Manual Therapy Treatment for Penile Pain- A Clinical Case Report with 6-Month Follow-up

ABSTRACT

Background

Male genital pain, which is neither related to genitourinary nor other obvious pathology, is an uncommon symptom in male patients and not frequently treated using manual therapy. The purpose of this case study is to describe a clinical reasoning process in combination with anatomy-based differential diagnosis and manual treatment for genital pain.

Case Description

A male patient with a 3-week acute onset of genital pain was hospitalized and referred for evaluation and treatment after unsuccessful treatment with medication and acupuncture. Clinical examination was performed indicating a possible nerve entrapment followed by interventions of ligamentous articular strain, high-velocity low-amplitude (HVLA) manipulation, and strain– and counterstain, coupled with soft tissue stretching to lumbar and inguinal areas to address a possible lumbar referral potentially from L1 and/or ilioinguinal nerve entrapment.

Outcomes

After 4 consecutive days of manipulative treatment, pain decreased from 9/10 to 0/10 and the Barthel Index improved from 50 to 95. A 6-month follow-up revealed complete resolution of symptoms with no recurrence.

Discussion

This case illustrates that a detailed history and examination along with a reasoned diagnostic process to determine an appropriate intervention strategy may improve patient care using manual therapy techniques.

Conclusion:

By utilizing a deductive reasoning process related to the penile area, clinicians may better apply manual therapy techniques for successful treatment.

KEYWORDS:

• Penis
• nerve pain
• physical therapy
• soft tissue mobilization
• spinal manipulation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Yingzhi Li

Dr. Yingzhi Li is the Chair and Associate professor in the Department of Acupuncture and Manual Therapy in the Second Affiliated Hospital of the Yunnan University of Chinese Medicine. He received his degrees of Bachelor of Medicine and Masters and Ph.D. in Chinese Medicine from China. Dr. Li worked at the University of North Texas Health Science Center as a visiting scholar in 2018. Dr. Li is passionate about manual therapy and wellness, and about the use of osteopathic principles combined with Chinese Medicine for primary care.

Howe Liu

Dr. Hao (Howe) Liu received his degrees of Bachelor of Medicine and Masters in Neuroanatomy from China, and degrees of Master of Physical Therapy and Ph.D. in Human Anatomy from the University of Mississippi Medical Center. He has been a licensed physical therapist engaging in teaching, research, and clinical practice in physical therapy (PT) in US for over 20 years. Currently, he is a full professor in the PT department at the University of North Texas Health Science Center. His research areas mainly focus on 1) how complementary and integrative therapy interventions like Tai Chi alone or in combination with traditional therapeutic exercise and/or hands-on manipulative techniques may work on patients, particularly the elderly ones; 2) how inappropriate use of assistive ambulatory devices (AADs) may affect on gait, balance, and posture in older adults under different conditions; and 3) surface projections of peripheral nerve pathways and potential impingement spots assessed in cadaveric labs.

Charles Nichols

Charles Nichols, PT, DPT, Sc.D. is an Assistant Professor for the Department of Physical Therapy for the University of North Texas Health Science Center. Dr. Nichols graduated from Texas Tech University Health Sciences Center with a Bachelor of Science degree in Physical Therapy. He then received his Doctor of Science degree in Physical Therapy from Texas Tech University Health Sciences Center in 2019. He is board-certified in orthopedics through the American Board of Physical Therapy Specialties, and a Certified Orthopedic Manual Therapist (COMT). He maintains his clinical practice at Therapy Excellence Inc.

David C. Mason

Dr. Mason is the Assistant Dean of Osteopathic Clinical Education at the Texas College of Osteopathic Medicine, University of North Texas Health Science Center in Fort Worth, Texas. He is a professor in the Department of Family Medicine and Osteopathic Manipulative Medicine. He is board-certified in both Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine and Family Medicine. Dr. Mason is passionate about wellness and prevention and the use of osteopathic principles and practice integrated into primary care. He has been a board member on national committees of the American Academy of Colleges of Osteopathic Medicine, Chairing the Educational Council of Osteopathic Principles, the American Osteopathic Family Physicians, and The American Academy of Osteopathy as a board member. He serves as a board member for the Texas Medical Foundation Health Quality Institute and the American College of Graduate Medical Education Osteopathic Neuromusculoskeletal Medicine Residency Review Committee. Dr. Mason regularly lectures nationally and internationally on Manipulative Medicine and co-authored the “5-Minute Osteopathic Manipulative Medicine Consult” now in its second edition.