Health Organization for Pudendal Education

I had an MRI with an MRN study done last week. Today my urogyn tells me my bones and nerves look good. She also says that I have possible tendonitis. Does anyone know what tendonitis relating to pelvic pain would be? She said maybe pt would help with it but I've gone to a pelvic floor physical therapist for 5 months now with little to no change. Do you think she meant a regular physical therapist? Since I don't really understand where the tendonitis is located, I have no idea what she means.

I am so frustrated because I've been dealing with this since my hysterectomy with full repairs back in 2008. The crazy thing is, my symptoms got gradually better on their own and for the past 6 years or so were 60-70% better. Then for some reason unknown to me, they came back about 5 months ago way worse than they were initially. I also have some lumbar spine issues so I don't know if that's what's causing my symptoms and no one else seems to either.

I have burning in the skin over my tailbone, tightness and burning in my left buttock in a very localized area near the cleft, anal/vulvar burning which seems to be on the left side also and sometimes vague burning pain that seems to be coming from inside my vagina/pelvic region somewhere.

The only test I have had is the MRI. The only "treatment" has been physical therapy. Does anyone have any suggestions on what I should do next? I really don't know what to do now and I don't feel like I can take this much longer. .

Hi Tamis,

It seems like the gynecologist who told you that you have tendonitis owes an explanation to you as to the location, how that could be related to your pelvic pain, and what kind of PT you should get. Are you able to get some clarification from the gyn?

I'm not very knowledgeable about the pelvic tendons but this is a pretty comprehensive article about them, with a lot of images at the end describing where they are. https://www.ajronline.org/doi/full/10.2214/AJR.10.4682
One of them shows an obturator internus myotendinous sprain which looks like it could be near to where the pudendal nerve runs but I have no idea if it could cause the pain you are experiencing. Burning pain is often associated with a nerve. Nerve blocks can sometimes help you sort out if it is a nerve issue and if so, what nerve, but they are also invasive and carry a little bit of risk. Sometimes it's worth it though, if your pain is bad enough already and no other diagnostics seem to be giving you the answers you need.

When the pelvic floor PT does internal work, does it cause flare-ups in your pain? Some of your symptoms sound like they could be in the distribution area of the pudendal nerve. Has the gyn or PT pressed on the pudendal nerve at the ischial spine and along alcock's canal to see if your pudendal nerve is tender? If not, maybe you could ask them to evaluate the pudendal nerve for tenderness. Does the PT have any idea what might be the cause of the pain? If not, maybe they could refer you to someone in your area who might be able to figure it out.

I know, it's hard to know exactly what to do next and it can be exhausting going from doctor to doctor.  Hopefully you will be able to find a provider who can figure this out.

Violet