Pudendal neuralgia on dorsal nerve?

[tommy72]

Hello everybody,

I have suffered about 1 year ago a bloodless injury on the glans.
It occurred in the aftermath of pain at the site, which intensified especially when sitting, coughing and urinating.
This condition lasted several months until suddenly a very strong period of pain with strong pressure in the glans has developed at a full bladder.

I was with several urologists, although all studies incl. MRI were without findings.
One then had the suspicion it could be a nerve injury.

Was then with Prof. Possover in Switzerland and a rectal palpation of the pudendus nerves could not provoke the pain,
However, the pain in the glans is caused by palpation of the prostate and he thinks it is neuropathic pain.
He then made an injection of lidocaine into the area around the prostate, which has, however, brought no relief.

I wonder now, what I could do. Possibly a nerve block, but where would the injection in my case be performed?
In case of neuromodulation I don't know what with nerve damage in the glans area could be the better alternative (SCS, sacral or sacral or pudendal)

I would be very grateful if someone could answer some of my questions, and I remain hopeful that an improvement in symptoms, but currently it looks unfortunately not
and I am therefore pretty desperate by the whole situation.

Many greetings
tommy

[Violet M]

Tommy, you might want to read Ezer's posts on the mindbody connection. I don't agree with everything Ezer says but I think that if a pain signal pathway gets established to the brain, that it can continue, even after healing takes place, and that by disrupting and redirecting that pain pathway that some people are able to get rid of their pain through the methods Ezer has posted about. He has listed a lot of research on the topic.

Another possibility is that if you initially had pain and started clenching the pelvic floor, maybe it's possible that you got into a cycle of clenching the pelvic floor and now you can't get out of that cycle and maybe the muscles are impinging on nerves and causing pain. Have you had a chance to see a pelvic floor physiotherapist yet to have an evaluation of the tension in your pelvic floor?

Violet

[tommy72]

Hello Violet, thx for your answer, i will read his posts although i don't really believe in those mindbody-things because i feel so many symptoms of PNE are accurate for me and i know i had this stupid incident that triggered all this. I still had no chance to see a pelvic floor physiotherapist, but maybe i should try, but i'm not sure if they can help me with pain located only in the glans?

Tommy

[Vjera]

Tommy,
maybe you can contact dr Aszmann who is located in Wienna, Austria?
He is treating pudendal neuralgia patients and if I understood correctly especialy those with problems at dorsal branch of the nerve.

[tommy72]

Hello Vjera,
thx for your advice, i have already consulted him, but he said if the problem is located in the glans he can't do any of his surgeries there. He also talked about Capsicum chili pain plaster but i can't imagine how that would burn if placed there.

Tommy

[Vjera]

What is Capsicum chili pain plaster ( I presume you thought flaster) ?

Did dr Aszmann suggest any other diagnostic tests or scannings you can do that will help you to find a cause or factors that are contributing to your current health issues?

Sorry for my english , I am not a native speaker.

[tommy72]

It's a pepper plaster to stick on to reduce pain.

He didn't make any other suggestions. I wrote him about a nerve block but still waiting for answer.

Elsewhere I had done Pudendus SSEP that were not good and shall do them again to exclude bad measurement.

(I'm not a native speaker too)

[tommy72]

I read an article about a traumatic penile neuroma after circumcation and wonder if that could be something like in my case. The skin in the area distal to the initial injury and around the urethral opening is always red and looks roughened and thats also the location where the pain comes from. I ponder if it's possible to inject something directly in the glans or near the nerves below the glans because my pain is only there and i'm not sure if a normal Pudendal block will have an effect in my case. Maybe anybody has an idea if that's a realistic thought?

[Violet M]

Tommy, if you have small fiber neuropathy that is localized at the nerve endings but no pathology along the main trunk of the nerve at the ischial spine or alcock's canal where blocks are usually delivered, a pudendal nerve block might give you a few hours of temporary relief but I don't see how it would help permanently. A block of the dorsal branch of the nerve might also give temporary relief and may be of diagnostic value but I'm not sure it would be worth it. I don't know if any doctors would deliver cortisone directly into the glans area to try to reduce inflammation -- I've never heard of it being done. Have you tried cortisone creams or lidocaine ointment or spray? I've seen a study on women concluding that capsaicin may lower pain levels in women with vulvodynia but I hear what you are saying about it burning.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480562/

Violet

[tommy72]

Hi Violet, thx for your answer.

I've tried Lidocaine and Cortison but it didn't help much. And Capsaicin i've not tried so far but i assume it burns. I still think about getting a nerve block anywhere.

Could it eventually be PGAD what occurs also in men as i've read?

I wonder if neuromodulation could help in such a case but i'm not sure which other treatments could
help for that and I also don't know if any doctors would deliver cortisone directly into the glans area.

I also found an article about hyaluron injections apparently often done for patients with premature ejaculation.
Anybody heard about that? Maybe that could also be an option for me if nothing else helps?

http://www.firstclinic.co.kr/global/eng ... ion031.htm

What strength of Capsaicin cream have you used? I think about trying it but am afraid of the burning.

Tommy