Health Organization for Pudendal Education

I started having symptoms many years ago after my first sexual encounter. Before that event I had mastrubated for years without experiencing any pain, or itch or electrical shock. I think if a man does it too hard and too fast it might damage some nerves. I don't think its illogical. My pn has become worst since I moved in with my bf 4 years ago. I suspect sex caused my symptoms to evolve. Its a bizzar idea, I know. Its just the only trigger I can point at. Any ideas? Has anyone had this happen to them?

The pudendal nerve is often accessed by doctors, by palpating the sides of the vaginal wall - so sex can definitely exacerbate PN. "Exacerbate" is a little different than "cause".
One way to describe it is that if you have any kind of pelvic abnormality / problem such as pelvic floor dysfunction, there is a "threshold" at which you feel it. You can picture pelvic dysfunction as a drinking glass with a horizontal line drawn on it at a certain level. The "normal" pelvis is represented by a glass with no water in it. Once you start to add water, that represents a growing amount of "abnormal", but while you are under the line you have no symptoms and FEEL normal. Once the glass fills past the line, you actually feel symptoms. So you probably exist someplace close to that line, where sex becomes that one added bit of "water" that overflows you into "symptomatic". Or if you had some symptoms prior, the sex just adds a bit to make the symptoms worse.
Probably you could stop having sex for a year, lose many or all of your symptoms, then go see a pelvic floor Physical Therapist...and you would still be diagnosed with pelvic floor dysfunction due to some underlying problem. Even if you never had sex again, chances are good the PN would progress at some point in the future unless the underlying problem is diagnosed and treated. I hope that makes sense.
It's difficult to get rid of PN symptoms once they settle in to stay, because pain causes changes in your central nervous system and throws you into a vicious cycle. So if you know sex is your major exacerbating factor, I would suggest leaving it alone until you get professional advice. A Pelvic Floor Physical Therapist and / or a Sex Therapist might be able to help you and your BF find ways to resume relations without causing you any further injury and pain. You mentioned "too hard and too fast", and that is something you can put a stop to. Many men feel like they have to "perform" sexually, so if there is not good communication about this, he might actually be injuring you simply because he is trying to impress you. A Sex Therapist might be particularly helpful in getting the two of you to communicate better in this area.

lol my boyfriend would never want to see a sex therapist. Its pointless anyway. It causes me horrible pain. He wasn't the one who did it too hard and too fast. That was someone else many years ago. It was a one time thing and then I never wanted to see him again. He didn't care about my orgasm. He only cared about his own. So I told him to get lost the next time I saw him. He was making fun of the fact I wanted the little finger on my clit. He was a loser.

I have to keep my dildo in the freezer. I can't move it around inside me much if I do the fire breathing dragon in my v gets pissed off. I also start to feel deep internal bruises on the left side. I believe it might be the obterater internus muscle. My clit can't stand constant touching. It needs cold, only cold, never heat. The heat causes my pain to start.

My pain is beyond sex. Its daily. I need icepacks daily. I have not had sex with anyone for at least 5 months now. I'm better off trying by myself. At least I know my own limit.

Let me ask....your telling me sex is not the cause, but that I might have some genetic predisposition to pn. I might have been born with something wrong. I wouldn't know until something like sex set it off?

I didn't say genetic predisposition, just an underlying cause - my pelvic issues started with a joint injury to the pelvic structure when I was 14 years old; and there are a number of other possible structures that can be injured (muscles, ligaments, direct injury to nerves creating scar tissue entrapment). If you were athletic when you were younger the chances of an underlying injury are probably highest, but a one-time incident could cause a problem too. A congenital structural defect is also possible: I believe there is at least one woman who has been on this board who was born with nerve entrapment within the ligaments. The only truly genetic cause of this I can think of is connective tissue disorder which can cause very lax joints and subsequently a predisposition to pelvic malalignment - this is something to suspect if you have a very unusual amount of flexibility in other joints. There are so many underlying causes I could not even begin to guess at yours; I assume you are getting or will be getting the appropriate evaluations from a PT and a Physician.

I was never athletic when I was younger. I guess I can rule that out as a cause.

HerMajesty wrote:Probably you could stop having sex for a year, lose many or all of your symptoms, then go see a pelvic floor Physical Therapist...and you would still be diagnosed with pelvic floor dysfunction due to some underlying problem. Even if you never had sex again, chances are good the PN would progress at some point in the future unless the underlying problem is diagnosed and treated. I hope that makes sense.

Interestingly enough, my symptoms started to show up within maybe about 6 months of becoming sexually active. Eventually I was diagnosed by Dr Antolak with pudendal neuralgia, although I still am skeptical. I currently haven't been sexually active for over five years, and basically have no symptoms. I recently went to see a PT who specializes in women's health and pelvic floor, primarily because I've been considering pursuing a relationship again since my husband's death. To put it bluntly, I'd like to know ahead of time if I can expect sex to be the nightmare it was before. She could detect no pelvic floor dysfunction. In fact, my biofeedback results were extraordinarly good.

I do plenty of other activities that I would expect should make the PN progress. Long hours sitting at work. Lots of exercises that Dr A told me I should stop. I can even go biking with no discomfort. Sex seemed to be my only trigger. And I too am trying to get an answer to your question, can sex cause PN?

That is interesting, acw. Did your PT mention anything about vaginal dilator sets? If you type "vaginal dilators" as an Amazon search, a lot of various sets will pop up. They are mainly used for vaginismus but I am wondering if they might be a good way for you to predict whether you are able to tolerate sex (??) As I said, the pudendal nerves do run along the sides of the vaginal wall - Dr. Weiss in San Francisco even does his nerve blocks by palpating transvaginally and doing transvaginal injections into the nerve at spots where the patient identifies pain - so if the pudendal nerve is irritated in any way, it is logical that sex would exacerbate it.
edit: I understand that the nerves in the inguinal canal (ilioinguinal, genitofemoral, iliohypogastric) should also be looked at when the primary symptoms are vaginal / painful intercourse - they could be the problem rather than the pudendal nerve.

Hi HM,

Yes, I had two PTs that mentioned the dilators as a possibility. Still hard to say how well that would guage things. First of all, it took a few months before my symptoms set in originally. Second, I'm not sure if it's a fair representation, so to speak. It may be hard to reproduce the real world. It's so different than say, a broken foot, where it's easier to judge when it feels good enough to walk on again!

I did have issues with my ilioinguinal nerve, but that was due to hernia surgery, and was well after my pain issues with sex started. That is another whole topic, but fortunately I was able to resolve the ilioinguinal nerve issues with blocks and ultimately cryoablation.

Take care,
Anita

I tried leaving a dildo inside me for about 15 min everyday for about 4 days. I noticed increased pain with removal of it, increased pain during the day. It did not help me.