Tip of Penis Pain

[Danzig1788]

Hi everybody,
first of all I want to thank everybody who is using this forum for their courage and their engagement. This site really rocks. My name is tammo, I'm from Bremen, Germany and i' m suffering from chronic prostatitis / chronic pelvic pain syndrome for about 2 1/2 years now. My only major symptom seems to be pain at the tip of my penis. When symptoms first came on there was a big urge to urinate, this symptom has vanished though. The problem is that my penis hurts about almost all the time and it has had a really devastating impact on the quality of my life. However, I muddled through and I'm very glad I'm still going to college and that I'm able to see the positive aspects of it all (healthier lifestyle, discipline, increased interest in sports, etc.).
I have read "a headache in the pelvis" and I want to really commit myself to the Stanford/Wise-Anderson Protocol. As most of you may know, the book says that tip of the penis pain is usually caused by the anterior portion of the levator ani muscle. I haven't had any internal PT yet, but I'm going to get some-maybe about three sessions- in Zurich, Switzerland hopefully sometime soon. I also have a good friend who is a PT who wants to help me, he' s not a chronic prostatitis / chronic pelvic pain syndrome specialist but I have given AHIP to him, and he wants to try it out. Since internal PT work is "illegal" in Germany, this is kind of something special and I will update information on how things work out as soon as possible. I also do daily relaxation, I got the tapes that Dr. Wise used to offer. It seems to work but I'm only doing this for about two weeks now so there still is a long way to go.
I never really did stretches though. I wonder if anybody has the same symptom and knows a stretch that worked for him. I also do jogging for a while now; I stopped it a while ago because it sometimes caused flare ups and since i`m in a lot of pain about almost all the time, my motivation was low.
Since I have the 3rd Edition of AHIP, I know about the stretches that are illustrated there. My point is:
- should I do all those stretches?
- does anyone know about a specific stretch for pain at the tip of the penis?
Thank you all very much, this forum is the best one for chronic prostatitis / chronic pelvic pain syndrome sufferers worldwide.
Have a pain-free day,

tammo

[webslave]

I think you should do the stretches, it's important.

[Clay]

I'm too new here to give you the detailed answer you want, but I agree with Webslave, you should do the stretches. My pain started in the penis too, but then migrated to other areas. The stretches aren't that difficult, and if I had done them all in the beginning, I might have kept this monster tension from moving into some of the areas it now controls. Stretching is one of the easiest ways I fight and win against this thing.

There's a wealth of information buried in the older posts here, it is indeed a great place to find.

[perth]

Mine started that way too and grew into so much more. While I'm happy to believe the whole trigger point idea, I've never had anyone find a specific trigger point for pain in the penis.

That might sound depressing, but I think the more important point is to deal with the symptom as best you can - relaxing helps me, stretches, massage (trigger point stuff in abdomen) - and look after the rest of you. I can't speak for everyone, but one sure way to tense your pelvis is to continuously guard whenever you expect penis pain. So you put you underwear on and tense in expectation of pain. That just leads to further tension-related problems. So do your best to treat everything else using stretches and relaxation.

[alprost]

Trigger points in the front portion of the pelvic floor in and around the prostate, and also some in the abdomen, can refer to this region. The ones around the prostate caused this problem for me, and the pain went when these were treated.

[Danzig1788]

Hello everybody,
Alright, I will do those stretches illustrated in AHIP from now on. Thank you all very much for the answers. I know I have to do whatever I can, its part of the the Stanford/Wise-Anderson Protocol. Of course those stretches are important, otherwise they would not have been illustrated in AHIP by Dr. Wise. I guess there are two reason why I didn't do `em:

• the first reason is depression. Who wouldnt be depressed when his penis hurts about almost all the time? But I'm sure youve been there, too. It took me a long time to realize that the Stanford/Wise-Anderson Protocol would be the right choice for me. Participating in a program that takes at least a year didn't seem to be a choice; I thought since I had to go to college there had to be a quicker fix somewhere. Thats why I first chose the TURP treatment (its supposed to kill bacteria by heat). Also (at an urologists) office, ultrasound showed up a pretty big inflammation in the prostate. The urologist said back then that my pain is caused by this inflammation, also they all recommended this heat treatment, which is available in Dortmund (a city in Germany). The treatment was very painful and it didn't make a difference to my condition. Ultrasound showed me half a year later that there was no more inflammation while the pain remained the same. Now I knew the Stanford/Wise-Anderson Protocol was probably the right choice. More reassurance was provided by a doctor that is specialized on pain- related issues. He examined my pelvic floor with a gloved finger and found a big muscle portion that was really hardened. He didn't look for trigger points though. I was given 2400mg gabapentin, a drug I stopped to take since (in my case) the side effects where immense. I didn't like the doctor anyways (and he didn't like me either, he made that very clear the first day I got there; I guess he just doesnt like rock musicians, he thinks theyre scumbags or whatever)
• the second reason is I was scared. Scared to get a major flare up. According to the Stanford/Wise-Anderson Protocol (as you probably all know) flare ups are supposed to be a good sign. Still I would like to have some reassurance here too.

Are there always major flare ups before things might get better? I'm worried because I read a thread where a guy was told to stop doing stretches because they didn't seem to do him any good. I will be patient anyways.

Trigger points in the front portion of the pelvic floor in and around the prostate, and also some in the abdomen, can refer to this region.

Can trigger points be located in the prostate as well? I didn't know that.

Mine started that way too and grew into so much more

Thanks again for your answer. I'm sorry chronic prostatitis / chronic pelvic pain syndrome affects you so bad.

My pain started in the penis too, but then migrated to other areas. The stretches aren't that difficult, and if I had done them all in the beginning, I might have kept this monster tension from moving into some of the areas it now controls

Same thing, I'm sorry that the "monster tension" has moved to different locations.

What we all have to do is to forgive ourselves. I read that in the "most useful messages" section on this site and it really helped me. I know this kind of thinking very much; I used to think: "if only I hadnt been riding my mountain-bike for 25 miles a day, if only I slept more, if only I never did any drugs, if only I were a different person." This kind of thinking simply gets us nowhere; we have to forgive ourselves. By the way, my pain medication at the moment is buprenorphine, sometimes referred to as "bupe" (2 times 0,4mg sublingual daily). It works better than gabapentin for me, but I definitely wouldnt recommend it because it causes opioid-dependence. I'm simply writing about it because it is part of my story. In the long run I wanna quit that drug. Its basically not worth it and its better to help yourself otherwise. After a year in pain I thought back then "i wanna give it a try, no matter what, because I want to survive no matter what".

Sorry for this being such a long thread.
Have a pain free day,
tammo

[LightningTree]

I'm glad you are going to do the stretches, they are very important.

I believe that pain in the penis tip can also be caused by the prostate/bladder neck region, as well as the upper rear Levator Ani.

To get the bladder neck to relax, you will be best off working on increasing your inherent state of relaxation and reducing your inherent anxiety. That will take practice.

For the upper Levator Ani, I can't stress enough how much the pigeon pose has helped me and seems to help my twin brother. At least try it and see if it helps you. Keep in mind that it helps me most when I keep the front knee as far forwards as possible, but it is also possible to tear muscles doing this stretch ( I tore one) and so you need to be reasonably careful.

[webslave]

I first chose the TURP treatment (its supposed to kill bacteria by heat).

Your uro is a fool. :x A TURP is not a recommended treatment for this condition at all.

He examined my pelvic floor with a gloved finger and found a big muscle portion that was really hardened.

From the definition of CPPS/pelvic myoneuropathy: The subsequent muscle spasm and hypertonicity of the pelvic muscles leads to a hyperirritability of the muscle fibers. The hyperirritable bundles of fibers within the muscles of the pelvic floor become "knotted", inelastic and unable to contract or relax.

Trigger points in the front portion of the pelvic floor in and around the prostate, and also some in the abdomen, can refer to this region.

Can trigger points be located in the prostate as well? I didn't know that.

Just a figure of speech. He does not mean inside the prostate, just around it.

my pain medication at the moment is buprenorphine, sometimes referred to as "bupe" (2 times 0,4mg sublingual daily). It works better than gabapentin for me, but I definitely wouldnt recommend it because it causes opioid-dependence.

Opioids can cause pain on their own, unfortunately.
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[Sleeper Service]

Hi Tammo.

I've been working with Bill Taylor in Edinburgh and I must admit that it is helping. His advice on the stretches was to be careful - get a physio to check you out as some of them may not suit you. For example, I do two stretches every day, not the ones in A HEADACHE IN THE PELVIS, and others have stretches that work for them.

If you can get over to Scotland I would recommend seeing him.

[perth]

Just to follow up what alprost sad: I've had Tim Sawyer poke around my prostate but to no avail. My wife does the regular SP probing right next to my prostate (in as far as her fingers will go) but nothing refers yet. The only thing that does was mentioned by someone else here (sorry, but I forgot who) and that is a trigger point under my public bone - accesses by pushing my abdomen in on the edge of the bone below my belly button then down towards my pelvic floor. This refers to my penis and with some movement, my prostate/pelvic floor.

Any tips would be great to hear (I'm trying the pigeon pose - though I look more like a deformed goose when I do it) but I'm not sure where the upper rear Levator Ani is. My guess is that once I can stretch my adductors enough then I'll get a good stretch there. Can I access it manually (or my wife?).

[GS]

the trigger points that most commonly refer to the tip of the penis are located in the anterior levator ani. These spots are difficult to reach by most people. You need a PT with long fingers to hit them. The only PT I know who can reliably work on these trigger points is Tim Sawyer.

[alprost]

Trigger points in the front portion of the pelvic floor in and around the prostate, and also some in the abdomen, can refer to this region.

Can trigger points be located in the prostate as well? I didn't know that.

No, I meant the pelvic floor muscles around/below the prostate.

[LightningTree]

THe abdomen connection seems almost universal. Its generally on the left side just below the belly button. Some have suggested that is a nerve conduit. I also wonder about the left psoas, the runs down from the side/front of the spine towards the left leg and passes through the abdomen under the superficial muscles at around that point.

Lots of possibilities.

As far as that rear levitar ani point that you can reach if you have really long fingers... that is what the pigeon pose stretch pulls on for me if I can do it right. Its a critical spot. If you can find a PT who can reach up that far you are in luck.

[Danzig1788]

Hi folks,
I've been to a doctor for orthopedics today in order to get a recipe for a couple of PT Sessions. I told the doctor that I was suffering from chronic prostatitis / chronic pelvic pain syndrome and showed him a medical certificate from an urologist saying that I live with this condition for quite a while now. This was just to make things easier because I experienced a lot of weird stuff in doctors offices and in the end I got the desired recipe - for gymnastics, not really PT but I think my PT can hopefully use it otherwise I gotta go there again.
Even though there seemed to be a lack of engagement on his side-he simply asked me to move each leg a little and asked if that hurts. It doesnt. A ten second long examination, what a shame.... but:
He said that the spine and the related nerves may be part of the problem as well. I sometimes read about that in the German pelvic pain forum (http://www.medizin-forum.de) but was never sure what to think about it `cause I never had any back pain. He than x-rays my spine just to see if everything is alright. As a diagnosis he said that there is a degeneration of the intervertrabal disc.
However, he couldnt show me at the x-ray pictures what actually had degenerated that much so maybe thats just kind of a scientific guess.
Still it is possible that there is something wrong with it since I used to work very hard (physically) for quite a few years and that may have had an impact on me. I think ill go to another orthopedic doc that I know personally and let him have a look at the pictures, since ill use the recipe for PT to get some internal work on my pelvic muscles done and also ask for some specific stretches after the examination. I'm glad I know this PT very well for more than ten years now - we both used to work in bars and spent nights and nights and nights of drinking and partying together. Hes kind of new in his profession but hes very motivated and he also seemed very interested in reading "a headache..." So maybe my first internal PT sessions will start by next week or so, I'm excited!!

The only thing that does was mentioned by someone else here (sorry, but I forgot who) and that is a trigger point under my public bone - accesses by pushing my abdomen in on the edge of the bone below my belly button then down towards my pelvic floor. This refers to my penis and with some movement, my prostate/pelvic floor.

Hi pert, I will put some research into these aspects. Thanks for posting this.

the trigger points that most commonly refer to the tip of the penis are located in the anterior levator ani. These spots are difficult to reach by most people. You need a PT with long fingers to hit them. The only PT I know who can reliably work on these trigger points is Tim Sawyer.

Hi GS,
Thanks for this essential information. Even though id love to go to stanford this won't be possible for me in the near future.

I've been working with Bill Taylor in Edinburgh and I must admit that it is helping.

Hi sleeper service,
thanx, I heard of this guy before, he must be good in his profession. Even though its not impossible for me to get there, I dont think its gonna be possible sometime soon. I'm going to see a lady in Zurich Switzerland as soon as I get an appointment. Her name is Jaqueline Mustafic and she knows the book AHIP and was recommended by a couple of people that use the german pelvic pain forum.

Your uro is a fool. A TURP is not a recommended treatment for this condition at all.

It wasn't even one uro. All together it was three of `em. And they all said
inflammation, which was visible by ultrasound, was the reason there was pain, and bacteria was the reason there was inflammation (except for one who wasn't sure about the germs but still prescribed antibiotics). I wish I could spend the money for the TURP (about $1400) on PT in a decent place.

I have read the opioid warning before posting. Can you tell me what mast cell degeneration actually means? Thanx.
Have a pain free day everybody,
tammo

[LightningTree]

Its up to you, Danzig. Just be careful, the bacterial theory of long term chronic prostatitis has been exhaustively tested, and it has been demonstrated to be a theory without any convincing evidence. So much so, that in the United States, Type III a and b chronic prostatitis is now refered to as Male Chronic Pelvic Pain Syndrome, to emphasize that the bacterial or 'abacterial' classification is not useful.