Intermittent Pain in Perineum or Base of Penis: Causes and Solutions - Urology

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Intermittent pain in the perineum or base of the penis can be concerning, especially when it recurs after certain activities like DIY (do-it-yourself) sexual stimulation. Based on your description, it seems you've experienced this pain intermittently after such activities, and you've already consulted with a urologist who has ruled out prostate issues due to your age and normal urine tests.
There are several potential causes for the pain you're experiencing, and understanding them can help you decide on the best course of action.
1. Pelvic Floor Muscle Tension: Engaging in activities that involve pelvic muscle contractions can lead to tension or spasms in the pelvic floor muscles. This can cause referred pain to the perineum or base of the penis. Stress, anxiety, or even physical exertion can exacerbate this tension.

2. Nerve Irritation: The perineum and genital area are rich in nerve endings. Activities that involve significant movement or pressure in these areas can lead to temporary nerve irritation, resulting in pain that may come and go.

3. Infection or Inflammation: While your urine tests were normal, it’s still possible to have a mild infection or inflammation that doesn’t show up in standard tests. Conditions like prostatitis (inflammation of the prostate) can occur even in younger men, though it is less common. Your previous elevated white blood cell count in semen suggests that there may have been some underlying infection.

4. Post-Surgical Changes: Since you had a microsurgical varicocele repair, it’s worth considering that changes in the anatomy or nerve pathways in the area could contribute to your symptoms. Sometimes, surgical interventions can lead to changes in sensation or pain patterns.

5. Psychological Factors: Anxiety about the pain or the activities leading to it can create a cycle where the fear of pain leads to muscle tension, which in turn can cause more pain.
Given that your symptoms have improved and that you have had normal test results, it might be beneficial to monitor the situation for now. However, if the pain persists or worsens, or if you experience additional symptoms (such as fever, changes in urination, or discharge), it would be wise to seek further evaluation.

Regarding your question about whether to return to the urologist who previously treated you or to consult the surgeon who performed your varicocele repair, both options are valid. The urologist may provide insights into any potential prostatitis or pelvic floor issues, while the surgeon may be able to assess any post-surgical complications or changes.
In the meantime, consider some self-care strategies:
- Pelvic Floor Exercises: Gentle stretching and relaxation techniques for the pelvic floor can help alleviate tension.

- Warm Baths: Soaking in warm water may provide relief from discomfort.

- Avoidance of Aggravating Activities: If you notice that certain activities consistently lead to pain, it may be wise to avoid them temporarily.

In summary, while your symptoms may not indicate a serious issue, ongoing observation and communication with your healthcare providers are essential. If the pain continues or you have concerns, don’t hesitate to seek further medical advice.