Health Organization for Pudendal Education

Hi all,

I am new to this website and to PN problems. Mine started this February. I've been misdiagnosed with chronic non-bacterial prostatitis and low-back pain so far.
It just made me stressed out and very sceptical about doctors in general. Especially after PT for my lower back made things much worse. After watching my symptoms for months (pain is positional, gets much worse after long sitting and even worse after sex, etc.), I self-diagnosed myself to have pelvic floor muscle dysfunction (hypertension) and because of that also mild IC (insterstitial cystitis, I have to avoid spicy and acidic foods).

If I avoid all triggers, the pain levels during the day tend to diminish and almost disappear in a few days. Usually I am pain-free in the morning. But lately one very unsettling symptom got much worse. I get involuntary erections during the night. I know about it because the pain from clenching pelvic floor muscles wakes me up. It happened in the past, but usually it woke me up only 1 time in a night (around 4-5 am) and after taking stroll around my apartment and going to bathroom, I was able to sleep again. Last three nights, this symptom got lot worse for some reason. I wake up several times a night. What's even worse (besides sleep deprivation), it seems that those night contraction are only making my pudendal nerve to get worse and it results in a self-feeding cycle.

My theory is either that lying on my back for a long time presses somehow my pelvis and the pressure results in this embarrassing condition. But it never happened during the day when lying. Or I get somehow tense while sleeping/dreaming when my unconscious mind takes over. Had anyone similar problem? Please, how did you solve it? Is it time for me to see neurologist or someone else?

ps: I am sorry for my English, I am new in USA. The healthcare/insurance system is very complicated here and I feel humiliated to ask ask my PCP all the time for new referrals to new specialists, he must already think I am some kind of hypochondriac. All that puts additional stress on me.

Involuntary erections at night (NPT) are completely normal and absolutely necessary for your health. They happen during your REM sleep.

https://en.wikipedia.org/wiki/Nocturnal ... tumescence

Why do you think you have been misdiagnosed with "non-bacterial prostatitis"?

Nonsequitur: I understand that nocturnal erections are normal. Maybe I didn't notice their frequency and length before when I was healthy. The problem is, that my erections hurt now....to the extent that I can't wakes me up. And I have strong suspicion that this somehow further irritates my pudendal nerve since I have sore perineum in the morning and the usual benefit to my pudendal nerve provided by sleep/rest is gone.

First of all, I don't even believe that chronic non-bacterial prostatitis is real (at least for most patients diagnosed). All the diagnose says basically is that your prostate must be inflamed somehow, although we don't see any signs of infection. And doctors admit they don't know what's causing it...either some mysterious bacteria, or some fungus, or some food intolerance, or.... But inflamed prostate would normally result in increased urinary frequency and/or weak urinary stream. I have neither (except when I irritate it by something spicy etc). My main symptom is burning pain in perineum. On the top of that, resting my pelvic muscles results in the pain going away (can't imagine an infection or inflammation that would respond like that).

I am not saying I am infallible. In fact, I am far from that and I was jumping from one possible self-diagnosis to another (especially after seeing doctors to make some wild guesses they din't seem to be sure of themselves). So I appreciate every idea. The notion that this might be normal NPT sounds plausible to me... but still don't have an idea how to avoid it. Exhausting myself sexually to avoid NPT isn't an option since orgasm aggravates my symptoms even more than erection.

Vickers, I'll reply in more details later but I had the exact fear about NPT and the same reasoning you had. I had similar pain also.
In retrospect, that was not the problem at all.

SSRIs like Prozac will reduce NPT at night as a side effect. You could try. It did nothing for my pain though.

nonsequitur: Yes, please explain in more detail when you have a time.

My condition is getting worse and worse last 3 days...I am trying now to get a referrals from my PCP to be able to see neurologist and some PT specializing in pelvic pain.

Vickers, I agree with Nonsequitur about SSRI's possibly helping with this symptom since one of the side effects is inability to maintain erection.
http://www.mayoclinic.org/diseases-cond ... t-20044825

You may also want to consider a benzodiazepine such as valium or clonazepam before you go to bed because they can help to relax the pelvic floor muscles.

Violet

Vickers, I have no solution for your problem but I want to tell something I experienced by myself and observed over the last years. I found exactly the same from the female side, and other women in a German forum also reported these things in the night.
I have the hypothesis that in altered states of consciousness sexuality is strengthened and with it the sexual arousal, i.e., especially in the sleep and also in the waking up state. It seems that in these states a kind of "hyper-sexuality" arises and that the autonomous nervous is highly activated and so may turn into pain. All women I had talked to reported the same things as you do. They experienced a high sexual arousal with automated orgasms without touching and often associated with pain. After each orgasm the pain became worse and therefore also the psychological situation.

Because I do not believe in a PN - I emphasize this is my view - but in a problem of the entire autonomous nervous system our sexuality is connected to, the altered states of consciousness play an important role.

Of course you have to sleep, that is the most important thing to stay as fit as possible in this situation. I also have taken a benzodiazepine. This is actually the only way to come to rest.

Vickers, in regards to prostatitis: It is standard procedure to give a course of antibiotics. It may have cured you. I had epididymitis pain a few years ago. I was given antibiotics blindly. It cured me. It was an infection.

Now non-bacterial prostatitis:

http://emedicine.medscape.com/article/456165-clinical

Patients with abacterial prostatitis/chronic pelvic pain syndrome (CPPS; category III in the 1995 National Institutes of Health prostatitis classification system) have the same symptom complex as those with chronic bacterial prostatitis. The chief symptom reported by patients with abacterial prostatitis/CPPS is pain. Genitourinary symptoms include perineal, penile tip, testicular, rectal, lower abdominal, or back pain.
Patients can also have irritative or obstructive urologic symptoms such as frequency, urgency, dysuria, decreased force of the urinary stream, nocturia, and incontinence. Other symptoms are a clear urethral discharge, ejaculatory pain, hematospermia, and sexual dysfunction.

Many patients with abacterial prostatitis have emotional strife and some psychological difficulties (ie, socially, sexually, or both). Patients should be questioned with regard to their overall social adjustment. Stress level is important because stress is responsible for increased tension of the pelvic floor and the internal urinary sphincter, resulting in the symptoms of prostatitis.

In short it is possibly a stress or somatoform illness.

You wrote:

I am new in USA. The healthcare/insurance system is very complicated here and I feel humiliated to ask ask my PCP all the time for new referrals to new specialists, he must already think I am some kind of hypochondriac. All that puts additional stress on me.

You are a recent immigrant. Did you suffer from high levels of stress prior to having pain? New boss. New job. New country. Loneliness. Do you feel guilty or regretful having left people, friends, and family behind? Are you homesick? Do you regret your decision?

But benzodiazepine leads to erectile dysfunction. Instead of drugs better find some natural way of relaxation. Also don't use Viagra ED pills. According to eddrugs2017.com, it leads to serious side effects. Better use some natural supplements or try for example meditation. It works pretty well.
Or you can try testosterone boosters. According to https://naturaltestosteronepills.com you can solve erectile dysfunction issue with taking testosterone supplements.
https://malepenisenlargementpills.com/t ... -boosters/
It was found out that approximately 28% of the participants had testosterone deficiency. And they also experienced loss of libido. An average age of the men didn’t exceed 47.

Hello
I have the same issues as you. I have pelvic floor dysfunction and when I trigger a PN flare up from laying on my left butt or my left side or from having my shorts pull up too tight on my adductor and testicle I can trigger a flare up. And if I have an erection the pain is even worse. I was even thinking that having a erection while I was sleeping makes the flare up more likely to happen. My pelvic floor PT helped me a lot I had lower back, hip, leg pain and I got up five times a night to urinate but the pelvic floor therapy gave my a lot of relief and I stopped getting up to urinate at night. But I also found out I had an infections as well that was a big reason for why my PN was getting set off from the littlest thing. I was getting close to a mental break down before I found my abscess and got into pelvic floor therapy. PM me if you want to discuss. I hope to be trying some new options possibly. Hope this helped hang in there house