pudendal nerve block?
@raising4girls you’ve touched on an important topic that has scared the hell out of me since my PVPS journey started. I remember in the beginning when I realized I had neuropathic pain, researching what nerves were in the scrotum and seeing that a branch of the pudendal was in there (posterior scrotal nerves). I broke out into tears when I saw that, since I have/had penis pain, scrotal pain, etc. and I had heard of pudendal neuralgia before I had my vas and knew how horrible and impossible to treat PN is.
Personally, I don’t think I have damage to those nerves since I don’t have any continence issues, no rectal pain and the pudendal pain that I have is more musculoskeletal pain. Besides, if I had PN wouldn’t I be in way more pain? Most of the folks on pudendalhope are disabled and take narcotics all day.
I discussed this possibility with Dr. Jarvi and asked whether he thought that nerve was hit during my vas - so he palpated the side of my scrotum where that nerve is usually found and it didn’t increase my pain, he was doubtful that I had a pudendal issue. His reasoning for the penis pain is that it’s a regional pain/referred pain from nerve damage during the vas. It’s a reasonable explanation, but I’m really not so sure at this point, I think there’s much more to it.
It could explain why SCD doesn’t work on a lot of guys, but then again, the pain could be centralized, or nerves could be missed during SCD, who knows.
I do notice that I have much better days when I do pelvic stretches, core exercises and go for a long walk. With the cold weather arriving here, I’ve had an increase in pain since I haven’t been going for walks, but I start pelvic PT on the 27th and I know it’s going to be unpleasant, but it should hopefully help.
You did have a pudendal nerve block earlier this year right? Did it help?
Most likely not pudendal nerve just muscle spasms from tightening the pelvic floor due to the testicle pain. Pretty common among all of us. Try pelvic floor therapy or stretches for the pelvic floor
@vasregret - I agree with you, and I’m in a similar boat. My PT said she doesn’t think I have full-blown PN saying I’d be WAY more miserable. Like you said, she said if you’re not taking ANY pain meds, you don’t have full PN. She said effectively what @Acschiro said, that muscle tension, bicycling, etc. have aggravated and irritated the pudendal nerve. She has a point. I stopped my stretching, and I haven’t done much exercising in the past 2 months because of the time I’ve spent disposing of my parents’ house and properites.
That said, because this bout is now 19 months, I worry that my pains are not something conservative methods can solve, so I am planning a trip to the Dellon Institute. Talking to Dr. Williams to see if I should see him or Dellon himself.
I agree entirely with Acschiro that pudendal damage is not likely more for PVPS victims. In my case, however, 2 of my 3 bouts started right after bicycling, and Pudendal Nerve Entrapment is also called Cyclist’s Syndrome. Granted it’s more common in competitive cyclists who ride hundreds of miles, but I wonder if the vasectomy made me susceptible to even my casual level of cycling.
Hard to deny, though, that I had a 50-75% pain reduction from Dr. P.'s spermatic cord block which would tend to make me believe in the cord and traditional nerves as the problem.
Hard for all of us to diagnose.
The only way I can see getting true pudendal nerve damage from a vasectomy would most likely be a large hematoma spreading retroperitoneally and actually damaging the nerve itself. In theory if they punctured the scrotum posterior enough they could damage one of the posterior scrotal nerves which is a branch off of the pudendal nerve and then the nerve damage spread along the pudendal nerve back to the nerve root like RSD or CRPS2 does. You could also get a true pudendal nerve entrapment from walking different if you are one of the lucky 10-15 percent of the population where the sciatic nerve and it’s branches pierce the piriformis muscle and it in turn compresses the nerve directly. The pudendal nerve can also get compressed between the sacrospinous and sacrotuberous ligament of the pelvis which in theory could occur from pelvis getting severely out of position due to the muscular changes of guarding against the pain. My old pelvic PT taught nationally for Herman Wallace and said she has only seen true pudendal entrapment from pelvic surgeries usually on women (lifting bladder etc.) due to scar tissue forming and entrapping the nerve or damage during the surgery. Usually those people wake up from surgery with immediate pain. She has seen it in weight lifters due to pelvic anatomy causing hypertrophu of the ligaments and from piriformis, obturator muscles compressing the nerve. The muscles usually are not a true entrapment but irritation of the nerve from the nerve not gliding properly through the muscles anymore from spasms. As raising4girls said it is called cyclist syndrome due to putting direct pressure on the nerve while sitting on the bicycle seat. This would be similar to how your arm goes numb when you sleep on it wrong or how a nerve can get damaged in a surgery from traction on the nerve for a prolonged period of time if they are positioned improperly. Hope this helps. I’ve seen 1 of the most world renowned pudendal nerve specialist who is almost 80 and been working on pelvic pain patients for 40+ years and he confirmed mine was either damage to the nerve from hematoma or piriformis and pelvic floor spasms from walking different and guarding due to the testicle pain. Dr. P said it is sometimes caused by crosstalk of the nerves which Can happen but in this case there is no compression it’s damage to the GF II or IH nerve reflexing into the spinal cord. I can say 100% this does occur I’ve been numb burning and tingling from the belly button down to the bottom of the feet since 6 months post vas. The nerve pain started spreading within the first 4-6 weeks on me.
I would strongly advise all members of the forum whom have pelvic pain, pelvic floor pain etc to either see a good pelvic pt (they are not all the same I’ve seen 2 really good ones and 2 really bad ones or reading the book heal pelvic pain or a headache in the pelvis which goes over stretches and trigger point therapy externally and internally for the entire muscular system that contributes to pelvic pain
Hope this helps.
Medical Cannabis - long-term experiences
Pudendal Nerve Pain - ultrasonic guided injection & surgery
Go see a pelvic floor physical therapist!
@Acschiro That was an incredible post, probably the most informative I’ve seen since I began this journey (hell) about 14 months ago.
You’re probably the most knowledgeable healthcare professional I’ve come across since this began, I am literally blown away with how much sense that post makes.
We do have one member here who has confirmed pudendal nerve entrapment/damage from the vas, which was confirmed via ultrasound or MRN, I can’t remember which. It must be a pretty rare occurrence for this to happen and the urologist probably screwed up really bad in his case. After all, most vasectomists are incredibly cavalier about vasectomies and rush through them to bring in the $$$. We’re just the lucky winners.
There aren’t many pelvic floor PT’s near me, and the only one I found that was recommended on pudendal hope wasn’t taking any new patients, so they sent me to another one. I haven’t found any reviews about her, although she is an educator and has over a decade of experience.
@Acschiro could you please tell me what I should look for in a pelvic floor PT and how to spot a bad one?
Again, thank you for that incredibly concise explanation.
The longer they’ve been doing it the better. The 2 I saw that were not very good had only been at it a little over 2 years the other 2 had been at it about 10 years. If you don’t notice a change in symptoms within a few visits might be worth trying another pt. The first 2 I went to I noticed no changes and was always worse after. The last lady I would always walk out feeling better even if it was only a few hours. I’ve read all the reasearch on pudendal entrapment there is a lot of debate about whether you can actually see compression of that small of a nerve on MRN. The lady I believe in New York or somewhere up there who supposedly reads the majority of mrn’s for pudendal wants the MRI set up a certain way. Since the nerve is so small they actually look at the adjacent blood vessels to help determine entrapment. A few of the big name pudendal MDs who do the pudendal nerve decompression surgery use to require a MRN showing compression but they do not now because they have operated on some people with documented entrapment on a MRN and could not find the nerve was not entrapped when they did the procedure. The best way is an ultrasound guided block to the pudendal nerve at the ischial spine. Dr Weiss prefers to do his blocks by palpating the nerve at the ischial spine and guiding needle to his finger. Unfortunately with pudendal neuralgia there are a lot of different views and no one seems to completely agree. The nanses criteria if I remember right was to help with coming to a common ground on accurate diagnosis but I still see a lot of variances out there. Ive had an injection at the pudendal nerve with only finger guidance. Had a reduction of symptoms for about 5-10 minutes max, but with dr p Mega cord block at the 6 month mark I had no testicle or pudendal symptoms for about 2 hours so I’ve went down the Gf II IH route mostly. Interestingly though if you talk to pain specialists since Dr. p does his blocks under anaesthesia some will say if it only lasts a few hours then it could just be from the anaesthesia itself and not the block.
@Acschiro Thank you so much for the explanation. I may reach out to Dr. Weiss’ clinic. How ironic, that the lying ‘doctor’ who did my vas was a Dr. Weiss, and I may seek help from another Dr. Weiss.
@Kyvas - I start pelvic PT next week and in the meantime I have tried massaging that muscle in the shower while soaking it with hot water, and surprisingly I had about 2 hours afterwards where I had essentially zero penis pain, so that’s encouraging.
I’m hoping PT can do something for me.
@vasregret that’s great Andrew. There’s definitely a pelvic floor component to a lot of our issues.
The one in the pic at the top of the page.
You kinda have to pull your sac forward to really get to it.
I had my vas 3 months ago, and I had pain already during surgery and ever since.
I had a hematoma over almost all of my scrotum for 3 weeks.
My pain is dependent on position. Usually the worst when sitting, a little less when laying (but then also feeling a pain the stomach, lower right). No pain when sitting on the toilet.
I am shocked what I read now, but thankful for the information, because I can see a lot similarities to my case. I must admit I am overwhelmed by the medical terms, so I don’t pretend I understand everything.
I have mostly a dull pain, hard to locate, sometimes a stabbing pain. I tried a bupovacaine injection 2 weeks ago, that made things worse, i.e. the % of stabbing pain went up (normally it’s 100% what feels like congestive pain). But after reading this, things make more sense for me (the large hematoma I had, the on-set of pain during surgery). I am going to see a PT tomorrow, and have high hopes for that.
I am also considering a reversal, but I have a hard time understanding why this could help in my case or similar cases (because of the removal of scar tissue?).
What’s your thought on that?