New here. Sitting pain in testicle/pelvic region/hip

[tooyoungforthis]

Hello all!

I've now had this chronic issue for 1.5 years and counting. 27yo male.

My initial symptom was that I get a dull ache in my right testicle when it is under some type of compression like sitting down, wearing tight pants, laying on my stomach. A couple weeks later I noticed a discomfort in my front right hip. I now have tightness when lunging from my quad up through my groin. It seems like maybe an issue with my adductor, as it tends to also be engaged more often than it should. I believe these issues may be related since they came on so close to each other. I also feel a warm radiating pain near where my right sit bone makes contact with the chair. This whole area is disturbed when I sit and standing up immediately relieves this discomfort, although the testicle sensitivity remains as well as the leg tightness/back soreness that has developed throughout the duration of this chronic pain. I can't think of a specific event that triggered this issue, however the week before it came I was sitting on a hard surface which seems to be a cause of these issues. I had an odd issue with an anal fissure 5 years ago and had to have LIS surgery for that which helped, but still suffer from chronic rawness in that area. Does anyone this this may be pudendal related or have any other similar symptoms with testicular discomfort or musculoskeletal hip/groin related issues? My libido has almost completely disappeared in this time and it is completely terrifying at my age. Thanks for any input you have!

I have had the following procedures to rule out certain issues:
hip xray - no hip impingement FAI
hip mri w injection - no labral tear
sports hernia mri - to sign of tears. Sent to sports hernia specialists. MRI did show cyst on right side of sacrum(newest lead). Looks like Tarlov cyst, but all doctors I've talked to say most don't cause issues.
2 testicular ultrasounds - no obvious sign of issue such as varicocele
abdominal ct scan - no sign of problem
urologist visits - anatomy looks fine
nerve blocks - femoral nerve and ilioinguinal nerve blocks seem to help relieve testicular compression pain, however it feels like I'm sort of still sitting on my scrotal contents and need to pull them out of the way. Something still feels tight while sitting
6 weeks of hip/leg strengthening pt - didnt help with pain
pelvic floor pt investigated - physical diagnostic did not recreate pain

[janetm2]

Welcome and so sorry you are having these pains earliy in life.I cannot find the thread but "HerMajesty" had tarlov cyst surgeryand is doing much better. Initially the doctors dismissed it but she pursued it. I am hoping someone else can point you to that info.
Janet

[tooyoungforthis]

Well after waiting 2 months to get into OHSU pain clinic, after an hour appointment of listing my symptoms and treatments they basically told me they didn't want to do anything for me including a pudendal nerve block and listed my symptoms with a "psychological factor"! No shit! After waiting months for appointment after appointment with doctors telling me they don't know what to do with me, it kind of creates a psychological factor! I haven't sat comfortably for 20 months now. Does anyone thing my symptoms could be PN? I'm now seeing a chiropractor to see if he has any ideas since the MD's are all out.

I share a ton of symptoms with this situation actually
http://www.pelvicpainrehab.com/male-pel ... inful-sex/

[Violet M]

I'm sorry but I sort of know how you feel because I was sent to a psychiatrist when my neurologist didn't have a clue. Did they even do a clinical exam or just take your history/symptoms?

Your symptoms are similar to what many people around here have but whether it's PN or not it's hard to say. Did the pelvic floor PT find any pelvic floor tension in the obturator internus or levator ani muscles? The pudendal nerve runs between those and may be tender to touch if you have PN.

So, you mentioned lunging. Are you a weightlifter? That's what got me in trouble. My worst pain was near the sit bone but I also had tight adductors and sore hamstrings.

Violet

[tooyoungforthis]

They did a short physical exam which consisted of checking my reflexes while tapping on my knee joints and such as well as a surface skin sensitivity test on my scrotum. I basically went there to investigate a pudendal nerve block since they do them although very rarely. Since I don't actually have any issues or stabbing pains on the surface skin, I assume this is why they didn't want to do anything with me. The only thing that has sort of helped so far is if i have a genitofemoral nerve block, the testicle compression pain goes away but I am left with some type of discomfort still that feels like I am sitting on my scrotum or something. Or maybe it's that radiating tuberosity pain. It's hard to tell and the nerve blocks only last a couple of hours so it's hard to figure everything out in that amount of time.

The pelvic floor therapist said everything was very tight, but since she couldn't reproduce the symptoms like the radiating pain or the testicular discomfort she didnt conclude that I had an issue there but was open to try therapy to see if it would help. I'm thinking I may end up trying it. One issue is that I had an anal fissure about 5 years ago that required surgery so that area is tender and can cause pain.

Around the time this all began I was doing some leg exercises like weighted lunges and squats but nothing extreme. I can't remember a painful incident.i was also sitting a lot at work and at night so I wonder if not warming up properly or bad posture led to overdoing something. I still have some type of adductor or hip flexor issue that won't heal completely so Im not sure if this needs to clear up to allow the testicle to relax or what.

I wonder if I did something like this quote

This is a *great* piece - maybe the best I've seen on the internet. However, as I can sadly attest to, the following statement is only partially true:"Individuals sometimes attribute testicular pain to Pubalgia, but in reality; the two conditions are unique and separate."They are and they aren't. In my case, (presumed) pubalgia led to, among other things, a genitofemoral neuralgia which masqueraded as testicular pain. Although the pain didn't come from the testicle proper, it may as well have. If you ever develop chronic pain after a horseback riding stretching injury, even decades later, look to the pectineus.

http://www.medwonders.com/medblogs/gene ... ed-829.htm

[Violet M]

Since I don't actually have any issues or stabbing pains on the surface skin, I assume this is why they didn't want to do anything with me.

The pelvic floor therapist said everything was very tight, but since she couldn't reproduce the symptoms like the radiating pain or the testicular discomfort she didnt conclude that I had an issue there but was open to try therapy to see if it would help. I'm thinking I may end up trying it. One issue is that I had an anal fissure about 5 years ago that required surgery so that area is tender and can cause pain.

Sounds like the PT was trying to elicit tinel's sign. The Nantes article states that tenderness, not tinel's sign, is the criteria to look for. http://www.pudendalhope.info/sites/defa ... iteria.pdf That article lists stabbing pain as one of the possible complimentary symptoms present. I never passed tinel's sign test. I never had stabbing pains on the surface of the skin.

Around the time this all began I was doing some leg exercises like weighted lunges and squats but nothing extreme. I can't remember a painful incident.i was also sitting a lot at work and at night so I wonder if not warming up properly or bad posture led to overdoing something. I still have some type of adductor or hip flexor issue that won't heal completely so Im not sure if this needs to clear up to allow the testicle to relax or what.

I had been doing lunges and squats for 2 month when the pain started. Never had pain during the exercises. The pain just slowly got worse over time. This is just my experience and may not be at all helpful to you but I'm saying this because just based on my own experience I would question some of the information you've been given -- that you have to have certain responses in order for it to be considered pudendal related.

If you have tight pelvic floor muscles maybe the right type of PT will help and maybe just being careful (lifestyle changes) will give you a chance to heal. Have you stopped weightlifting?

Violet

[desperate]

Check for an Inguinal ligament compression. Also check and see if you have an occult inguinal hernia. Your symptoms of testicle pain and thigh pain signal this to me. Believe me when I tell you that could be causing all your symptoms. "Could" not "is". Maybe do some tests for this.

[desperate]

Oh and bc you were doing lunges when this happens suggests that you inflamed your Inguinal ligament. Look at the anatomy of the surrounding structures. Do some searches like transversalis fascia, Inguinal ligament etc. You can try and do some psoas stretches and see if it changes any of your symptoms. Remember, your looking for amy change in symptoms. If it makes things worse or better it's still a change. Keep that in mind.

[tooyoungforthis]

Thought I'd give an update on my case. I've been to a couple more physical therapists, an osteopath (useful! I didn't know they existed), and read a few books including Amy Stein's "Heal Pelvic Pain," Wise/Anderson's "A Headache in the Pelvis," and Davies' "The Trigger Point Therapy Workbook." I think these have all helped me center in on where the pain is coming from.

I have 3 sources of pain on my right side only.
1. Testicular compression pain. Hard to pinpoint where, just generally uncomfortable and extra sensitive in that region
2. Sitting pain that radiates near right ischial tuberosity

This case seems to have a lot in common with these symptoms so I have started doing the pelvic floor stretches in Amy Stein's book as well as started Gabapentin which has reduced testicle pain 50% but sensitivity is still there
http://www.medhelp.org/posts/Urology/Re ... ow/1824974
From the pictures I've seen it looks like this radiating pain could be coming from close to the Alcock's canal

3. Chronically sore adductors/hip flexors

The physical therapist and osteopath independently told me that my right pelvis is tilted anteriorly. The osteopath also said my sacrum is slightly twisted out of place. He has made adjustments three times but every time I go back he says everything has slipped back out of place. I believe this is due to the chronically tight and enflamed adductors and hip flexor pulling everything out. I noticed that I also have anterior hip pain caused by snapping hip syndrome where my right psoas snaps across something when returning my leg to the ground out of the frog position while laying on my back.

Its crazy how all of this stuff can snowball but at least I think I'm making progress identifying what is going on. Desperate, you may be on to something with the inguinal ligament, when the PT pushed on mine, it made me jump a little. She then stretched me and the pain went away. The same happened with my adductor attachment points. The psoas tightness may be irritating inguinal ligament. I'm just not sure how to treat all of this stuff. It seems like I need to get my alignment taken care of by getting my adductors/hip flexors to relax and stretch, but they are so sore like I have tendinopathy where they don't heal. Has anyone tried PRP of these muscles? I think if I can take care of those exterior muscles and get my alignment taken care of then maybe my pelvic floor can relax, lengthen and possibly the testicle and sitting pain will slowly fade.

Anyways thought I'd share my story. If anyone can relate or has any suggestions moving forward that would be great, just passed the 2 year mark with this..thanks

[desperate]

Hey buddy,

Reading your stuff sounds a lot like my case. I have a tilted pelvis. It is rotated (twerked). I get regular adjustments and the pelvis just goes back. Continue with the pelvis structure. Probably most important. Takes multiple treatments to stick (sometimes 100 lol).

I have a compression by my inguinal ligament bc of my psoas and pectineus. Focus on your hip flexor stretches. Mine flares me up bUT I know it's my problem. Do some fascia stretches for the illiopsoas. Your adductor are compensating bc of a weakness and tension in your psoas. Your glutes my be inactive as well. Get a therapist to check if both of your glutes activate. Mine is worse on my left. Causing my psoas and adductors to compensate.

Your pelvis tilts bc of the tight hip flexors. The inguinal ligament is highly related to the psoas, pectineus and also the external obliques. Stretch all three. If you have testicle pain most likely it's the hip flexors bc the spermatic cord runs through the transversalis fascia and the inguinal ligament. This is the covering of fascia of the external obliques and the abdominals. You'll be fine one day bro. Just stretch them and slowly you'll get better.

Believe it bro.

-Dom