Nerves to the penis

[resianam]

New to the forum. I'm seeing a PT for this condition and have had symptoms for many years but only consistently in the last year. Anyway, I had a varicocele repaired a few years ago. My PT said it could have been caused by CPPS, as the nerves could have been compressed by muscles. Have you heard of this? I already had the surgery already unfortunately and I suppose it was still necessary. More importantly, lately I've been having trouble with nerves to the penis. Sometimes I get tingling there with sexual activity. Of course the next few days my pelvis will hurt like hell but I'll also feel some pain in the penis too and tingling here and there. It sounds like nerve entrapment somewhere. I also get hypersensitivity in my left calf sometimes, strangely. Is this common with the condition? Others with experience here?

[webslave]

Varicoceles are not caused by CPPS.

Do you mean pain in your calf? It could be sciatica
viewtopic.php?f=37&t=5385

[resianam]

I guess it'd be S1 root pain. It's not pain though, just hypersensitive but not so bad that I need treatment. There's a few pages on the internet that come up about varicoceles and CPPS but nothing on Pubmed.

What do we know about the paresthesia of the penis? My PCP didn't know what to do about it except said he'd refer me back to urologist again. Last time I saw him he checked for prostate inflammation (rectal ultrasound) but found nothing and said he couldn't do anything.

[webslave]

I removed the link you posted because it provides blatantly incorrect medical information.

Tingling in the penis is not something I've seen discussed before. You may be confusing those sensations with fasciculations (search the forum for that term).

[resianam]

I guess it's good to hear that I didn't get an unnecessary surgery. I mean compression of the vein earlier for the varicocele, not nerve. I'm familiar with what fasciculations feel like since I have benign fasciculation syndrome, though it's been mostly in remission the past few months. I've never had one in the pelvic area. Typically they'd happen in the arms, legs, abdomen, and face. I was anti-VGKC positive at one point in time.

My physical therapist mentioned nerve and vein entrapment was possible with pelvic floor dysfunction. You're sure she's incorrect? The wikipedia page on pudendal nerve entrapment says that a pelvic spasm could be the cause. My calf hypersensitivity and penis paresthesia are much worse in the first few days after sexual activity and disappear afterwards, though lately I've had a mild dull ache in the penis that persists. Sometimes during intercourse even a light touch to the penis can cause tingling to occur in the penis. I don't have any incontinence but a few years ago I had trouble starting urination while standing up and that lasted for a few years. Anyway, if the problems in the penis aren't caused by CPPS then I should start look for other possible treatments. What else would you suggest? I have a sitting job so maybe there's a pillow I can buy. Any recommendations? I have a standing desk now but typically can only stand it for an hour or two at a time.

[webslave]

1. The wikipedia page does not say that pelvic spasm causes PNE.
2. If your symptoms are also in the calf, rule out pudendal nerve only (it is not connected to calf)
3. It sounds like you could have an issue near the spine. Have you had an MRI or any imaging of the lower spine?
4. Change position for sex. If you are heterosexual, lie supine and put a small pillow under the lumbar region to support the lumbar spine, then see if the post-coital tingling and pain in penis and calf is the same or different, or absent

[resianam]

1. You are correct. I think it simply implies that produce similar symptoms. Which nerves are compressed with CPPS?
2. Useful to know - thanks!
3. I had a nerve conduction study done once. I had lost some reflexes in my feet at one point and I had them examine the calf at the same time. All came back normal. No MRI of spine yet but that's a useful thing to keep in mind. The hypersensitivity isn't too bothersome and hasn't been getting worse so I've let it be. I figure some day I'll need a nerve graft and I'll be able to tell them exactly which one to take lol! In any case, I don't know if my PCP would order one. I know insurance companies hate them and I'd probably need it from a specialist. Any advice about how to justify such a thing?
4. We change positions every time. Last time we did it doggy style. Actually, I had a little blood come out for a few minutes afterwards too. That's never happened before but PCP isn't concerned and it hasn't happened since. I'll try that experiment though and report on outcome. I presume I need to be on bottom then? Will be traveling so won't be for two weeks.

[webslave]

No nerves are compressed in CPPS. Nerves are chronically overused in CPPS, at a low level of activity.

If you lost some reflexes in the foot then it looks very much like a nerve impingement issue near or at the spine. Get a MRI of the lower spine if you can. Mention calf pain, reflexes in foot lost (did you have foot drop?) and ask for imaging of lower spine. See how far it gets you (MRIs are expensive). Good imaging will will show if you have disc herniation, spinal stenosis, etc.

Yes, you will need to be on your back.

[resianam]

I come here off an on so just wanted to provide an update to my case. So I haven't had any nerve issues with the penis in a while, which is good news. Pelvic pain remains and flares up from time to time into the legs and butt muscles. My back and abdomen seem to be completely unaffected. A stressful day makes it all hurt to hell. I spend about 30min-1hr each day trying to relax and do stretches and trigger point therapy, though to be honest I don't know what I'm going with trigger point therapy. I've been seeing a local therapist for about 8mo now who specializes in pelvic pain but I don't know how good she is. She's had pretty much the same routine the entire time and her expectation has been that I'd be over this in a few months. Other than pain, at this point I have trouble getting and maintaining an erection. I hope its simply due to tight muscles and that it's reversible cause, well, it sucks. I have general warmth in the area at times, typically when symptoms are flaring suggesting an inflammatory process.

Where am I going now? I've been seeing a therapist weekly for about two years now. It's clear I have some anxiety issues but she's just a LPC. I'm thinking about switching to a psychiatrist or psychologist with expertise in anxiety issues. I mentioned it a few times before and my case is complicated so I've been reluctant to switch and start over. I think she is too, she likes the business and I'm a good customer lol I've been paying cash but I guess I should switch to insurance, record be damned. I've learned a lot at least and can now recognize the dysfunction in my family that's resulted in my taking on these symptoms. I'm reading Anxiety Workbook and Headache in the Pelvis, albeit with slow progress. I'm about to start jaw surgery. I'm hoping that sleep apnea is a large component of this and that after surgery my anxiety tendencies should get a lot better but it's a 1-2 year process. CPAP has helped a lot but hasn't cured my sleep apnea according to the Stanford study I did last summer. I haven't been under the care of a urologist so I'm thinking of getting a referral to one who cares and understands the disorder - the two I've seen previously didn't. I'm going to ask about anti-depressants. I'm debating visiting the clinic at Stanford, especially since my jaw surgeon is there anyway and I need to visit him at some point. I just got the pelvic PT yoga video, which I'll start soon. I'm trying to find time for regular meditation but it's hard to find time with stretches, exercise, and life in general. I'm working on my sleep schedule again, trying to get to sleep between 11pm-12am and getting 7-8 hours. I seem to be worse when this happens actually, all my muscles ache and become sore but I'm hoping it's just a hump I have to get through and eventually things will start healing and get better. I've been Paleo for a few years and my diet is generally pretty good. Sex is extremely relaxing but I'm tring to bring the frequency down from daily to 1-2x/week, not easy. Somehow mid-30s I still have a very strong sex drive despite ED issues, maybe anti-depressants will help here lol. My wife is borderline asexual so at least no marital issues there except for the lack of fulfilling sex.

I would add that I have a stressful life in general. My wife also suffers from anxiety and we have two young kids at home. She hasn't been able to cope and tends to hide in the bedroom most of the time, leaving me with nearly the full brunt of stress of caring for two young kids. She's not social and so it's hard to find outlets for distraction. I do my best to get out with the kids at least.

[webslave]

You describe a very tense life. There are a lot of issues going on. Unfortunately, my own feeling is that it's hard to heal when so much tension is lurking in your everyday life. Seeing a psychologist to discuss these issues is a good idea.

[resianam]

Fortunately, my case isn't too bad. I just have mild pain that flares up in stress and some ED issues. I likely wouldn't be able to impress a 25yo but I can have sex still. It's just the tightness in the butt, thighs, and pelvic area. Back and abdomen have been spared somehow. If I can keep things stead for a few more years, then stress at home should decrease a lot. My youngest is 3 so maybe 3 more years until I reach that point.