PPOD Case Report 13

PPOD Syndrome Diagnoses: phallodynia (pain in the penis), orchialgia (pain in the testicle), urinary frequency (voiding more often than normal), impotence (erectile dysfunction).

A 27-year-old man was seen with the complaints of penile and bilateral testicular pain of approximately 18 months duration. He reported that approximately 7-8 years earlier he had been involved in a snowmobile accident during which time he had sustained injuries to his low back. As a result of these injuries he underwent chiropractic treatment. Receiving spinal manipulation over the course of about 4-5 months, he experienced a complete resolution of his back pain and related complaints. However, approximately 18 months prior to being seen, while working as a waiter and having to carry large trays filled with heavy ceramic plates of food, he began to note the spontaneous onset of a burning pain that extended down the center of the penile shaft. This pain was described as feeling like a “tube of pain” that extended from the base of the penis to its tip. In addition, accompanying his penile pain, was the development of a deep intense aching pain that was felt in both of his testicles. He stated that, in addition to these complaints, he had also developed an accompanying increase in the frequency of having to empty his bladder, and, that when he would void his penile pain became much worse and felt as if his penis were “on fire.” He noted that his penile and testicular pain were distinctly aggravated by sitting and that these complaints were consistently worse by the end of his work shift than they were at its beginning. Approximately 2 weeks after the onset of his penile and testicular complaints, he spontaneously developed a rapidly progressing loss of the ability to attain an erection. Simultaneously, as this problem developed, he additionally became aware that his penis had become “numb” to touch. As a result of these complaints he initially consulted with his family doctor who, after being unable to account for his problems, referred him to a urologist. A complete urologic workup was performed, however, no abnormalities could be found that would account for his problems. As a result, he was referred to a neurologist who performed an additional battery of tests, all of which were negative. Accordingly, he was given a prescription for medication to help control his pain and advised to return for more testing if his condition should change. His problems remained unchanged for about 15 months at which time he presented to the author. Interestingly, despite having received a “clean bill of health” from his urologist and neurologist, he exhibited multiple findings indicative of the mechanically induced pelvic pain and organic dysfunction syndrome on his PPOD syndrome examination. During the first two weeks of treatment, he experienced a distinct increase in the intensity of his penile and testicular pain due to the effects of the “post treatment flare”. By the end of the third week of treatment he began to note a distinct reduction in the intensity of his penile and testicular pain and additionally reported that the frequency with which he had been emptying his bladder had returned to normal. After four weeks of care, he became aware that his penile numbness was receding and that his erectile function was beginning to return. At the end of six weeks of treatment erectile function had returned to normal and all of his remaining complaints had completely resolved.

Comment: In some cases the extent of PPOD involvement is confined to a specific location or organ system. In case 2, pain had been confined solely to the inguinal region. In this case the complaints consisted of both pain and organic dysfunction, which, with the exception of the accompanying symptom of urinary frequency, were entirely confined to the reproductive organs.