I used to have the perineal pain and rectal pain early on.
I honestly think it was from being in pain and tensing my pelvic floor. Felt like I was sitting on a tennis ball all the time and my perineum was burning/pins and needles.
I don't get that anymore fortunately - I'm 8 months out and I think what's worked best for me is pelvic floor stretches and hamstring stretches, at least twice daily, and if you can stand it, try to walk for at least 20 minutes a day. It's not easy, but my pain levels are much lower on days when I walk and stretch.
I've also stopped taking all meds (lyrica and nortryptiline) so I think my nerve issues have improved a bit, but they're still there and flare up when I exert myself - which for me is life changing.
You may want to consider trying alpha lipoic acid - see my thread here: http://www.postvasectomypain.org/t/alpha-lipoic-acid-anyone-else-try-it/1891 I take 600mg on an empty stomach in the morning and it's almost as effective as lyrica so far - yet I've only been taking it for 3 days now. It might be worth trying.
Hang in there man, you'll eventually get a bit better. I'm not saying you'll be cured, but eventually you'll become accustomed to the pain and some of the worst pains will hopefully settle down.
I was in rough shape for a good 6 months, but now at 8 months, I'm mostly functional and don't pop pills around the clock anymore - still in pain everyday with flareups, but definitely ahead of where I was.