Dear Dr. Roach: I developed pudendal neuralgia several years ago (confirmed by rectal EMG), and am unable to sit for any length of time.
The majority of my pain is in the peri-anal area and into the testicles. This happened after I was misdiagnosed following an ankle injury and was very sedentary for three months (sitting most of the time), which caused compression of the nerve.
Physical therapy (deep-tissue massage, ultrasound, laser) has helped. I take Lyrica and Cymbalta, and wear a Butrans patch. More than a dozen nerve blocks were not helpful, although the past block seems to have lessened the pain to some extent. I also have undergone dry needling for trigger points and internal massage of the pudendal nerve. Acupuncture did not help. Are you aware of any other treatments that may help with this problem?
G.M.
The pudendal nerve moves in a complex way through the pelvis, and can be damaged in several ways, including through pelvic surgery, but I most often see it in male cyclists. The typical symptoms are pain in the perineum, but pain can be in many areas around the pelvis, and may be more of an electric shock sensation or numbness rather than pain.
Some people are incorrectly diagnosed for years, as this is an uncommon disorder. You already have had many of the treatments for it, including physical therapy, medications and nerve blocks (which can help with diagnosis as well).
In people with insufficient relief after as much as you have been through, I would recommend that you consider pudendal nerve decompression surgery. This is a situation where several surgical techniques can be used, and having an experienced surgeon is of paramount importance. Most people have at least a 50 per cent reduction in pain with surgery, but there is no guarantee of a perfect outcome.
I found a website with helpful information at pudendalhope.info.
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Dear Dr. Roach: After reading your article regarding symptoms of basal cell skin cancer, I found the information extremely helpful, but would like to add my history of a very serious basal cell issue.
It was on my nose, about the size of a quarter and required Mohs surgery followed by cartilage and forehead skin transplant 鈥� ultimately requiring three separate surgeries. The reason this cancer became so severe was that I and my doctor were unable to differentiate between the cancer and psoriasis. I did further damage by intentionally sitting in the sun during the noon hour for about a week, thinking I was treating psoriasis.
I am writing this to you in case you touch on this subject in a later column. Those with psoriasis breakouts on the face should be checked for basal cell cancer. I had only mild psoriasis patches previously on my face, and the basal cell really looked identical to what I had seen.
The difference was bleeding, which would start and stop. My regular physician assumed it was psoriasis. It was only when I called it to his attention that he said I needed to be rechecked by the dermatologist.
G.F.H.
Thank you for writing. This is a great reminder that skin cancers can look like benign conditions, and that bleeding is a big red flag. Patients and primary-care doctors should be vigilant and schedule a dermatology visit for nonhealing lesions.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu.
