Chronic penile pain may have multiple causes, the most frequent one being an irritation of the pudendal nerve.
I report here for the first time on the finding of a bilateral compression of the internal iliac vein between the psoas muscle and the internal iliac artery.
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The patient reported on a gradually increasing pain over the last 15 years starting at the lower poles of both testicles and the glans of the penis gradually spreading across the entire external genitals. The pain was of a more congestive nature and thus described as dull and had only less prominent neuropathic qualities described as burning and stinging.
The pain increased while the trunk was an upright posture and could be relieved by lying down.
The mechanism provoking the pain in the external genitals is seen in the congestion of the internal pudendal vein with a painful distension of the genitals veins and a mechanical irritation of the pudendal nerve within the Alcock canal by the engorged internal pudendal vein.
Similar pulsatile venous flow patterns are found in the left renal vein and the left common iliac vein at the May-Thurner-point
