Medical Clinics of North America
1921, 5: 37-44 (July)
Northwestern University Medical School
The case of a 28-year-old woman is described. She developed cramping coccyx pains, associated with panic, which could last a short period or carry on for hours. She had her coccyx removed without curing the pain. Hamill reported:
In conclusion, I would say that this case of so-called coccygodynia is really a sort of vaginismus which, in turn, is closely related to the muscular condition of erection and orgasm. The muscular conditions have their emotional tone fixed by the location of the sensation - they are in the perineum, they are normally voluptuous and pleasant, but in a condition such as exists in this case they are painful and induce panic.
Surgical procedures may be of benefit, but I strongly suspect that all cases of coccygodynia are of much the same nature and can be far better handled with understanding than with anesthesia and blood-letting. In that respect I would emphasize the change in emotional status especially. Contentment has taken the place of despondency, and I do not believe that would occur as the result of a surgical procedure, no matter how successful.
To return to Oppenheim's definition, I would be inclined to add that coccygodynia is closely related to vaginismus, is increased by contractions of the muscles inserted into the central fibrous point of the perineum. Also, as regards the statement "these conditions (local inflammatory processes) can usually be distinguished from neuralgia by careful bimanual examination." I would say that in these cases there may be such wincing from any examination that the surgeon might easily be misled into thinking that there was inflammation, when, in reality, the real trouble is in the mental attitude.
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