Looking for advice - penile pain

[Tazar]

Hello!

I am very sorry for my bad english, it is not native for me.

Please be kind to give me an advice of how to solve my problem.

I am 26 old male, live in Moscow, Russia. I experience some burning pain at the tip of my penis.

First time in 2009 the pain (score 5-6 out of 10) lasted for 6 month. During that time i consulted with several urologists and neurologsts, but they found nothing, exept spinal problems at L4-S1 lvl (hernia). The pain was constant, i felt it even in lying position. The only relief was to touch the penice, it gave 3-5 sec pain break.

One day the pain disappeared and i dont understand why, i just wake up one morning and it was gone. It was a great relief for me and i forgot about it untill th summer 2013. The pain came back for one month in july. This time it was (3 out of 10), i could hardly notice it while standing or lying. The only problem was sitting. While sitting at office the pain growed, sometimes to lvl 4 out of 10. Again the pain dissapeared in august.

The last part of my story started in september, the pain came back again. My current symptoms are: 1) main is burning pain in the tip on my penice on the right side - this pain is hardly noticable when i walk or sleep, but it grows when i sit at office or drive a car (score 3-rarely 4 out of 10), strangely when i sit at toiet the pain dont grow like when siting at office chair 2) sometimes it is painful to urinate 3) some problems with potention, but i think it is more the psyhological problem.

It is quite a pity, that local doctors dont know about PE or PN, and they cant explain the cause of my pain. I have succesfully passed all urological tests, and at last doctors said that my hernias at lvl L4-S1 cause this pain.

Last week i found a very good PT (he specs in spine problems, helped many people to avoid operation).He tested my muscles and said that my pelvis muscles are in very bad condition (too weak, internal organs tend to fall down into pelvis), all the spine is not working correctly due to the weak pelvis. He suggested working with my pelvis muscles 2 times a week to return them to normal condition. The problem is that i am frst in his practice with penile pain, he knows how to work with patients with leg and spine pain, he also knows a lot of exercises to strenghten pelvis muscles, but he cant say for sure that this exercises will fit my conditions.

We tried some of the pelvis muscle exercises and i immediatly felt some changes in my pain - it has become more noticable while standing still and lying, it was quite annyoing, but the pain lowered the next day to pervious state.

I have come to the coclusion that exercises had direct effect on muscles that cause my pain. Due to their poor condition and spasms the exercises casue them to overload and make the pain harder for 1 day. I hope it is possible to continue exercises and they will strenthen my pelvis muscles and they will stop pushing my nerve.

Yestrday while trying to explore the mechanisms of penile inervation i found pelvicpainrehab.com and pudendalhope.info site and read a lot of usefull information.

I dont have a medical education, and it sems that there are no proper specialist in Moscow to consult me about the strategy of how to fight against my pain. I aspire to understand the cause of my pain and to find a way to struggle against it.

For now i have some questions, that i cant find the answers. I would thank you ever so much if you can explain me:

1) can hernias at level L4-S1 cause this penile pain? I am curious that the pain is only at the tip of my penis, and that it changes intensivity according to my position (3 of 10 while sitting, tending to grow, especially while driving; 0-1 while lying or walking)? According to my sympthomes is it possible to assume where is the problem - in spine or in pelvis?

2) I dont understand why my pain dissapeared twice? I assume that my muscles in pelvis cause nerve tension and somehow they relaxed and thus give me relief from pain. If this theory is possible - the way to solve the problem is to do special exercises on pelvis muscles? I am little bit affraid that my first exercises with PT on pelvis muscles resulted in more penile pain, but pain lowered the next day. Is it possible that muscles are in so bad condition that they quickly overloaded and caused more nerve tension? I am willing to continue training with PT, and i hope that it is the right way to deal with pain.

3) I dont understand why even a little change in the position of my penice brings relief?

4) The last question - am i right that i have PN?

I'll be very grateful if you could help me deal with my condition.

Sincerely, Alexander.

[janetm2]

Welcome Alexander,
I can only provide some information to start and others should be able to add when they see you post. Hernias have similar symptoms to PN. Sitting pain is a PN symptom with toilet sitting being less painful or pain free. PT can help if it is a muscular issue but if it is PNE PT will not help (surgery is usually required to release the entrapped nerve). The general guidance is to try PT from a PN aware PT but you may be getting the best local help with your PT at least knowing about pelvic muscles. Also rule out and fix everything else like spine, hernias, labral hip tears, and tarvlov cysts (this was found on an MRI). Althouggh PT suggested my nerve was entrapped between the two ligaments only the PN/PNE Doctors can diagnose. The get info from your history, nerve blocks and sometimes MRN or MRI, and a few other tests. The faqs on the homepage have information on steps to take, medicines that can help and various other topics. The doctors are listed off the homepage and would require travel from your homeland - as you said it is a pity there is not more medical help. This website and members have a good collection of information to help you. Good luck.
Janet

[rick]

Hello,

I have had penile burning pain on and off for years.

Difficult to manage, seems to be related to bladder spasms.

An antispasmodic has helped me greatly.

Tried vesicare, too constipating.

I now use oxybutynin-xl, 10 mg x 2. Helps a lot.

Rick

[Violet M]

Alexander, the pudendal nerve typically comes off of S2,3,4 but there can be variations in anatomy so sometimes it's hard to say whether a herniated disc is the problem. It can also be difficult to tell whether the pain is caused by a nerve entrapment or other things like tense pelvic floor muscles. Your pain sounds like it is in the distribution area of the pudendal nerve which innervates the penis. If your pelvic floor muscles are already tense and overly contracted, strengthening exercises can cause them to contract more and aggravate the pudendal nerve which runs in a canal between the obturator internus and the levator ani muscles. If you could find a PT, man or woman, who does myofascial release of the pelvic floor and can press on the pudendal nerve via the rectum that might help you sort this out. Also, check out the article on the Nantes team criteria on the symptoms page of the website at pudendalhope.org near the bottom of the page. According to the article, sitting pain is one of the common symptoms of PNE.

Best,

Violet