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Burning at Penis Tip
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Burning at Penis Tip

After five months of treatment by my primary physician and a urologist, including digital exams, PSA of 1.6, several antibiotics and a cystoscopy my problem was diagnosed as being neurological in nature.  I continue to have sporadic burning at the tip of my penis, as well as to the rear of the penis head and some times on the scrotum.  The symtoms (symptoms) come and go and are of varying intensity. There seems to be no relationship to urination or ejaculation, sitting, standing or walking. There are no other discomforts. I am 72 years young and in general good health.  I am currently seeing a chiropractor who is adjusting my sacrum, which doesn't want to stay where it should.  There doesn't seem to be any change in my symptoms post sacrum adjustments.   Where do I go from here?
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9 Comments
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Avatar_m_tn
Congratulations on your overall good health.  If your problem is neurological (and at this point it seems a reasonable conclusion), the nerve responsible ought to be easy to identify, as in almost all men the lower 1/3 of the penis is innervated by nerve fibers originating from S3 (the third sacral nerve).  Considering that your sacrum doesn't want to stay in place, it's a good bet that S3 has been injured either by the wandering sacrum or by manipulations aimed at repositioning the sacrum.  You could have an imaging study done (MRI or CT), but the study may not reveal anything.  Very small nerve lesions or other relatively minor trauma can still cause considerable discomfort.  At this point, it may be simpler and more sensible for your doctor to try medications aimed at reducing the pain impulses without completely numbing the penis tip.

A good neurologist or pain doctor ought to be able to find an appropriate therapy for desensitizing S3.  

Best of luck!
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Avatar_m_tn
What you suggest as the cause of my problem is intersting in that back in April soon after I starting having the symptoms, which I thought was an "overactive bladder," I went to the chiropractor for another complaint:  pains in my right hip and lower leg.  He adjusted the sacrolliac and after a few adjustments it seemed to stay in place.  Those pains went away., but the sacroilliac being out may have irritated the "nerve" of which you speak.  In retrospect, the other symptoms are better described as "burning" at the lower end of the penis and sometimes the scrotum.  I would sometimes feel as if I had had an accident as the inside of my right thigh felt as if it were wet, when it wasn't.  Now I have been tod that it isn't a UTI and I have been going to chiropractor again and he is a adjusting the sacrum, I have not noticed the burning on the scrotum nor the wet feeling on the thigh. Since seeing him. The "burning" on the penis continues.  With your expertise could you give me some insight as to how long it might take the "nerve" to heal if and when the chriopractor is successfful in keeping the sacrum in place.  Is the nerve that you speak of the pudendal nerve?  Also, my daughter, who is a PT, has me doing some exercises to strengthen the hip flexors.  She has suggested that I might want to see a PT who is experienced in treating pain associated with the pudendal nerve.  Any thoughts there?
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Avatar_m_tn
No expertise here! I'm just a long-time (30 years) sufferer of occipital neuralgia, and have had to research treatment options after doctors told me they'd done all they could. Most of these doctors were quite competent, but for some reason couldn't think creatively. That's where doing your own research can reap huge dividends, and I am finally getting relief because of the combination of drugs I requested to try. It also helps that I bounce ideas off of my twin brother, who is a doctor, so I get to learn a lot in the process.

Based on what I've learned thus far (which is barely anything), I can tell you that nerve regrowth/repair is a very slow process, with no guarantees.  Once a nerve is damaged, the portion no longer receiving normal stimulus begins to release a substance known as "nerve growth factor (NGF)". This stimulates any nerve tissue in the area to start growing little "fingers" (dendrites) in 'hopes' that the destroyed connection can be re-established. Nerve tissue usually grows at a rate of between 0.1 and 1.0 mm per year. In the process, some of the new growth often attaches to any adjacent tissue (nerve, muscle, bone, etc.), with a good chance that these unintended targets will stretch the new nerve tissues through normal movements, giving off their own pain signals.  The "healing" process for damaged nerves is therefore so variable that any estimates of recovery time are, at best, wild guesses.  Your neurologist will probably have the best guess, but it will still be a guess.

And yes, the pudendal nerve contains fibers from S2 thru S4, so treatment for your discomfort would be directed at the pudendal nerve. PT in that region is probably a reasonable and safe option to try. How lucky of you to have such a knowledgeable daughter!
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Avatar_n_tn
Has your Urologist ruled out interstitial cystitis? If not, did he try Elmiron?
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Avatar_n_tn
How did they determine it was nerve damage for sure?  I went to see a neurologist who said that regular nerve conduction tests are impossible on the penis because the tissue is unique.

This post caught my eye as I have been experiencing bunning and aching at the tip of my penis. I was checked in June for UTIs and STDs.  Definately have noticed it while urinating sometimes (maybe dehydration) but also in other situations - pressure from touch can produce  a similar pain - it has a couple times in last 2 months - similar sharp, shooting pain inside shaft.  Often after urinating the discomfort seems to linger after the stream is long past.  

I saw the neurologist because I think I have lost sensation and have various pains in my penis from an electric shock - but because I passed the feather test and have successful erections doc said localized nerve damage was impossible - is this true?  Is there more testing that can be done to reassure me he's correct or show that there may be real damage somewhere?

I feel the need to see another specialist because the discomforts continue to hang around. The worst is that just rubbing the head itself can produce pain but I'm starting to be unsure of what normal is supposed to feel like down there.

Any advice on how get helpful treatment without wasting my time or anybody else's?  

thanks (35 yrs old)
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Avatar_m_tn
Your symptoms differ from mine in that I have not had any "pain; " only the sporadic burning.  No one has determined that the burning was caused by nerve damage or irritation.  It is an assumption that it is a nerve irritation in that no infections where found after five months of treatment.  I have not seen a neurologist.  The chiropractor did find that the sacrum was out and that  could possibly cause the pudendal nerve to be irritated.  After ten adjustments by the chiropractor I have noted some relief.  I have my fingers crossed.
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Avatar_m_tn
Imaging studies (MRI, CT, etc.) are useful for detecting central nervous system lesions, tumors, and demyelinating diseases, but peripheral neuralgias due to isolated lesions or trauma often are made on the basis of history, signs, and symptoms, and are confirmed or refined by the response to treatment.  Nerve conduction studies are most useful for ruling out or confirming lesions, trauma, or demyelinating diseases in difficult cases where the above mentioned testing is inconclusive.  As mentioned, the penis is unique in its distribution  of sensory end organs, but I'm not sure that nerve conduction studies are impossible (tricky - yes, but impossible - ?).

Sharp, shooting pains are almost always indicative of neuralgia. Determining the location of the responsible lesion or trauma is very difficult in electrocution cases because of the myriad paths that electric current passes through the body.  Treatment is usually restricted to medications aimed at reducing the sensitivity of hyper-sensitive nerves, blocking the release or reception of neurotransmitters for pain, and minimizing seizure activity (if present).
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Avatar_m_tn
FYI  After  ten chiropractic adjustments, over eight weeks, I have now had over two weeks of being completely symptom free.   Since I was doing nothing else for relief during that period, I feel it was the adjustment of sacrum to point of being stable that relieved a nerve (pundendal nerve) irritation that was the probable cause of the burning.  Relief was not immediate following the first adjustments, but gradually relief was noted and the last two weekly visits to the chiropractor showed that stability has been achieved,  which coincided with the relief of the burning.
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Avatar_m_tn
Congratulations Harry! I'm so glad to hear that you are doing well. - Jeff
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Avatar_n_tn
A related discussion, Penile Burning was started.
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Avatar_f_tn
Hi guys I've had burning and pain constantly for 8 years now in the penis and tip since I was nineteen and I too get a feeling like my leg is wet every now and then. I have been to many urologist over the years and many test which have all came back negative as well as a couple of cystoscopes and colonoscopy's which were all clear besides a couple of hemorrhoids and had them treated which has helped reduce the burning in my bum but the burning in the penis remains. My partner is a nurse so we had a look at her anatomy book and the pundendal  Nerve came up saying how it contols the nerves in the pelvis just like previous post have said so this will be the avenue I'm going to try by seeing if my back is out as well as reading the book, headache of the pelvis by dr wise which talks about the Stanford protocol as it could be a tight muscle in the pelvic floor which could be causing the pundendal nerve to be hit , which in turn causes the burning sensation in the penis and tip and a prostate massager which may help the tightness in the pelvis. One drug that did help the pain  was edep which is a anti depressant but also used for nerve pain as I think it is a alpha blocker. I hope im on the right path, fingers crossed.
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