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Pelvic pain - complicated

20 months ago while sitting I experienced an acute burning/stabbing pain on both sides of my pelvis. No movement or trauma caused this. The location was almost directly in the crease between my pelvis and my thigh, and about 1 cm above the line where the top of the shaft of my penis contacts the pelvis.  This would put the pain right at the top of the pubic bone on either side, before they join with the pubis symphysis. The pain was concentrated in this area, on both sides, and not very deep (near the surface).

The pain began to fade and after a week I could only feel it when I would tense the muscles in the area, as if I were cutting off my stream of urine.

I visited a urologist and my general practitioner.  Blood, urine, and guaiac negative.  No pain when putting pressure on the area.  No hernia was found. Testicular ultrasound revealed a large varicocele on the left side.  This gives me a slight dull/heavy feeling in my testicles from time to time, but not related to the aforementioned pain.  

After a month the pain was gone completely so I didn't get an MRI.

A month ago the pain had returned, but I only feel it when having intercourse, possibly because I am applying pressure to the affected areas.  As soon as motion stops, so does the pain.  more of a pinching/stabbing pain now, no longer burning.

This evening I felt a very similar stabbing pain directly in front of the pubis symphysis, when moving my torso (kind of bending over and twisting) and when sitting in a chair and leaning forward. Pain was quick, only lasting a second.  I could reproduce the pain only once by applying pressure to the area.  I am unsure if this is a urological issue or a skeletal issue with this new development.

No problems or pain with urination, ejaculation, erection.  No pain anywhere else in the region other than what I mentioned before.
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233190 tn?1278553401
You have had a comprehensive evaluation for your symptoms, including checks for a hernia and testicular ultrasound.  

Referred pain from a lower GU infection or prostate can be considered.  A rectal exam and prostatic massage can be done to exclude this possibility.

I agree that imaging may help - this can evaluate whether this is an enlarged lymph node or mass leading to the symptoms.  An MRI or CT scan would be appropriate for this.

If the tests remain negative, a musculoskeletal cause can be considered.  An evaluation by a physiatrist (rehabilitation MD) or orthopedist can be considered if suspected.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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