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Urology/Penile/perineum/anus symptoms


QUESTION: Hi,  I have contacted this site before about these symptoms and was told it could be a problem with the prostate.  However I am not convinced about this as the problem has not improved with antibiotics, Tamsulosin, or hot baths over many months.

My history is that I am 29 years old and had a circumcision 4 years ago for a minor foreskin issue.  I had no other health problems.  A few weeks after this I started getting a pressure in the perineum and anus area, and pins and needles in the glans.  Erection was possible but weak, and on erection the glans felt virtually numb making pleasure or orgasm hard if not impossible.  Over the following 4 years this has changed to virtual numbness in the penis, still with a pressure in the perineum area, and a twitch whenever the glans rubs which goes up the perineum and anus area which sets off a kind of spasm.  Unless I remove my underwear to avoid any contact of the glans with clothing this twitch is virtually constant.

I have had an MRI pelvis and lumbar spine, and a trans-rectal ultrasound of the prostate.  I have been told there is no apparent cause for what I experience.  However, the pressure in the perineum/anus area is so intense that I am sure there must be a mechanical cause, as if the area where the perineum meets the anus is being restricted.

Please note that these are not subtle symptoms.  I am not the kind of person exaggerate.  I was open at first to the idea that some of this is anxiety-related but I have taken medication for this for long enough to know that my symptoms do not improve under reduced stress.  My quality of life with this is extremely low and I have considered suicide many times over this but have pushed through, although I am constantly left disheartened by how little doctors seem to be able to help.

My dilemma is that I have already had some scans and doctors I visit seem unwilling to investigate further.  However, there must be some other scan or investigation that could be done? The problem is that I don't know what to ask for when I see a urologist.  Is there anything you can suggest I ask for?  It feels like the problem is in the perineum/anus area but have been told there is no scan specifically for this.  Surely one could be done?

Thanks for giving up your time to help.


Possible scans for a problem involving the pelvis include transrectal ultrasound of the prostate, cystoscopy, CT scans and MRI scans.  That's about it.  If these don't show anything wrong, then imaging is not going to help your situation which remains a dilemma.

---------- FOLLOW-UP ----------

QUESTION: Thanks for the reply.  

I understand there are limitations with scanning and that many things are still unknown in medical science.  On the surface it would seem I have been investigated, and I guess I can't ask for much more than that.

I do wish this particular doctor hadn't messed about circumcising me and caused such damage when there were other solutions to the problem.  He has left me in a far worse situation.

I have looked into Chronic Pelvic Pain and it this seems to fit with what I am experiencing - although this is a fairly broad set of symptoms.  I remain unconvinced that the prostate is the cause.

Thanks again.


Usually prostatitis or CPPS is credited with any chronic pelvic discomfort that cannot otherwise be identified.

Try some general therapies like taking aleve twice a day as an anti-inflammatory, see if you can find a good supplement that contains quercetin (a natural anti-inflammatory that seems to work on the pelvis and prostate), avoid caffeine and hot spices (generally helps any pelvic problem), and try a hot sitz bath twice a day for 10 minutes.  Any of these things might help a little and won't do any harm.  Make sure the water for the sitz baths is real hot!


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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