Chronic Pelvic Pain (Male)

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Zarathustra333
New Member


Date Joined Feb 2017
Total Posts : 2
   Posted 2/27/2017 2:36 PM (GMT -7)   
Hey everyone. So a year and a half ago (Oct. 6th 2015) I had a painful ejaculation that took me by surprise and over the next month, a dull ache in my perineum (sometimes known as just the taint colloquially) grew and grew.

about two months later it was like a stabbing pain and the only thing that helped was soaking in hot baths all day long. I no longer could work and was diagnosed with prostatitis by several urologists. I was on all sorts of antibiotics and they helped a bit but later started seeing a pelvic floor physical therapist and my chronic pain was dropped by about 30 or 40%. I then saw a doctor in New York and got prudenal nerve injections that helped a lot but the pain would always come back after a few days.

I do pelvic floor stretches for two hours daily and it helps but my pain is still mostly there. It's particularly bad if I get an erection, in which case the pain can last for days. I'm only 31 currently and am just so frustrated about how this has ruined me in so many ways. I'm getting a divorce (stemming largely from my issue) and I really don't think I'm in any shape to reenter the work force, which I really need to as Ive got 241k in student loan debt.

I've been reaching out to a lot of pelvic pain doctors but most don't treat men and even less seem to be willing to let me have botox to paralyze my muscles down there for awhile which I think is my only option now at this point. I'm getting desperate and I don't know what to do next. If you've read this, thank you.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 679
   Posted 2/27/2017 4:06 PM (GMT -7)   
Zara
Dysfunction of the pelvic floor is not reserved to women. I am sorry that you are finding it difficult to access a pelvic floor clinic that sees male clientele. It must feel like gender discrimination to be turned away.

Botox makes logical sense to try, especially given that you have found some measure of success with localized nerve blocks of the pedundal nerve and tributary roots. I would keep researching to locate a physician who would agree to a Botox injection. A larger private hospital or larger teaching hospital would likely be better candidates for pelvic floor programs that serve both women and men than would be a small community hospital.

You mention that you have seen a physician in New York for pedundal nerve blocks - that were successful albeit for short duration relief. Have you since talked with this physician about botox injections to the same?

You may also want to look into compounded topical creams that combine lidocane, tramadol, amitripyline, and gabapentin - among other medication combinations. Compounding medications allows customization of medication formulations, upon the request of a physicians, to best suit a patient's needs. Ketamine and clonidine and dexamethasone are also possible neuropathic agents that could be compounded into a creme for application. CentralDrugsRx.com has a comprehensive listing of pain medication preparations that are possible via personal compounding. I would suggest visiting the web site and printing their contents of speciality formulations to review/discuss with any one of your MD physician providers. You might be able to find significant and specific relief with a customized compounded transdermal creme or patch.

I hope that you begin to find some relief from the ongoing prostatitis. The lower pelvis has a high proportion of sensory nerve endings, so I can appreciate that your pain would be more than annoying - it would be pain that would impact your day-to-day being.

- Karen -
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Zarathustra333
New Member


Date Joined Feb 2017
Total Posts : 2
   Posted 2/27/2017 4:55 PM (GMT -7)   
Thanks for the reply. I actually believe my prostatitis diagnosis was incorrect, instead I just have a classic pelvic floor dysfunction or possibly prudendal nerve entrapment as my prostate has been walnut sized for over a year now. This may have very well been triggered by prostatitis though. I have have trigger point injections on my pelvic floor and prudendal nerve and that did help. My doctor was open to doing Botox but Ive since moved away from NYC and am now in Dallas.

I'm seeing a new doctor who doesn't want to do botox but wants to take a closer look at my prudenal nerve and go from there, I'm getting a scan done in about 2 weeks. My only concern is though that erections are my biggest trigger and so far every specialist I've talked too says that cant be causing my pain, yet my experience tells me otherwise. If I can go several days without an erection I feel much better, but sometimes I just wake up with one and the process starts all over. If anyone has had any experience with post-erection pain in the perenium or the base of the penis I'd love to hear from you.

I also appreciate your pain compounding medication suggestions, but I would be more eager to learn the cause of my pain rather than just covering it up with pain medications the rest of my life. Thanks again for the input!

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 679
   Posted 2/28/2017 3:50 PM (GMT -7)   
Zara:
Of course you would like to more fully understand the origin and nature of your pelvic pain. That is a universal desire, I think, of almost everyone with a health condition - to be able to understand the nature and origin of what ales one's body.

In my 20+ years of compromised health, I have lost faith in the medicine to give of the focused attention and time to thoughtfully arrive at a sound and concrete differential diagnosis. I have had more incorrect than correct diagnoses applied to my medical record.
Be prepared that you may have to be your own best and most vocal advocate in ensuring that the answers that you want answered regarding the cause of your pain are fully investigated and vetted.

My suggestion in exploring compounded medications are simple: 1. To provide you with better pain control than you are now experiencing; 2. Knowing that ongoing pain has collateral damage effects - insomnia and less than restful sleep, chronic fatigue, changes in mood (more easily angered and frustrated), social isolation. Compounded topical or transdermal medication might afford you better pain control so that you can better focus your mind and body in guiding your medical care and in living a better quality of life day to day.

As a physical therapist, I spent time working with patients with pelvic floor disorders - both women and men. Vulvodynia was a fairly common disorder that my colleagues and I saw and treated. I am thinking that the pain with vulvodynia is not dissimilar to what you are experiencing - the pain threshold can be excruciating due to the high sensitivity of the sensory nerves associated with the ***oris (in women) and with the penis (in men) in an aroused state. Patients experienced good pain reduction with the topical compounded medications. Individual variation, person to person, was noted. That's why we often had patients try several of the different possible medication combinations as are presented in the information on the compounding website.

All to say . . . do not be too quick to dismiss the benefits of one or more of the compounded mediations as outlined in the compounding web site information. You can benefit from pain relief as you explore and try to discern the root cause and treatment that is more focused. But also remember that there are not always known answers as to why an area of the body is in pain. There are not always known answers as to why certain sensory nerve pathways are hyper-sensitive or why the brain perceives sensory messages as overly painful.

In suggesting compounded medications I am not suggest that you "cover up your pain with pain medication for the rest of your life." Rather, I am trying to toss you a life-preserver that can help keep you afloat as you and your medical providers try to understand the pain and is root cause.

Prudendal nerve entrapment is certainly a valid possibility. If so, any of the topical compounded medications would have value in lowering your pain experience. In the clinic I worked at, men with foreskin irritation (non-circumcised individuals) found the neuropathic compounding formulations very helpful as did women with vulvodynia. In many cases the relief was dramatically positive. Within 5-10 minutes of applying, these individuals were smiling and able to get up and walk out of the clinic being able to engage in their lives. Certainly, it is something to discuss with the new MD that you are seeing as you and he/she review exam and scan findings and decide on a treatment plan.
- Karen -
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

ChronicPainSurvivor
New Member


Date Joined Jan 2013
Total Posts : 4
   Posted 3/15/2017 6:43 AM (GMT -7)   
Hi Zara, I am male and have chronic one sided Testicular pain. I spent at year with a Physical Therapist for male Pelvic pain, but no real significant results from that. I as well did research on Botox and actually saw a Urologist who researched it and after giving to one other patient she agreed to try it with me. Her initial patient had no effect from it, so she advised me on this. I decided to try it and well, it completely worked for me! It is however a short term success, as it is only effective from 3-6 months. I am starting to get my pain back after 6 months of trying the botox injection. My advice is to find a urologist and ask her opinion on Botox, it's worth a try if it will work. Again it is not a fix, but just a symptom relief, me like you there is no diagnosis as to why I have this pain, I have had numerous MRI's, Xrays and Ultrasounds but nothing is found, hence I believe it is Neuropathic, which Botox has an impact on. Stress reduction, meditation, etc. also helps calm the nerves. There is no guarantee, just some of my experience. Take care, I feel your pain.
55 y/o male with Chronic Back Pain - Large Vertabrae Osteophytes, Right Shoulder Osteo Arthritis (OA), Hip OA.
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