Health Organization for Pudendal Education

Hi Everyone,

First, let me say I know very little about human anatomy, except for the tidbits I pick up here and on the web trying to understand PN.

I recently had an MRI performed on my spine in the lumbar and sacral areas.
The report sounds REALLY bad when I look at it. My lumbar discs sound like they are heavily damaged, but I keep hearing it is quite normal for people to have lots of damaged discs with age. I am now 64.

I went to a spine physiatrist and he had a theory that one of those bad discs in my lumbar spine were causing my PN.
Sorry, he showed me the specific region on his cell phone and why he thought this could be the problem, but my head was spinning trying to keep up with what he was saying and I just cannot remember which disc it was. I suppose it's the one that has this on my MRI report.
"There is severe right and mild left neural foraminal stenosis." This was the L2-L3 disc. I have no idea what this means. The severe right neural foraminal stenosis sounds bad though. And my pain is primarily in my right testicle.

Unfortunately, although I liked him and felt he was really trying to figure out what and if these discs could be the problem, I had to stop going to him because all procedures have to be performed at his clinic and it costs me $500 each visit. With all the injections I get I simply cannot afford this.

It seems a lot to ask, so I hesitate. But I've been very forlorn about this lately, and so out of a bit of desperation, I ask.
I'm wondering if folks who know about the spine would be willing to make comments if I put my MRI results for the lumbar region here.

I would really like to understand if my lower spine is really not that bad for my age. Then I can forget about pursuing this theory and go back to a more conventional treatment for PN (if there is such a thing). I'm going to so many doctors and PTs my head is spinning.

It is true that you can have a terrible-looking spinal MRI and have no symptoms, or you can have a great looking spinal MRI with lots of symptoms -- according to an orthopedic surgeon I know. Spinal radiculopathies can cause the symptoms of PN. Dr. Bautrant excluded people who had spinal radiculopathies from being in his study. For a definition of spinal radiculopathy you can see this link: http://www.medicinenet.com/radiculopathy/article.htm

I would not expect a problem at L2-L3 to cause the symptoms of PN because the pudendal nerve typically comes off of S2,3, and 4 but your doctor must have a good reason for believing what he told you. The pudendal nerve is not the only nerve that goes to the testicles. You could google what other nerves innervate the testicles and see where they come off in the spine -- the lumbar area or the sacral area. Some physicians diagnose pudendal neuralgia by pressing on the pudendal nerve via the rectum or the vagina. If you have tenderness along the course of the nerve at the ischial spine or along Alcock's canal that could be a sign of a peripheral nerve problem rather than a spinal problem. But it can be difficult for physicians to distinguish between a spinal radiculopathy and a peripheral nerve problem. What does your PT think?

Violet

Thanks so much Violet. You are always such a comfort and a wealth of knowledge on this forum.

Your mentioning that you doubted L2/L3 could be causing the PN, reminded me of a comment the Dr made when he was showing me a horizontal slice of the MRI through one of these bad L disc regions. Imagine 3 circles, one large, and 2 small off to the sides of the big one.
He said the spinal cord was the one in the middle, and off to each side were smaller nerves (nerve roots I guess?). He said these were not the pudendal nerves, but the pudendal nerve did come off of this nerve further down.
The nerve on the left was nice and round as it was supposed to be, but the one on the right was compressed such that it looked like a square and was quite a bit smaller in area than the left. He said my vertebra there had shifted forward and twisted which caused this distortion in the right hand side turning it into a square. He thought this 'squishing' of the right hand nerve might cause symptoms like PN.

My mind was rushing to take it all in and I can't say for sure if he was talking about L2/L3. All of the L's have problems according to the report. I saw the word 'severe' in the L2/L3 disc section and I thought this had to be it, but it could have been one of the others.

My PT thinks very highly of this doctor and was the reason I went to him. I ran his theory by her and she thought it 'reasonable'.

At any rate, he gave me 'blocks' which didn't have much effect on my PN, but my lower back felt better.
Still not sure if I can rule out this 'squished nerve' causing the PN though. Did he inject the right places? These blocks are rather sensitive to placement according to my pain doctor. I showed her the injection points and she thought they were 'weird'. The insertion points were far from the spine and she said, 'they must use very long needles' but had no further comments, so I took that as the injection points were OK.

I'm going to see another spine doctor in network. I need some closure on these discs.

Thanks again Violet,
Skip

Skip, yes you can have a spinal radiculopathy at the nerve roots but I just wouldn't have expected L2,3 to cause PN symptoms. I would have expected S2,3, or 4. I could be wrong though -- I'm not a neurosurgeon! The fact that the nerve blocks at the nerve roots didn't help your PN symptoms also raises a red flag.

Anyway, I hope you can get this sorted out and I think you are smart to get a second opinion.

Violet