Pulsed RFA as a Consideration


I’ve learned so much here and hope I can contribute, as well.

I want to recommend that those with nerve pain investigate and consider pulsed RF ablation (pRFA)if blocks provide some short-term relief rather than jumping right into denervation.

I had pRFA done to my left GF about 2 months ago and can state that one of my symptoms, scrotal pain along the left cord, remains gone. The pRFA procedure was no big deal, essentially the same as a block, and much less invasive than a surgery like denervation or reversal. Not riskless, of course, but our group knows about balancing risk and reward.

The pRFA results have also helped my doc and me conclude that I have another pain source, perhaps the primary culprit in the pudendal nerve because the severe left perineal pain remains.

I’ve been reading a lot on the web that pRFA is safer than conventional RFA and cryoablation though the results aren’t as durable. To me, this lower risk profile translates to “try this first.” That is just my opinion, not a statement of fact, and I encourage everyone to do their own research. But, why not try a low-heat needle carrying RF pulses before being opened up?

I’m scheduled for pRFA on the pudendal nerve on January 2nd and will report results to everyone.


@raising4girls Glad to hear you got some relief and good luck to you in January.


Thanks. Yes, the operative word is “some” relief. Still in a lot of pain. Any sense of optimism is that I feel like we’re getting closer to identifying the culprit. Two of my three bouts started right after bicycling, and pudendal nerve entrapment is also known as cyclist’s syndrome.

I think most guys here with nerve pain have it from the GF or II/IH. I think (THINK) mine is the rarer form of pudendal damage. I understand why the docs wanted to first check the GF or II/IH since they’re more often the culprits for scrotal pain and more likely to be nicked during a vasectomy, so no complaints about how the docs have attacked my situation. Just frustrated.

I hope your husband is able to get some relief.



Here’s something interesting. For 2.5 years my pain has always been RIGHT sided. Last week I woke up with a light zapping in my left perineum. It starting there and would go part way down my penis on the left side. I’ve never had left sided problems, this was a first. I got to work at 6:45 and by 7:30 I was elbow deep in a root canal trying to ignore the pain. It almost felt like a burning pee feeling but annoyed the hell out of me. Almost out of no where I had the worst pain in my lower left back I have ever felt. I think the nerve pain caused my psoas to spasm. Wow! I turned ghostly white, vomited three times in the bathroom, drove home, fired up my trusty bath tub, vomited a few more times, and woke up two hours later in cold worry with my wife crying at the side of the tub.

I tell this because I don’t think my left side was damaged. I worry how much of these issues are the nerves trying to balance via crosstalk or possible pelvic dysfunction. Fortunately the pain hasn’t returned. I haven’t felt that since the week after my vas. In my opinion, it’s much more difficult to hit the pelvic splanchnic nerves than the other two based solely on location.

Also, who did your radioablation? Sounds promising


This whole cross-talking of nerves and the concept of central sensitization make our problems really has to diagnose. In truth, I think docto completely discount these one-off episodes like you had and look for consistent themes in what we tell them.

Wish I had a better explanation. Dr. P. told me nerves are “clever” and that sometime they will re-route around blocks to maintain pain signals. Diabolical.

I’ve had my blocks and ablation thru Dr. Grimm (ironic name, huh?) at the Cleveland Clinic. I wasn’t keen on him at first but have really grown to trust and like him. I think he’s very good diagnostically and in the OR. I wouldn’t hesitate to recommend him.


I have a gf nerve block coming up but think I may alsihave involvement of nerves from my pudendal branch as well. I get sensations of tearing, stabbing, burning from underneath my spermatic cord closer to my seat. Don’t know why. Im also considering going to.ser Dr P for botox. I am also consideting disability or cutting back on work. I’m in Costa Rica with my family and am in so much pain the second and third day I was still a mess. It takes me days to recover from a regular work week. That is no way to live. The pain is so high up though I don even think removing a testicle would help, that’s not where my pain is anyway.


Mike - sorry to hear about your struggles, especially on vacation. I know what you’re saying, though. I skipped Christmas Eve mass because my pelvic floor felt like a tight fist.

SO, SO hard to know if we’ve got GF or pudendal issues. Definitely try the GF block and see if you get any relief. Even that is hard to know, though. I’ve been sedated for my blocks, and I still think the sedation (general anesthesia) provides some of the short-term pain relief. Acschiro agrees.

Does your guy do pudendal blocks, too? That might be an option after the GF block. Or, if the GF block works somewhat, then you could try ablation. Maybe Dr. P. has some theories. I agree with you on considering botox. That’s on my hit list. If this pudendal block doesn’t work, I’m going to talk with him about doing botox to the perineal area.

I wish you well Mike. I sense you’re in much worse shape than me. I’m not close to quitting work although I don’t have much of an option. My wife stopped working 20 years ago after our 3rd daughter was born. All on me right now.

Stay in touch. Let’s keep comparing notes.


Glad i was able to recommend Grimm to you. I wasn’t keen on him at first but after a few visits where I felt I wasn’t getting answers, he saw I wasn’t happy and he stopped and asked me what was up. I told him I had a ton of questions and felt he was just assembly lining me. He sat for like 10 minutes and we went thru things. Felt MUCH better after that. I don’t see him anymore since we’ve run thru the options.


Yes, thanks. I’ve definitely seen that in-and-out side of Dr. Grimm. I think he gets to the answer quickly and forgets we need some answers. I think he knows me well enough now and doesn’t rush things.


No worries. I like him. He’s funny at times. He does do the line at times but once he realized I was lost and needed answers he sat and talked for a bit. It helped a ton too.