Neuropathy of the genital organ: what can be understood from the symptoms?

Chronic pelvic pain syndrome often affects athletes or fitness enthusiasts, and this middle-aged man is no exception. He came to the urologist complaining of painful urination, burning, discomfort, and a constant sensation of bladder fullness—even minutes after visiting the restroom. The doctor suspected prostatitis, but the diagnosis was not confirmed.

— Tell me, are there any other difficulties? For example, with your sex life.

— You know, doctor, yes... I feel like there might be issues with potency. Although, when you're almost constantly in pain and discomfort, it's not surprising.

— Did this start suddenly?

— Quite quickly. Initially during workouts, I felt numbness in my genital organs, and then the pain appeared.

— What kind of workouts?

— I participate in cycling, cross-country races. I've won first place several times at regional events, and even participated in international ones a few times.

— And are you still cycling?

— Unfortunately, no. It's very painful. And, to be honest, I'm hoping you can help me because I haven't been separated from my bike for long since I started riding it. It's been about forty years.

Here we have one of the main risk factors. Impingement of the pudendal nerve in Alcock's canal is even termed "cyclist's syndrome" among specialists. The position of the body while cycling and pedaling, prolonged close contact with the saddle often lead to constant pressure on the nerve, which subsequently results in pudendal neuropathy.

— Does it get easier in other positions?

— If I don't sit and lean over the handlebars? In general, yes. Standing is not as painful compared to cycling. But the discomfort is constant. Ordinary painkillers, I think, don't help.

— And if you imagine yourself sitting on a toilet and relax, do you feel relief?

— I've even tried that a few times, not intentionally, just noticed that it becomes easier. Doctor, can you tell me what's wrong with me already?

— For now, there's a possibility that you've developed what's called Alcock's canal syndrome, and the cause of the pain and other symptoms lies in the impingement of the pudendal nerve. But before making a final diagnosis, we'll conduct several tests. I'm afraid if my assumption is correct, you'll need to work on changing your lifestyle.

Fear reflects in the patient's eyes.

— I won't be able to cycle? Is it not treatable?

— It's hard to say. It depends on many factors: the nature of your condition, your body's response to therapy. Some patients find relief with the first prescribed treatment. Moreover, if the diagnosis is confirmed, then you could say you're "lucky": genital neuropathy with compression specifically in Alcock's canal is typical for professional cyclists. Many models of special seats have been created that relieve pressure from the nerve and reduce pain.

— So, it's not possible to cure it completely?

— I can't answer that yet. In some cases, surgery—pudendal decompression—is recommended. It has a fairly high success rate. Conservative treatment is palliative, but with the current level of medical advancement, patients can receive comprehensive treatment and, with some limitations, continue to engage in the same activities as before the illness. But right now, we need to focus on determining the diagnosis as quickly as possible...