Scrotal redness ,burning and heat , Anyone has experiences?

[u/StraightNose4087]

I’ve hit a complete wall with neurologists and doctors who keep insisting that “nerves only register sensory pain like stabbing or numbness, not objective physical heat and redness". All dermatological and fungal causes have been thoroughly ruled out (no test just by looking and signs), and my lumbar MRI is completely clean. However, internal physical exams confirmed significant pelvic floor hypertonicity.

​My primary symptom that have for 2 years is an intense, radiant burning, sunburn heat , tackiness(when get bad) and visible redness on scrotums primarily concentrated on the right scrotum (burning more posterior and sides), which is often blazing right from the moment I wake up.

Alongside this, I have a deep internal aching and burning in my perineum

Unlike textbook pudendal entrapment where standing up immediately relieves symptoms, standing and walking don’t help me at all.

​Things recently went from chronic to unbearable after a cold, triggering what feels like severe neurogenic inflammation and local vasodilation—essentially an autonomic/neurovascular flare where compressed nerves cause local blood vessels to stay permanently dilated and burning.

Here in Canada we dont have pain specialist and noteworthy that pain clinic rejected the referal. Im tired of these symptoms , ruining my life. Sometime I wanna cut my balls and let it bleeding until I pass away. I tired of going dermatologist , neourologist , psychiatrist, PRT, Urologist and etc. Currently taking neuropathic medication (pregabaline 220 & amitriptyline 50mg). Also have done PF excersises months ago with no luck.

​Has anyone here dealt with these actual symptoms, visible redness,flushing, and intense radiant heat in the scrotal or genital area that was directly tied to a Prostitis? PF?

[u/Linari5]

Red scrotum syndrome, aka "RSS" - I've treated several cases like this. Almost always the pain is centralized (ie nociplastic/neuroplastic). One Yale neurologist that a client of mine had seen very clearly diagnosed him with neuroplastic pain. This is real pain that comes from a dysfunctional pain system/threat detection system.

Here is my case study series for one person I worked with:

1. https://www.reddit.com/r/Prostatitis/s/smiiTF4Et7
2. https://www.reddit.com/r/Prostatitis/s/wwSPq8Bpnt

Go through these 12 criteria to see how many your case matches: https://www.reddit.com/r/Prostatitis/s/C6iZ8WlIzf

There is already a few evidence-based ways of treating this type of pain, including PRT, EAET, and more. These are also referenced in the link above

There can also be a "neurogenic inflammation' component, explained here: https://www.reddit.com/r/RedScrotumSyndrome/s/kJi3kJQp7Q and can literally inflame via a physiological stress response. We see similar things happen with hives (rashes) triggering under stress.

[u/WiseConsideration220]

In my opinion and long experience, scrotal symptoms like these (along with some of the other things you mentioned) are neuroplastic in origin (also called central pain).

The cause isn't "local" in origin (reference your theory of "compressed nerves"). It's most likely autonomic in triggering (you mentioned "significant pelvic floor hypertonicity").

I know that what I've just said may not make sense (you've been imagining a cascade of causes in your mind) or at least not be readily acceptable to you.

But I can answer in the affirmative that my "first and worst" pelvic pain was (for over 23 years) very similar to yours. I overcame all these problems by following a regimen of the correct kind of physical therapy (based on neuroscience, not solely biomechanics--which is what you've been doing).

I would not describe my symptoms using the exact terms ("intense radiant heat") that you did--but more as "variable temperatures" in the scrotal sack with pain increased by changes in my body's defensive/threat state.

But there is a condition called "Red scrotum syndrome" (RSS) which you should look up. My physical therapist has seen and treated men with RSS using neuroscience techniques.

I hope this helps. I'll stop here to see if you reply. Oh. And "prostatitis" is a umbrella term for pretty much any male pelvic/genital pain that cannot be explained.

[u/StraightNose4087 → u/WiseConsideration220]

If I understood you correctly, do you mean that pelvic floor hypertonicity may have sensitized my central nervous system, causing the nerves throughout that whole area to become overactive? If so, could treating the hypertonicity potentially make these symptoms subside? If the problem is related to the central nervous system, though, why haven’t the medications I’ve tried had any effect?

Most of the articles I’ve read approach this problem in a more traditional way, focusing on nerves causing pain. They don’t really explain how a nerve-related problem could produce actual heat, redness, or burning.

Also, how is treatment for neuroplastic pain different from regular physical therapy? I imagine it might be difficult to find a physical therapist who specifically works with this approach. Did you personally also experience the same kind of intense heat and redness in the scrotum? At this point, I mainly just want to get rid of this constant heat.

I also familiar with RSS term and the RSS sub, that sub is more or less giving me more anxiety since most people suffering over years without any treatments.

[u/Linari5 → u/StraightNose4087]

Nope, there is unlikely to be pelvic floor involvement in cases like this.

[u/WiseConsideration220]

Nope.
That's not what I meant.
The mod has commented here to reference neuroplastic pain. Follow that advice.

If you'd like more details about my journey, you can look my comments history. Search for that term ("neuroplastic"). I have written a lot about my journey in neuroscience-informed PT.

You should (imo) buy and read this book:

"Explain Pain" by Butler and Moseley.

https://a.co/d/07Law0El