Question: Hi

I have a very nagging problem where the sun doesn't shine.

Since I was 18 years old (28 today) I have been having this dull aching pain in my private area and I have not yet been diagnosed or found out what is causing it.

It all started randomly one day and it has remained more or less unchanged since until now, but my symptoms have gotten worse over the last 6-12 months now.

After sexual activity I get the heavy dull aching in the perineum and in the penis which comes roughly 20-30 minutes after the sex. Standing up and being physical makes it only much worse and sitting down helps but doesn't make it go away. The sensation remains for around 4-6 hours or until the next morning where it is usually gone.

Together with the pain is also some urinary symptoms, these includes that I felt the stream of urination got weaker when this all started in 2008 and that I sometimes get a burning sensation while or just after peeing in the urethra or the bladder. I also always have a little pee left in the urethtra that comes out shortly after finishing the peeing, or by sitting or coughing.

Lastly I randomly feel some pains in my testicles, not excruciating but they happen once in a while and I have a hard time sitting 'correctly' on a chair as I get a burning sensation in the perineum or anal area if I put pressure there. It seems to spread especially to the right side of the anal spinchter area and annoys my right buttock when I sit down. This makes me slouch a lot to try avoid hitting the areas, but sitting no matter what still aggrevate it all.

All these symptoms started at the same time together in 2008.

I've been tested many times for UTI or STDS and they are always negative. Though I did have a UTI one time for 6-7 years ago which was treated with antibiotics.

I've also been visiting an OB Gyn PT, who specializes in pelvic pain for men/women and she examined my abdomen and pelvic area and concluded that I was tense and I felt sore/pain when she poked the pelvic muscles. I only visited her once as she said stretching and breathing is a key.

What is wrong with me and what should I do? This is driving me mad and I am feeling it everyday now.

Hi Dr Christensen

Thank you for your reply.

Have you heard about the condition Chronic Pelvic Pain Syndrome or Chronic Prostatitis (CPPS)? Could it be that?

I have had my testes ultrasounded last year and found that I had some varicocele on the left testicle. I have been holding back on the cystoscopy as I've heard it should be super painful and on its on can cause problems in the urethra afterwards.

I think I may have some hemorrhoids, could they be causing these problems? If I sit longer times at the toilet or don't clean properly after a bm, then when standing I can feel some swelling at the anus. This gets worse while standing and gets better sleeping/sitting and zinc ointment also help. The swelling goes away and can't really be felt until the above is done or after straining or similar.

So basically the same as with ibs. I've been diagnosed with ibs after many tests that came after a stomach flu almost a year back. If I wipe only then it's hard to keep it clean and if it's not clean the area itch and will annoy me the rest of the day. I use water to wash the area to keep good hygiene and to avoid the itching of the anus.

It's long ago, but for many years I do once in a while see the smallest pink spot on the paper after wiping a lot. But using water to clean it and I have noticed this much since starting. But I am pretty sure if I wipe harder and perhaps frequent with paper then it might bleed slightly.