Non-Operative Treatment in Gynecology
1923, p. 230-2
D. Appleton Co., New York
The term 'coccygodynia" implies a painful affection of the coccyx and the lowermost portion of the sacrum. The disease occurs almost altogether in the female, probably because in men the tubera ischii are closer together and the coccyx is thereby more protected.
Etioiogically, coccygodynia is most often due to the traumatism of labor, such as a difficult forceps delivery or the rapid passage of a large, hard head. This may lead to periostitis, subluxation, luxation, fractures, and in some cases to ankylosis. Other etiologic factors are falls, kicks, or repeated severe jolts by which the bone may be broken, the joints stretched, or the inserting muscles torn off. In other cases, a genital affection may be the underlying cause. I saw a young woman who had suffered with the most intense coccygodynia ever since her first confinement fourteen months previously, A surgeon and an orthopedist had been unable to give relief. I found a sub-involuted uterus in extreme retroflexion and cured the patient permanently by simple replacement of the uterus and insertion of a pessary.
Occasionally, a circumscribed edementous swelling is found as the starting point of painful sensations, presumably a rheumatic condition, but likewise present in caries, necrosis, or neoplasm of the coccyx. If no gross anomaly it found, textbook writers are only too prone to ascribe the condition to marked neurosis, hypochondriasis, or malingering. I deprecate this rather popular tendency of calling neurasthenia what we cannot readily diagnose, and I believe that in such an obscure case the primary cause is an irritation of the fine nerve branches which owes its origin to a long-forgotten traumatism. A preexisting neurasthenia or hysteria exaggerates the neuralgic pain, but it does not produce it.
In mild degrees of coccygodynia, the pain in the affected part occurs only at certain times, in some patients only during menstruation. In the majority of cases, however, the pain is constant and so severe that even the slightest motion of the coccyx is excruciating. Such patients can neither sit, stand, nor rise from the sitting posture without distress. They have to sit more upon one buttock than upon the other, so that the weight rests on one ischial tuberosity and does not reach the coccyx. Defecation and coition are likewise painful.