I had Dr. Dellon cut the perineal branch of my pudendal nerve several months ago. I was up and walking the next day with what I figured must just be surgical pain. It wasn't.
Although my primary trigger point had been in my left perineal area, and that spot is just barely tender now, my left testicle pain (pre-and post orchiectomy) persists.
I've had no real new urinary issues. My urologist found prostate cancer when trying to find the source of my pain, so I have had a prostatectomy. There is minimal numbness in perineal area. Dr. Dellon said that is because I still have my posterior femoral cutaneous nerve and inferior cluneal nerves.
I flew out the day after my surgery and experienced unbelieveable swelling in my penis due to the pressure change in the plane. Scary, but it went away after a while. My main complaint is that I have had major penile shrinkage. Not sure if that is from the surgery, but it's certainly new.
Right before I left to have the surgery, I went in for a nerve block with my pain doc. I had intended to have him block the left posterior cutaneous femoral nerve, thinking that if it DIDN'T help, I'd be confident the pudendal nerve was the problem. I'd had the pudendal nerve blocked once before, but he used so much of the numbing agent that my hwole left leg went numb. At that time, the thinking was that my problem was pelvic floor dysfunction. That meant that I didn't pay all that much attention to the pain I was feeling and was focused on rushing to see my PT and see if I felt and different internally to her, which I really did not. At the time of the second block the doctor said if it was him he would numb the pudendal nerve to prove the surgery was likely going to help. So I did that and my pain was gone. GONE! For the first time in three years! I even ran into a McDonalds just to sit on their hard plastic chairs to see what it felt like to not be in pain! Of course, that relief only lasted for a couple of hours.
Long story shortened - I am glad I had the $15,000 (out-of-pocket) surgery.When I have really bad days, I remember what bad days used to be like. The knife in the perineum pain is less, but I still have that damned constant ache and the sharp pain that feels like it is going into my soul.
A few weeks ago, I had my first ever bout of sciatica. The sciatic pain was really bad for a few days, but as it lessened I noticed the left side of my left foot and left heel had gone numb (S1), and has stayed numb. I know from a 2009 Lumbar MRI that I have a bulging (toward the spine) spinal disc at the L5-S1 location. I repeated the MRI and it showed the L5-S1 nerve is causing "mild left neural foraminal narrowing". My next two higher discs now have small bulges as well.
It was very interesting to read the part of the post by nyt that said: “The pudendal nerve originated from the S2 to S4 foramina, exited the pelvis through the greater sciatic foramen, traversed Alcock's canal, and branched to innervate the external anal sphincter, the external urethral sphincter, the perineal musculature, the clitoris, and the skin.”, I thought the pudendal nerve originated as L5-S1???
My pain doc is of the opinion that since the nerve block he did (where I was pain free) was away from the spine, that the source of pain was PROBABLY further away from the spine than the injection point. He said he has always wondered if enough of the numbing agent was able to seep back toward the spine.
I went to DiagnosisPro.com, a very interesting website that provides differential diagnosis techniques for single or multiple symptoms. I came up with two potential causes for BOTH sciatica and unilateral testicle pain: (1) Piriformis Syndrome, and (2) Ischial Tunnel Syndrome.
Both are diagnosed by EMG using something called the FAIR Test - Delay of H-reflexes in
flexion.
adduction and
internal
rotation.
Apparently, 15% of all people have their sciatic nerve pass through the piriformis muscle. (I've already tried botox in my left piriformis muscle but got no relief.)
Ischial Tunnel Syndrome involves entrapment of the sciatic nerve as it passes by the ischium. "The pudendal nerve may be separately involved". Reference
http://www.sciatica.org.
I am going to see an osteopathic doctor about this next week.
I started a new topic regarding the FAIR test.
http://www.pudendalhope.info/forum/view ... =36&t=3605