Health Organization for Pudendal Education

Hey guys


Just wondering about a constant symptom i have, haven't really heard anyone else describe anything like it.

I get a strange pinching sensation that i can actually target and pinpoint if i press on my perineum/bottom side of the base of my penis.

When i press it feels like i am pinching a nerve or my urethra, i can't quite tell, and i am not pressing real hard.

the feeling starts where my perineum meets the testicles, and i can almost follow that "Tube"(Nerve, urethra?) up past my testicles through to the base of my penis.

It gives a pinching burning sensation that radiates to the tip of my penis as well.

I have circled where i am talking about in the attachment.

When i squeeze my pelvic floor, it also replicates this pain. I believe this symptom is the most annoying at this point, because it seems like the reason why sex is painful, urination is sometimes painful, and if i sit to far forward this spot gets pinched.


Anyone else get this symptom or have any idea what it could be?

Hi,
It sounds like you have found a trigger point for your Prudendal nerve. I would advise you stop irritating it. Have you seen a Pelvis Floor Therapist yet?

I have seen a PT, but she doesn't really understand the pain i am trying to describe.

There are 2-3 trigger points she has found in my pelvic floor, all which are excruciating, but none that replicate this pinching sensation. And they always come back the next week at therapy again.

Joe, pinching sensation is one of the possible symptoms of pudendal neuralgia. You might find some helpful info on Dr. Dellon's website at dellon.com>pain solutions tab>download chapter 12 for free. There is a lot of info on pudendal anatomy. Also Dr. Dellon and his colleagues published an article (see below) on pudendal nerve anatomy. Unfortunately patients who have undergone surgery from Dr. Dellon and Dr. Aszmann who have reported results on this forum haven't seen a lot of success so I'm not suggesting you go have surgery but thought you might be interested in the anatomy info.

http://www.ncbi.nlm.nih.gov/pubmed/16286101

Urology. 2005 Nov;66(5):949-52.
Anatomy of pudendal nerve at urogenital diaphragm--new critical site for nerve entrapment.
Hruby S, Ebmer J, Dellon AL, Aszmann OC.
Source

Department of Surgery, Danube Hospital, Vienna, Austria.
Abstract
OBJECTIVES:

To investigate the relations of the pudendal nerve in this complex anatomic region and determine possible entrapment sites that are accessible for surgical decompression. Entrapment neuropathies of the pudendal nerve are an uncommon and, therefore, often overlooked or misdiagnosed clinical entity. The detailed relations of this nerve as it exits the pelvis through the urogenital diaphragm and enters the mobile part of the penis have not yet been studied.
METHODS:

Detailed anatomic dissections were performed in 10 formalin preserved hemipelves under 3.5x loupe magnification. The pudendal nerve was dissected from the entrance into the Alcock canal to the dorsum of the penis. The branching pattern of the nerve and its topographic relationship were recorded and photographs taken.
RESULTS:

The anatomic dissections revealed that the pudendal nerve passes through a tight osteofibrotic canal just distal to the urogenital diaphragm at the entrance to the base of the penis. This canal is, in part, formed by the inferior ramus of the pubic bone, the suspensory ligament of the penis, and the ischiocavernous body. In two specimens, a fusiform pseudoneuromatous thickening was found.
CONCLUSIONS:

The pudendal nerve is susceptible to compression at the passage from the Alcock canal to the dorsum of the penis. Individuals exposed to repetitive mechanical irritation in this region are especially endangered. Diabetic patients with peripheral neuropathy can have additional compression neuropathy with decreased penile sensibility and will benefit from decompression of the pudendal nerve.

PMID:
16286101
[PubMed - indexed for MEDLINE]

I don't have major pain in the region described by you (unless I am sitting for a while), but it hurts badly if I press along the length of the dorsal nerve and goes all the way into the perenium. This seems to be a classical PN/PNE symptom (tinel sign) and this was one of my earliest symptoms that started way back in 1989.