Health Organization for Pudendal Education

Ill try to make this as brief as I possibly can.

Ive had some strange sensations in my groin and genital area for about 2 months. Mainly there was transient numbness of the penis and difficulty getting/maintaining an erection. Went to regular doc and she said stress-induced prostatitis (Dx w/o a digital rectal exam), started me on 500mg naprosyn 2x day and doxycycline 100mg 2x day. Over 2 weeks things started to get better and I was able to return to the gym for some light exercise, mostly some walking/jogging, pull ups, and upper body strengthen training. However, I avoided everything that dealt with bending or flexing my hips.

Then last Thursday, I was driving home from class, and I felt myself getting an erection. Immediately, there was moderate pain behind my penis/pubic area, my penis shriveled up, and I lost some sensations. Felt like I sense needing to pee but had to force it to come out. However, there was no dribbling of urine before or after, other than that typical "last drop." My legs also got very weak and began to burn, primarily in the thighs. I went to the closest ER and a urinalysis and pelvis/lower lumbar CT scan was conducted. Everything they did came back normal. Urinalysis was clean. Blood work done 5 days earlier were spotless with only a minor increase in monocytes (11 on a 5-10 scale). Doc (actually a PA in conjunction with the doc) said acute prostatitis with acute unilateral sciatica from the prostatitis. He told me he wouldn't be doing a digital rectal exam as it can make it worse. I mentioned the pudendal nerve to the PA, and he looked completely clueless. I don't think he liked that I was questioning him. I left with a stronger antibiotic scrip to add to my current regimen.

Last night I had pain directly above and behind the penis about 2 hours after (trying to) have sex. This pain was like a moderate throb, much like a muscle that has been pulled and it healing. This morning, I proceeded to the ER (since all my doctors couldn't see me on such notice, despite having had a horrible evening) and they did a full blood work up on me (all clean), and the ER doc did a rectal exam. When she hit my prostate there was a def. sharp pain there, but not doubling me over like I had expected. Since there was pain on palpitation she said it confirmed the prostatitis diagnosis. Told me to stay on the current meds, piled me full of rocephin/xythromax, and sent me on my way. She also got my uro appointment moved from 2 months away, to 2 weeks.

My current symptoms include minor anal "twinges", hard to get/maintain an erection, reduced sensation of the penis, and pain directly above and behind my penis (aka pubic area). The lil' guy down south is hanging about half his normal size. The scrotum seems to be OK, but seems to not be reacting to heat/cold as it should and doesn't seem to have any diminished sensations. The symptoms are mildly worse when sitting, minor while standing, and laying down they come and go. Urinary tract seems OK most of the time with only only needing to "push" to get the flow going. I haven't had an incontinence of either the urinary or defecation systems, even with the antibiotic induced diarrhea.

I am quite familiar with pudendal nerve issues as I had a friend who had temp. pudendal neuralgia from being a hardcore cyclist, but his got better over a few weeks. I also had a single episode of "crotch numbness" when trying to take up cycling years ago, but I never rode again after that. The sensations I had then are not at all like the ones I am having now. I have, over the last year, done some major workouts on the stairclimber and the elliptical trainers as I was training to climb a mountain. But the movements didn't seem like they could cause the pudendal impingement. Since I am "duck footed" and have been my whole life, I considered piriformis syndrome. Then of course we still have prostatitis.

But I am completely clueless and scared to death, Im only 30 years old so the thought that I wouldn't have full use of my genitals in the future terrifies me. Im just really seeking out advice and information from everyone who has been there and is way more knowledgable than I. Any advice, insight, or reassurances would be like striking gold for me right now. I am already a nervous person and this whole situation has been keyed up beyond belief.

I seen the Uro for the first time today. He did a prostate exam and massaged the prostate. Might be the most painful thing I've ever felt. I told him of my concern of Pudendal Entrapment and after a short Q&A he told me that I didn't fit any of the criteria for PN/PNE, but did for chronic prostatitis. He told me the sciatica and the other symptoms are all hallmarks of this illness, but was thinking there was some cross over somewhere. He suggested some massage therapy to help loosen the piriformis up some (he checked it, it wasn't horribly painful, just a twinge) and to keep exercising.

Are you comfortable with the urologist's assessment? Do the prostatitis meds seem to be helping you at all?

If you aren't sure and you want another opinion you might check out a good pelvic physicial therapist who knows about pudendal neuralgia and just see what they think.

Good luck!

Violet

I personally believe that the diagnoses of "chronic prostatitis" is a bogus one. To me, it's some generic term which means "you hurt chronically and in the area near the prostate". Doctors have been misdiagnosing people who have PN for years, and if they are urologists, the common incorrect diagnoses has been chronic prostatitis.

If I were you, I'd go to one of the PN doctors that are listed on this website or on www.tipna.org (you'll have to travel some) and try and appropriately define what your diagnoses really is. To cut down on your travel, you could give us an idea where you live and I/we could point you to someone who could properly diagnose you.

Greg