This article - link posted by Savaici - has a lot of useful information about chronic proctalgia, a condition that in my experience appears to be more or less ignored by many medical practitioners, who tend to confuse it with proctalgia fugax. In particular, I was struck by the following passage:

However, the minority of proctalgia patients affected by unspecified functional anorectal pain are still left without a satisfactory treatment option. In this regard, depression and anxiety are both frequently reported in non-responsive proctalgia patients[6,10]. Brain processing of pain may be altered in functional gastrointestinal disorders, but data in proctalgia patients are lacking[22]. In addition, no trial has actually evaluated the effect of either psychotherapy intervention or psychotropic drugs in proctalgia patients. Finally, there is no evidence that surgery can help these severely disabled patients. Invasive interventions should be avoided in the absence of a clearer etiologic understanding of non-responsive proctalgia patients.

Although I'm not severely disabled and can cope with day-to-day life in spite of the pain and discomfort, I have searched in vain for anything that might might explain my proctalgia and ongoing perineal inflammation, which has lasted for several years and shows no signs of going away. No GP or CRS I have consulted has been able to offer such an explanation, apart from an initial diagnosis of AF, which healed long ago.

There seem to be some areas of colorectal disorder and pelvic floor dysfunction where doctors either don't have answers or are still in quest of them, and I'm left wondering why this should be so.

I agree. There seems to be no real solution. Maybe it’s in a grey area that neither CRS’s or pain specialists study. Possibly it’s not considered a big enough problem to throw money at. I’m sure there are so many people who suffer in silence through embarrassment, and never visit a dr about it?

I sometimes have the impression that it's not only the patients who feel embarrassment, but also many of the doctors and specialists who are involved in treating colorectal disorders. Maybe the grey area is just an area of the body that is still subject to a form of taboo - I don't know, but it seems strange that it should still be so in the 21st century.