would prevent more scar tissue forming with whatever surgical approach he would use.

Wishing you all the best and I hope to hear some good news from you in the future.

Violet

Posted: **Sun Oct 11, 2026 2:21 pm**

I think that's a very important point because so few surgeons sadly do the surgery internationally, it does mean the surgeons that do probably build up a lot of experience.

Violet M wrote: ↑Sun Oct 11, 2026 2:49 am Hello Betterdayscoming,

I'm sorry to hear you are still on this difficult journey. I will give you what information I can and hopefully it will give you some ideas.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am My questions:
Is it possible to have pudendal nerve decompression without cutting the sacrotuberous ligament at all?
Yes, Dr. Bautrant used to do this using the transischiorectal fossa approach. I don't know of any surgeons who are still using that approach but the laparoscopic approach, which many surgeons are using now, gives the option of either cutting just the sacrospinous ligament or cutting both the sacrospinous and sacrotuberous ligaments. You can read more about it in Dr. Tibet Erdogru's article.
https://www.pudendalhope.info/wp-conten ... rdogru.pdf

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Would a transischiorectal approach change anything, particularly in terms of preserving the ligament?
Yes, it would preserve the sacrotuberous ligament but I don't know of any surgeons using that approach as I mentioned above. My understanding is that it is one of the more difficult pudendal nerve decompression approaches to perform.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Based on my symptoms, is there any way to tell where the entrapment is likely located?
I can't say for sure. That would be a question for an experienced surgeon. Have you had any nerve blocks at either the ischial spine or in Alcock's canal? Your response to those blocks could give a clue as to whether you have entrapment at the ischial spine or in Alcock's canal, or whether you even have pudendal nerve entrapment. By response, I mean temporary pain relief from the anesthetic for a few hours for diagnostic purposes. Since you have symptoms in the penis area there could be dorsal nerve root involvement but your symptoms are also in the scrotal and under the buttocks area so it sounds like it would be more widespread than just the dorsal branch of the pudendal nerve so would likely also involve the perineal branch. My symptoms were primarily from the perineal branch but the main trunk of the nerve was entrapped at the ischial spine and in Alcock's canal. Some of your symptoms are atypical for pudendal nerve entrapment, which doesn't necessarily rule out pudendal nerve entrapment because there are some cases of PNE where the person has no pain with sitting, but you have some right heel pain and back of the thigh pain which could indicate some involvement of other nerves such as the posterior femoral cutaneous. This would be something to ask the surgeon about.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am If the entrapment site can’t be pinpointed, is the transgluteal approach the best option since it gives access to the entire nerve?
Not necessarily. The laparoscopic approach seems to be showing good results, based on a fairly recent publication. https://pubmed.ncbi.nlm.nih.gov/38942945/ As discussed in Dr. Erdogru's publication above, laparoscopic approach can access entrapments in Alcock's canal and the ischial spine which are the most common points of entrapment. It also may be less likely to cause as much scar tissue as the transgluteal approach since it is not as invasive. This could be an advantage if you are prone to forming scar tissue, as evidenced by your ultrasound that shows some scar tissue. This is just my understanding though -- you would want to ask your potential surgeon these questions.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Does the transgluteal approach provide full access to Alcock’s canal?
Yes, according to Prof. Robert's description at the top of page 8 of this article.
https://www.pudendalhope.info/wp-conten ... Robert.pdf

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am I drive about 30,000 miles (50,000 kms) a year for work and currently have no pain when sitting. Once the incision has fully healed, is sitting pain after surgery likely to come only from the surgical site, or could the surgery itself cause ongoing sitting pain?
There is no way to predict with certainty what the results of your surgery will be, but most people don't have a worsening in sitting pain after surgery. If you are worried about incisional pain from the transgluteal approach, you may want to consider the laparoscopic approach.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Who do you consider the best surgeons for this procedure based on the forums and my symptoms?
I can't endorse a particular surgeon but I can say the laparoscopic approach is becoming more widely used and seems to be having good results based on this meta-analysis. https://pubmed.ncbi.nlm.nih.gov/38942945/
I honestly don't know of any "bad" PNE surgeons. Many of the surgeons will do an online consultation, so you might want to consider talking to several of the PNE surgeons and having them answer your questions.

Betterdayscoming wrote: ↑Fri Oct 09, 2026 2:33 am Also if you know anybody who's had similar symptoms to me I'd love to touch base with them as well.

Sorry, I can't think of anyone with your exact symptoms. Since penile pain seems to be one of your primary concerns, you could do a search in the upper right corner to find posts on this forum from guys having that same issue.

Wish I could answer your questions better but hopefully you will be able to find a surgeon who can give you satisfactory answers. I have only heard good things about Dr. Aszmann. I don't know what particular approach he would use in your case but since you have some possible scar tissue already, it might be important to ask how he would prevent more scar tissue forming with whatever surgical approach he would use.

Wishing you all the best and I hope to hear some good news from you in the future.

Violet

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