Chronic penile or scrotal pain, where urological investigation and ultrasound show no cause, is one of the most frustrating problems - patients move between specialists and are told there is “nothing there”. Yet very often the pain does not originate in the organ where it is felt.
Trigger points in the pelvic floor, abdominal and adductor muscles refer pain to exactly these areas. Irritation of the pudendal nerve, or of the ilioinguinal and iliohypogastric nerves, does the same - producing pain, burning and hypersensitivity at a distance from the source. This is pelvic pain syndrome, and physiotherapy is one of its main treatments.
The condition for starting is that causes needing medical treatment have been excluded - infection, varicocele, hernia, testicular changes. If the patient has not been through that route yet, I refer him to it rather than starting therapy on symptoms alone.
Therapy
- Detailed history and a pain map
- Examination of the pelvic floor, abdominal muscles and adductors
- Searching for trigger points that refer pain
- Manual therapy and dry needling of trigger points
- Work on the nerves of the perineum - mobilisation and decompression
- Learning to release, and breathing work
- A home programme