Ideas..Feedback please

[neis]

I've been well for a long time now. By well I mean rare low level perineal pain and very occasional tip of penis pain. I'm able to ride my bike and go to spin classes without triggering any event. One of my worst triggers when this began was soft, deep couches. It would trigger burning and nerve sensitivity that could last weeks. I've avoided this trigger for a long time, and haven't thought much about it until last night. I was invited to watch a movie by someone who has a soft, deep couch. I was good for 15 minutes then began to feel a nerve buildup in my perineum. I tried shifting positions not thinking any event would result. Instantaneously I got a nerve jolt like I've never had in the left side of my perineum. It happened 3 times rapidly which resulted in me screaming in pain and jumping from the couch...and scaring the bleep out of my lady friend. This is clearly nerve excitement...and dare I say entrapment, induced by this sitting position and relieved when I get out of position. My guess is soft couches squeeze the butt cheeks together putting pressure on the pudendal nerve running along the inside of the cheek resulting in the shocks. I'm looking for any other ideas, and possible diagnostic imaging/testing that could help me figure this out.
Other than this trigger all is manageable. Thanks for any input.

[webslave]

I cannot sit on soft chairs because it disturbs the alignment of my lumbar spine, creating symptoms in my back, buttocks, legs and feet. It's possible you are affected even further down the spine, in the space where the sacral spinal nerves emerge. (The pudendal nerve arises from the sacral nerves S2, S3, S4.) Moral of the story: avoid slumping or sitting in soft chairs.

pudendal-nerve.png

[neis]

Great diagram...thanks. Sitting upright and/or slumping triggers the nerve in the deep couches. The nerve is now irritated from last night, and just a moment ago a sneeze produced muscle tightening in my perineum resulting in the nerve pain. How effective are nerve blocks for these specific symptoms? Yes, continual avoidance of these seat types is the game plan. Theater seats used to get me, but no longer, which is a small indicator of healing.

[Jay]

How effective are nerve blocks for these specific symptoms?

There are never any guarantees with nerve blocks. My pain management doctor has long been wanting me to try a caudal epidural, which would pretty much hit every nerve in the pelvis, but he has always specified the uncertainty of it. One could get some pain relief for six months, or it may not work at all. Some folks even flare up from their blocks, though this seems to be uncommon. Their effectiveness varies a great deal from one person to the next. Steroids are usually required in the injection in order to reduce inflammation and encourage a lasting effect, but that carries its own risks.

[neis]

Thanks Jay for your feedback.

[webslave]

And always keep Dr Dimitrakov's warning about nerve blocks making this condition worse in mind:
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