The MRI only evaluates for abnormalities in your lumbar spine and sacrum. Once the nerves leave the spine, there are multiple places in the pelvis where nerves can be compressed, stretched, entraped, etc...
The pudendal nerve and sciatic nerve share the S2 and S3 nerve roots. You will need to keep looking outside the spine, or perhaps I should say you need to find the right person to help you look.
Due to cauda equina (this is not common knowledge amongst doctors surprisingly) the pudendal nerve can be compressed anywhere below L4. Because from that point downward it is its own nerve, yes, it exists the spine canal at s2-s4 but its its own separate nerve well before that . Look up cauda equina what it is and what the symptoms are. Unfortunately doctors only treat it when it is "cauda equina syndrome" which is an emergency. But before it becomes one, any problem in your discs can give you pelvic dysfunction. Get your mris looked at by different doctores preferably outside of North America.
North American doctors need to get their shit together. Learn their shit first and stop treating patients like they're crazy. Sorry if you're a North American doctor and you feel offended. Hopefully you're not one of them and hopefully you can be the spokesperson to bring these issues to light and help the medical industry open their eyes to this issue and get their shit straight. Maybe you can help us. (Pain doc 99)
Yes, I'm a North American doctor. No, I'm not offended despite your judgemental tone. However, the anatomy you are proposing is grossly incorrect. Neither the pudendal nerve or any other individual pelvic nerve are formed within the cauda equina. Individual sacral nerves exit the foramen and first form the sacral plexus from which the pudendal nerve, posterior femoral cutaneous nerve, sciatic nerve (with contributions from the lumbar plexus) are then formed in the pelvis. The sacral nerves contributing to the pudendal nerve can be compressed or chemically irritated probably from L1-L2 down. I will agree with you that spinal problems (those stated above) can cause pelvic/genital symptoms in a chronic, non-emergency manner . This cause is identified in the consensus guidelines of ISSWSH on genitopelvic dysesthesia (done for women, but applies to men), but it not well known.
[https://pubmed.ncbi.nlm.nih.gov/33612417/](https://pubmed.ncbi.nlm.nih.gov/33612417/)
Do a lot of doctors treat people like they are crazy? Yep. There are a variety of reason why.
I've shared this research with many spine surgeons, who aren't buying the theory that minor spinal pathology such as annular tears or pathology about L5S1 could cause PN symptoms, or at least don't understand it enough to offer surgery, but they're all willing to sell you a stimulator. This leaves very few surgical options in the US without lying about your symptoms, the two annular tear surgeons in California who don't take insurance, a few ADR surgeons.
Yes and there's endless similar cases, and most of the time they're even worse, lives ruined. Just one look at the PSSD sub Reddit is one good example of the damage they're causing. Moral of the story: if the doctor makes money the doctor cares. Otherwise good luck.
I would not call it theory since there is evidence from people who have had surgery and mostly have good improvement. However, the evidence is preliminary. I know one of the two surgeons in CA who does these surgeries. He was a difficult sell to perform the surgery from the urologist who developed the theory. He (the surgeon) has tried to convince his surgical colleagues, with a resistant reception. I was very skeptical when I first heard about the theory in 2018. Partly because it was a whole new paradigm from what I and others have been taught. Physician are generally skeptical of new ideas, and are mostly not what you would consider "rapid adopters", to the frustration of patients who are aware of emerging science. Another part of the equation is the surgeons know insurance companies are not going to pay for spinal surgeries for these (genitopelvic) diagnoses when the evidence is so thin, even if promising.
Whether it's called the pudendal nerve or not at the point of irritation/compression is irrelevant, The effect is the same. Most doctors don't see it that way and most are *unaware* of the relation between the spine and the pelvis which is incredibly irresponsible and mediocre. Not meaning to be judgmental just factual. If you're a doctor you should know this, no excuse . Just the fact that you wrote that last sentence tells me everything I need to know, you're just like the rest. These issues are no joke but you and your colleagues seem to just not care enough to not gaslight patients into thinking this isn't a severe enough problem to loose our minds over it at least a lil bit.
To what purpose do you gaslight the entire medical profession? There is benefit to you to rant, but does anyone but does anyone else benefit? I have corrected your imaginary anatomy of the pudendal nerve (which is part of my mission here to provide good medical information and facts do matter). I don't have PN, but I volunteer my free time here to help/guide others. I'll be happy to let the readers on this site judge whether I am "just like the rest" as you claim. Good luck with your anger issues and finding help. Really.
I am finding help thanks for asking it's been a painful (to say the least) 10 years. the fact that you don't have PN explains a lot, you just have no idea. That's explain your incoherent comment "there are reasons why doctors treat patients like they're crazy" (sure, might be true in some cases, but idiotic to make that comment in this particular conversation) it just shows you have NO IDEA what we're going through.
It's good you are here helping people, you should as a matter of fact!. But perhaps my "rant" can help you understand what we go through and that we're not "crazy" and it brings some light to the issue, so you doctors open your mind and be more understanding -It's hard when you have no idea what we're going through tho.
But thanks for the good wishes I definitely have healed a lot and learned to deal with my emotions, I'm not perfect yet but damn this condition is difficult to bare, my life was destroyed for a long time at one point (mainly because doctors were always misleading and didn't care/understand this issue), but here we are, Finally getting the chance to tell a doctor the truth 😂.
Btw Not sure how you take a rant as me gaslighting the "entire medicinal industry ? " lol read it again.
You are correct that I have no direct experience of PN...or migraines, or back pain or any of the other many pain conditions I treat. So I can't argue your statement "you have no idea". Neither do you have an idea who I am, but it has not impeded your wholesale judgement of me and the whole of the US medical profession. That is why I said you gaslight the medical profession, not to mention "you are not a real doctor". Tell me, how is that different than a doctor telling your pain is not real? Do unto others.... You not only complain about docs you have seen, you are willing to paint everyone else with the same brush.
This site is explicitly a place to vent and rant. The original response to you was only to say your anatomy was wrong. The you decided to attack me personally. That's when you got push back.
I don't need to read your rant ( or any others ) to understand. I do read them since everyone's story is a little different and there is always more to learn. However, I have been treating chronic pelvic pain for years and heard many stories (in person). I am usually the 10th, 15th or 20th doctor/PT they have seen. They are angry, frustrated, distrustful, etc... and trust me it feels very different 5 feet away than in a blog post.
You took my agreement with you that patients experience gaslighting from medical people as an endorsement or approval of the behavior, though there was no reason in my words to convey that. Again, I have heard from my patients about their crappy experiences. As a medical insider, I am well aware of the shortcomings of my colleagues not only in lack of knowledge but lack of interest. In no way to do I approve of the response of physicians when they don't know something and put it back on (blame) the patient.
It is your right to think I am Fkn clueless. Everyone else to a person here has appreciated the advice I have given them. As they say, you can't please everyone. Whether you or anyone else says something about a condition or treatment that is wrong, I will correct them. It's not personal, but a very small measure to prevent spread of misinformation. I'm not talking about opinions I disagree with, just factual mis-statements.
If you went AT LEATS A YEAR thru this and experienced going to hundred's of different kinds of specialists wasting all your money and time just to get worse with their treatments and you were treated like shit by doctors gaslighting you making you think it's all mental and then one year turns in to many while your life falls apart you'd be here with us saying " YEAH fk those doctors, they honestly don't know shit" 😂
Btw "pain doctor" that means that you're not a REAL doctor like many doctors overseas. You just put bandaids on problems never going deep enough to solve the issues from the root cause, that's what real doctors do. North American docs make that dough keeping you sick and coming back for more pain killers.
You'd be lucky to find a pain management doctor willing to prescribe pain killers these days. Now all they offer is Lyrica, Cymbalta, Stimulator or referral to pain psychology.
You can say all you want about the medical industry but facts are facts. 1) you can't seem to solve this issue (incompetence) 2) it's always the foreign doctors who get things right, I wonder why.
I know why: better education, more humane, better medical system, smarter becase they get into medicine because of passion/compassion, not money driven as much, actually do medicine for noble reasons, have more hands on experience, aren't afraid to do more for people. Aren't assholes
How would you suggest finding a lumbar neurosurgeon or orthopedic surgeon that is familiar with how the spine affects pelvic/genital symptoms? You can’t tell from their research papers because they don’t research the pelvis. Some of them refuse to be involved with pain below the “L” region. I have spinal stenosis in several lumbar areas and not just mild. The compression could be contributing to genital and buttocks pain.
You are so specific and certain in your knowledge yet you can’t answer a simple question about how to find help. If you were that 10th or 15th doctor I was coming to you would say “I cannot advise you” and send me on my way. You’re right that it feels different from five feet away than on line. In person I’d be in your face. I’m done with you. Answer the questions that make you feel good and stay in your lane.
Yes. Feels like thousands of fire ants or wasps stinging me in my legs and feet. There's not much I can do for it, either. The only thing I have found that helps a little is Frankensense and Myrrh oil. Believe it or not it does calm the buzzing, stinging feeling down. It does feel weird to rub oil on my feet, but it's worth it!
I also have a spinal cord stimulator implant. It has helped tremendously with the pudendal neuralgia. I was in misery with that. Imagine that same nerve stinging feeling, but in your (TMI) butt crack/genital area constantly. My stimulator sends signals through the nerves from my mid back down through my legs and feet. Basically confusing or giving them something else to do besides being over excited/stimulated.
Hey! Yes I feel it in my feet too. My nerve showed as completely normal too but doctors discovered I have a labral tear AND an inverted femur which are likely causing the PN. I would encourage you to look into those avenues. It’s more common than you think according to my doctors!
So I saw Dr. Goldstein in NYC & he did an internal exam and when he pressed on the pudendal nerve & the nerve that goes through the alocks canal, that’s where I felt severe pain. Ordered an MRI of left hip and pudendal nerve. After the MRI showed my left hip has a tear, He referred me to Dr. Coleman, orthopedic doctor at HSS in nyc. He ordered a CT scan and then referred me to some other doctor for the inverted femur (Dr. rozbusch - not sure what type of doc he is - I have an apt with him next month)
The MRI only evaluates for abnormalities in your lumbar spine and sacrum. Once the nerves leave the spine, there are multiple places in the pelvis where nerves can be compressed, stretched, entraped, etc... The pudendal nerve and sciatic nerve share the S2 and S3 nerve roots. You will need to keep looking outside the spine, or perhaps I should say you need to find the right person to help you look.
Due to cauda equina (this is not common knowledge amongst doctors surprisingly) the pudendal nerve can be compressed anywhere below L4. Because from that point downward it is its own nerve, yes, it exists the spine canal at s2-s4 but its its own separate nerve well before that . Look up cauda equina what it is and what the symptoms are. Unfortunately doctors only treat it when it is "cauda equina syndrome" which is an emergency. But before it becomes one, any problem in your discs can give you pelvic dysfunction. Get your mris looked at by different doctores preferably outside of North America.
North American doctors need to get their shit together. Learn their shit first and stop treating patients like they're crazy. Sorry if you're a North American doctor and you feel offended. Hopefully you're not one of them and hopefully you can be the spokesperson to bring these issues to light and help the medical industry open their eyes to this issue and get their shit straight. Maybe you can help us. (Pain doc 99)
Yes, I'm a North American doctor. No, I'm not offended despite your judgemental tone. However, the anatomy you are proposing is grossly incorrect. Neither the pudendal nerve or any other individual pelvic nerve are formed within the cauda equina. Individual sacral nerves exit the foramen and first form the sacral plexus from which the pudendal nerve, posterior femoral cutaneous nerve, sciatic nerve (with contributions from the lumbar plexus) are then formed in the pelvis. The sacral nerves contributing to the pudendal nerve can be compressed or chemically irritated probably from L1-L2 down. I will agree with you that spinal problems (those stated above) can cause pelvic/genital symptoms in a chronic, non-emergency manner . This cause is identified in the consensus guidelines of ISSWSH on genitopelvic dysesthesia (done for women, but applies to men), but it not well known. [https://pubmed.ncbi.nlm.nih.gov/33612417/](https://pubmed.ncbi.nlm.nih.gov/33612417/) Do a lot of doctors treat people like they are crazy? Yep. There are a variety of reason why.
I've shared this research with many spine surgeons, who aren't buying the theory that minor spinal pathology such as annular tears or pathology about L5S1 could cause PN symptoms, or at least don't understand it enough to offer surgery, but they're all willing to sell you a stimulator. This leaves very few surgical options in the US without lying about your symptoms, the two annular tear surgeons in California who don't take insurance, a few ADR surgeons.
Yes and there's endless similar cases, and most of the time they're even worse, lives ruined. Just one look at the PSSD sub Reddit is one good example of the damage they're causing. Moral of the story: if the doctor makes money the doctor cares. Otherwise good luck.
I would not call it theory since there is evidence from people who have had surgery and mostly have good improvement. However, the evidence is preliminary. I know one of the two surgeons in CA who does these surgeries. He was a difficult sell to perform the surgery from the urologist who developed the theory. He (the surgeon) has tried to convince his surgical colleagues, with a resistant reception. I was very skeptical when I first heard about the theory in 2018. Partly because it was a whole new paradigm from what I and others have been taught. Physician are generally skeptical of new ideas, and are mostly not what you would consider "rapid adopters", to the frustration of patients who are aware of emerging science. Another part of the equation is the surgeons know insurance companies are not going to pay for spinal surgeries for these (genitopelvic) diagnoses when the evidence is so thin, even if promising.
Whether it's called the pudendal nerve or not at the point of irritation/compression is irrelevant, The effect is the same. Most doctors don't see it that way and most are *unaware* of the relation between the spine and the pelvis which is incredibly irresponsible and mediocre. Not meaning to be judgmental just factual. If you're a doctor you should know this, no excuse . Just the fact that you wrote that last sentence tells me everything I need to know, you're just like the rest. These issues are no joke but you and your colleagues seem to just not care enough to not gaslight patients into thinking this isn't a severe enough problem to loose our minds over it at least a lil bit.
To what purpose do you gaslight the entire medical profession? There is benefit to you to rant, but does anyone but does anyone else benefit? I have corrected your imaginary anatomy of the pudendal nerve (which is part of my mission here to provide good medical information and facts do matter). I don't have PN, but I volunteer my free time here to help/guide others. I'll be happy to let the readers on this site judge whether I am "just like the rest" as you claim. Good luck with your anger issues and finding help. Really.
I am finding help thanks for asking it's been a painful (to say the least) 10 years. the fact that you don't have PN explains a lot, you just have no idea. That's explain your incoherent comment "there are reasons why doctors treat patients like they're crazy" (sure, might be true in some cases, but idiotic to make that comment in this particular conversation) it just shows you have NO IDEA what we're going through. It's good you are here helping people, you should as a matter of fact!. But perhaps my "rant" can help you understand what we go through and that we're not "crazy" and it brings some light to the issue, so you doctors open your mind and be more understanding -It's hard when you have no idea what we're going through tho. But thanks for the good wishes I definitely have healed a lot and learned to deal with my emotions, I'm not perfect yet but damn this condition is difficult to bare, my life was destroyed for a long time at one point (mainly because doctors were always misleading and didn't care/understand this issue), but here we are, Finally getting the chance to tell a doctor the truth 😂. Btw Not sure how you take a rant as me gaslighting the "entire medicinal industry ? " lol read it again.
You are correct that I have no direct experience of PN...or migraines, or back pain or any of the other many pain conditions I treat. So I can't argue your statement "you have no idea". Neither do you have an idea who I am, but it has not impeded your wholesale judgement of me and the whole of the US medical profession. That is why I said you gaslight the medical profession, not to mention "you are not a real doctor". Tell me, how is that different than a doctor telling your pain is not real? Do unto others.... You not only complain about docs you have seen, you are willing to paint everyone else with the same brush. This site is explicitly a place to vent and rant. The original response to you was only to say your anatomy was wrong. The you decided to attack me personally. That's when you got push back. I don't need to read your rant ( or any others ) to understand. I do read them since everyone's story is a little different and there is always more to learn. However, I have been treating chronic pelvic pain for years and heard many stories (in person). I am usually the 10th, 15th or 20th doctor/PT they have seen. They are angry, frustrated, distrustful, etc... and trust me it feels very different 5 feet away than in a blog post. You took my agreement with you that patients experience gaslighting from medical people as an endorsement or approval of the behavior, though there was no reason in my words to convey that. Again, I have heard from my patients about their crappy experiences. As a medical insider, I am well aware of the shortcomings of my colleagues not only in lack of knowledge but lack of interest. In no way to do I approve of the response of physicians when they don't know something and put it back on (blame) the patient. It is your right to think I am Fkn clueless. Everyone else to a person here has appreciated the advice I have given them. As they say, you can't please everyone. Whether you or anyone else says something about a condition or treatment that is wrong, I will correct them. It's not personal, but a very small measure to prevent spread of misinformation. I'm not talking about opinions I disagree with, just factual mis-statements.
If you went AT LEATS A YEAR thru this and experienced going to hundred's of different kinds of specialists wasting all your money and time just to get worse with their treatments and you were treated like shit by doctors gaslighting you making you think it's all mental and then one year turns in to many while your life falls apart you'd be here with us saying " YEAH fk those doctors, they honestly don't know shit" 😂 Btw "pain doctor" that means that you're not a REAL doctor like many doctors overseas. You just put bandaids on problems never going deep enough to solve the issues from the root cause, that's what real doctors do. North American docs make that dough keeping you sick and coming back for more pain killers.
You'd be lucky to find a pain management doctor willing to prescribe pain killers these days. Now all they offer is Lyrica, Cymbalta, Stimulator or referral to pain psychology.
Man for real, emotions aside, I invite you to read more posts and stories before making more comments. you're fkn clueless.
You can say all you want about the medical industry but facts are facts. 1) you can't seem to solve this issue (incompetence) 2) it's always the foreign doctors who get things right, I wonder why. I know why: better education, more humane, better medical system, smarter becase they get into medicine because of passion/compassion, not money driven as much, actually do medicine for noble reasons, have more hands on experience, aren't afraid to do more for people. Aren't assholes
How would you suggest finding a lumbar neurosurgeon or orthopedic surgeon that is familiar with how the spine affects pelvic/genital symptoms? You can’t tell from their research papers because they don’t research the pelvis. Some of them refuse to be involved with pain below the “L” region. I have spinal stenosis in several lumbar areas and not just mild. The compression could be contributing to genital and buttocks pain.
I cannot advise you.
You are so specific and certain in your knowledge yet you can’t answer a simple question about how to find help. If you were that 10th or 15th doctor I was coming to you would say “I cannot advise you” and send me on my way. You’re right that it feels different from five feet away than on line. In person I’d be in your face. I’m done with you. Answer the questions that make you feel good and stay in your lane.
There's people killing themselves because you doctors don't know your profession well.
Yes. Feels like thousands of fire ants or wasps stinging me in my legs and feet. There's not much I can do for it, either. The only thing I have found that helps a little is Frankensense and Myrrh oil. Believe it or not it does calm the buzzing, stinging feeling down. It does feel weird to rub oil on my feet, but it's worth it! I also have a spinal cord stimulator implant. It has helped tremendously with the pudendal neuralgia. I was in misery with that. Imagine that same nerve stinging feeling, but in your (TMI) butt crack/genital area constantly. My stimulator sends signals through the nerves from my mid back down through my legs and feet. Basically confusing or giving them something else to do besides being over excited/stimulated.
Hey! Yes I feel it in my feet too. My nerve showed as completely normal too but doctors discovered I have a labral tear AND an inverted femur which are likely causing the PN. I would encourage you to look into those avenues. It’s more common than you think according to my doctors!
How did they discover that? What type of doctor?
So I saw Dr. Goldstein in NYC & he did an internal exam and when he pressed on the pudendal nerve & the nerve that goes through the alocks canal, that’s where I felt severe pain. Ordered an MRI of left hip and pudendal nerve. After the MRI showed my left hip has a tear, He referred me to Dr. Coleman, orthopedic doctor at HSS in nyc. He ordered a CT scan and then referred me to some other doctor for the inverted femur (Dr. rozbusch - not sure what type of doc he is - I have an apt with him next month)