Chronic Pelvic Pain (Male)

Zara
Dysfunction of the pelvic floor is not reserved to women. I am sorry that you are finding it difficult to access a pelvic floor clinic that sees male clientele. It must feel like gender discrimination to be turned away.

Botox makes logical sense to try, especially given that you have found some measure of success with localized nerve blocks of the pedundal nerve and tributary roots. I would keep researching to locate a physician who would agree to a Botox injection. A larger private hospital or larger teaching hospital would likely be better candidates for pelvic floor programs that serve both women and men than would be a small community hospital.

You mention that you have seen a physician in New York for pedundal nerve blocks - that were successful albeit for short duration relief. Have you since talked with this physician about botox injections to the same?

You may also want to look into compounded topical creams that combine lidocane, tramadol, amitripyline, and gabapentin - among other medication combinations. Compounding medications allows customization of medication formulations, upon the request of a physicians, to best suit a patient's needs. Ketamine and clonidine and dexamethasone are also possible neuropathic agents that could be compounded into a creme for application. CentralDrugsRx.com has a comprehensive listing of pain medication preparations that are possible via personal compounding. I would suggest visiting the web site and printing their contents of speciality formulations to review/discuss with any one of your MD physician providers. You might be able to find significant and specific relief with a customized compounded transdermal creme or patch.

I hope that you begin to find some relief from the ongoing prostatitis. The lower pelvis has a high proportion of sensory nerve endings, so I can appreciate that your pain would be more than annoying - it would be pain that would impact your day-to-day being.

- Karen -

Zara:
Of course you would like to more fully understand the origin and nature of your pelvic pain. That is a universal desire, I think, of almost everyone with a health condition - to be able to understand the nature and origin of what ales one's body.

In my 20+ years of compromised health, I have lost faith in the medicine to give of the focused attention and time to thoughtfully arrive at a sound and concrete differential diagnosis. I have had more incorrect than correct diagnoses applied to my medical record.
Be prepared that you may have to be your own best and most vocal advocate in ensuring that the answers that you want answered regarding the cause of your pain are fully investigated and vetted.

My suggestion in exploring compounded medications are simple: 1. To provide you with better pain control than you are now experiencing; 2. Knowing that ongoing pain has collateral damage effects - insomnia and less than restful sleep, chronic fatigue, changes in mood (more easily angered and frustrated), social isolation. Compounded topical or transdermal medication might afford you better pain control so that you can better focus your mind and body in guiding your medical care and in living a better quality of life day to day.

As a physical therapist, I spent time working with patients with pelvic floor disorders - both women and men. Vulvodynia was a fairly common disorder that my colleagues and I saw and treated. I am thinking that the pain with vulvodynia is not dissimilar to what you are experiencing - the pain threshold can be excruciating due to the high sensitivity of the sensory nerves associated with the ***oris (in women) and with the penis (in men) in an aroused state. Patients experienced good pain reduction with the topical compounded medications. Individual variation, person to person, was noted. That's why we often had patients try several of the different possible medication combinations as are presented in the information on the compounding website.

All to say . . . do not be too quick to dismiss the benefits of one or more of the compounded mediations as outlined in the compounding web site information. You can benefit from pain relief as you explore and try to discern the root cause and treatment that is more focused. But also remember that there are not always known answers as to why an area of the body is in pain. There are not always known answers as to why certain sensory nerve pathways are hyper-sensitive or why the brain perceives sensory messages as overly painful.

In suggesting compounded medications I am not suggest that you "cover up your pain with pain medication for the rest of your life." Rather, I am trying to toss you a life-preserver that can help keep you afloat as you and your medical providers try to understand the pain and is root cause.

Prudendal nerve entrapment is certainly a valid possibility. If so, any of the topical compounded medications would have value in lowering your pain experience. In the clinic I worked at, men with foreskin irritation (non-circumcised individuals) found the neuropathic compounding formulations very helpful as did women with vulvodynia. In many cases the relief was dramatically positive. Within 5-10 minutes of applying, these individuals were smiling and able to get up and walk out of the clinic being able to engage in their lives. Certainly, it is something to discuss with the new MD that you are seeing as you and he/she review exam and scan findings and decide on a treatment plan.
- Karen -