I am trying to find a delicate way to describe a delicate subject, but have found that those patients affected by it have lost any false modesty in describing a problem for which they can be pretty desperately seeking relief. And so it goes.

Dr. Alvarez and I each had a patient presenting with genital/perineal pain in the same week (one was a female patient with acute onset of unilateral labia burning pain and the other a man with severe testicular pain). It reminded me of the very first patient I saw with such presentation, three months into clinical practice, and it made a lasting impression. He was an 18 year old young man with intractable testicle pain on his left side. Long before COVID nasal swabs made us shudder at the sight of a very long Qtip in a sterile pack, the young man’s age and interest in young ladies had earned him, not only one, but three swabs up a different orifice in search of an infection that never materialized. He failed to respond to a broad spectrum of antibiotics. A CAT scan later, he remained a medical mystery. He developed sacroiliac pain that landed him in our office, and to everyone’s delight resolved both his butt and groin pain in a few treatments.

Pain in the genital, perineal, and inguinal area, can have many sources and chiropractic will not fix all of them for certain. But once internal and infectious causes have been medically ruled out, I am amazed by how many folks are sent home without a good reason for their continued symptoms. And in those instances, you really need to look at the neurology of the area and investigate the possibility that this very pesky problem may be a “pinched nerve in your undercarriage”. (line stolen from one of my patients)

The attached image is a good summary of the sensory innervation of the pelvic floor front to back . Of those nerves, I want to circle in on the pudendal nerve because it is the most frequently missed source of pain in men and women. In men, testicular pain can be referred from the mid lumbar spine through the lumbar nerve roots at L2 and L3, and this will usually affect the anterior groin into the front of the testicle. The pudendal nerve will cause pain that is more directly in the groin area and in front of the rectum, slightly laterally. In men this will feel like pain shooting into the posterior aspect of the testicle and penis, and in women the pain will affect the area of the labia, lower vagina. The pain can feel deep and internal, or more superficial like a burning, prickly sensation.

The pudendal nerve has a path that makes it vulnerable to entrapment in several areas, most commonly as it exits the lateral lower sacrum and travels by the sacrotuberous ligament and around the ischial spine. The nerve can be easily injured by sacroiliac strains, falls on the buttocks, and chronic repetitive frictions sitting on the wrong chair. Patients with pudendal nerve entrapment of neuromusculoskeletal origin will frequently report associated pain in the upper gluteal and tailbone pain at some point.

The moral of the story is that pain in your private areas is worth bringing up to your chiropractor if you have no good medical explanation for it. A pinched nerve is a pinched nerve, no matter how “private” its location.