Health Organization for Pudendal Education

Hi,

I was diagnosed with PN in July. Had all the common symptoms. The doctor prescribed me medicamentation, which indeed helped me. But I still have problems:
- decreased sensation during sex
- sharp pain after hard physic exercises, like snowboarding
- mild pain in my anus .. I can cope with it though

The doctor advice is that the next step for me would be a pudendal nerve infiltration. For me the biggest problem now is not pain, but decreased sensation. I am 27 male, and I feel I m loosing interest to sex as I do not feel anything .. This is the most concerning thing to me. Nerve block may help to relieve pain as I understand, but it cause numbness as well, so sensation may get even worse I guess.

I have read several stories here, and looks like my case is really mild as pain is manageable, and I do not scared to live with it. Should I just wait? As it takes long time to heal .. Or should I go for nerve block?

Thx

Welcome Denar,
So sorry to hear you have this loss. I am not sure how to guide you but just wanted lend you some support and wishes that you can find a good way forward. There are others here that may be able to guide you. Hang in there.
Janet

Hi Denar, welcome.
Heavens, the question are real toughies tonight!
As you say medically that would be the usual 'doctor' next step, although if you haven't tried PN physiotherapy, I would give it a go first rather than the injection. There is a list on the home page for pn aware physiotherapists.
To me, numbness has got to be a nerve issue, not necessarily entrapment of course so diagnostically the injection isn't going to give answers any more than say a good clinical examination would do. You already have a diagnosis too. Of course it may have a therapeutic effect but so might physiotherapy and it's less invasive. I have never heard that an injection can have an effect on numbness, so not therapeutic in that respect.
What does the doctor say? Does he/she say that there could be any effect on the lack of sensation at all with the injection or only an effect on pain?
I would actually love to know the proper medical answer to that one, but would want a good explanation if the reply was yes.
Take care,
Helen

I believe physiotherapy is not my way as i live in Russia, and there is no physiotherapists here in this area. My doctor is in Italy so things are a bit complecated already.

on a 10 scale, i would say i fill 6 or 7 .. Thing is that i do not want to get myself into more trouble after nerve block. What is concerning that the doctor is saying there is no risk at all connected with pudendal nerves infiltration procedure. Is it really so? Any one on the forum who experienced a bigger problem afterwards?

Thank you for the replies

just to add up.. the doctor suggests cortisone nerve block.. reading the forum i saw several posts that steroids may have some negative effects after the infiltration .. even permanent

Denar, welcome to the forum. I have known several people who had worse symptoms long-term after a nerve block but it is not usually the case.

One theory is that if the neuropathy is caused by inflammation then the steroid might cause the inflammation to decrease and allow the nerve to heal. But to be honest, I don't know many people who had significant improvement from nerve blocks. Some physicians consider them primarily diagnostic, not therapeutic.

Do you know what caused your PN symptoms? If you have some kind of mechanical problem such as pelvic misalignment or SIJD dysfunction a nerve block may give you some very temporary relief but the nerve may continue to be irritated by whatever structures are impinging on it. It would be nice if you could see a physiotherapist at least for an evaluation. I'm sorry, it must be very difficult when there aren't many trained professionals near you who treat pudendal neuralgia.

Violet

i got this after several workouts in the gym in feb 2012.. weightlifting. I had a pretty big gap from my last time in gym and i started my training pretty intensevely. First symptoms were burning filling in my anus .. all the time. than i started to feel burning when urinating, some other symtoms. Firstly, i have been to many doctors before pn diagnos. One urologist started curing me from prostatitis! ... I have never undergone any scans, but medicamentation that was prescribed to me after pn became my diagnos really helped.. so i guess this is my problem.. Also the doctor said, that the pain i have mostly comming not from an injured nerve, but from contraction of the muscles. Injured nerve is causing muscles to contract and this causes all the problems ..

what physiotherapist can do? i mean how can he evaluate the problem, and what he can do about it if i will not visit him regurarly?

thx

A physiotherapist may be able to asses which muscles are involved. it could be the pelvic floor area or higher up maybe at piriformis level. The treatment would be different for whatever was discovered. They may be able to give you a programme of therapy that you could do at home.
With the problems you have described and the history of how things probably happened, ie weightlifting, it may need more than one physiotherapy session for a solution but that is always a good place to start.
Helen

Denar, my problems started from weightlifting too. A good physiotherapist can help determine whether your problems are primarily due to muscle tension or possibly nerve related. They should also be able to tell you if you have related structural or mechanical problems such as strained ligaments or sacroiliac joint dysfunction.

Invasive therapies such as nerve blocks/surgery are not always the answer so it makes sense to try conservative treatments like physiotherapy first.

Violet