Hi there. first thread, a little history. I've had pelvic floor dysfunction and mild interstitial cystitis (came on after frequent bladder infections) since i was a late teenager. I had a long remission, lasting years (pelvic floor continued to be tender, as did bladder upon palpitation, had some urinary burn and painful intercourse, but pain level was at a constant 1-2, and i managed) and i've always had anxiety and insomnia and other hypochondriac mysterious health ailments that i would work myself up about, then they'd mysteriously go away. I believe now they were TMS. Anyway, my terrible bladder pain returned in 2015 during some relationship stress, as a vicious flare lasting a year. The pain specialist seemed to confuse my pelvic floor dysfunction pain with possible pudendal neuralgia, and suggested a nerve block. I should have said no...it was the biggest mistake of my life to get that block. I went ahead with it, and the block badly irritated my pudendal nerve, and i ended up with pudendal neuralgia from the shot!!! PN is hell on earth. Worse than all my other ailments. Suddenly i felt disabled whereas before, i was just in bad pain, but i could DO things. I should say, it probably wasnt just the shot. You see, i was an avid cyclist. The mountain biking never bothered my pelvic pain before the shot, in fact, i always felt BETTER on the bike. I believe it was because i was livng in the moment while biking, rather than stewing in the past, or obsessing about the future. Well after that nerve block, i hastily jumped back on a bike and did a 25 mile race and my crotch started hurting really bad. My pain doctor assured me the nerve would calm down. I would take small breaks from the bike, then cautiously get back on the saddle, and boom, crotch pain. Maybe i should have waited longer for the nerve to chill out....but then pain then became permanent. Do you think it was my deathly fear that "i'll never bike again" that made the pudendal pain permanent? So here are my clues that this is TMS: 1. the pain moves all around the nerve, from sacrum, to dorsal tip 2. after the nerve block, pain jumped right from the bladder, to the pudendal nerve! (well, maybe there was a month overlap, but how do you explain that? i stopped obsessing about the bladder, because there was a new enemy in my body, this PN was ruining my love in life, mounting biking) 3. sometimes when im distracted and very involved with say, housecleaning, i'll suddenly realize i barely feel pain at all. and if i think about it too much, the pain comes back. 4. i only had crotch pain at first, but when the pudendal doctor told me "stop doing all things (fun) that might hurt the nerve for 3 months, and see if it calms down. that means biking, sex, etc," At that point, the diagnosis became "real". Next day, i had sitting pain and rectal pain too, whereas i didnt before. 5. in those 3 months of feeling depressed and basically not moving, i got worse. So i said screw this, and got a special saddle, and started riding again. I took baby steps, but i went from not being able to sit on a bike, to riding 2 miles.....then for a while 5 miles (before the burning set in and i had to turn around). Then i learned about TMS and i decided to tell myself "stop having this ritual of fear surrounding riding. Pretend it's like the old days, and just ride with your friends!" now i'm up to 10-15 miles, sometimes pain free. I did this just by changing my fear response. Before, i used to have this fear before and after rides, like i've probably damaged myself, so i'd freak out, get my TENS machine, pop pills, lay down, take baths, and cross my fingers. I dont do that anymore, and i've tripled my miles. I still get temporary pain, but i always go back to baseline. Here are my hesitations though. I rarely feel pain DURING an activity. I flare after. Usually 6-24 hours after. (usually a day later). TMS experts will tell you to get out there, fight thru the pain and not fear it. But how do you do that when the pain comes a day later? I feel like i AM following the directions, but then i get a huge flareup afterwards, and i cant tell if it's the nerve itself, or the pelvic floor spasming up. Yes, i still see my pelvic PT. She actually believes in TMS and urges me to go with it, but she also believes in tight pelvic floors because she literally feels the knots and tightness and breaks them up. i have a new knot every week near my pudendal nerve, usually after a big weekend of biking. I do believe in TMS...but something is still causing me to tighten and create giant trigger points/knots a day later and be in serious pain. My brain? Am i fearing a delayed flare, so that it happens? The weird thing is, even though i have tripled my miles per ride, i still cant ride more than once a week or i get horrible PGAD (painful arousal in the genitals, one of the most dreaded pudendal symptoms). You might say "your fear of riding more than once is causing the flare" but usually i ride more than once because i'm feeling good, so i ride extra, and i'm smiling and i'm happy and i feel whole again, and then BAM. The more i read, the more i'm certain this is TMS. i'm not so much afraid of structural causes, or "nerve damage", i think i have enough clues that it's not that. I fear the TMS pain itself and how much it affects my social life, my biking life, my sex life and how much it ruins everything. Anyone who's ever had pelvic pain knows how it's a special kind of hideous. So if you can stop fearing structural cause, how can you stop fearing the awfulness of TMS pain coming, as you try to live your life?