Asked for Male | 47 Years
Why do I experience pelvic pain after ejaculation?
Patient's Query
Good evening, male, 47 y/o. For about 30 years I have been suffering from pelvic pain that arises ONLY a few hours after ejaculation. The pain originates precisely at the base of the scrotum and extends over hours to the entire scrotum and sometimes to the shaft of the penis. It arises as an itch, then a pinch, then grows in intensity until it becomes aching with a strong sense of heat accompanied by pronounced relaxation of the scrotum. Ice and (sometimes) supine position are the only things that provide temporary relief. I should add that prolonged abstinence has always given me discomfort and sensation of urinary urgency, which disappears with orgasm. Until two years ago the pain disappeared with sleep at night, so I only had regular sexual activity before going to sleep, and in this way I had a normal sex life and children. Then it began to occur EVEN THE NEXT DAY starting around noon and escalating into the evening, then (usually) disappearing the next morning. Over the years I have consulted several urologists. In 2001 the first transrectal ultrasound (all negative). Recent worsening of symptoms (i.e., their persistence even the next day) prompted me to confront other urologists, who were unable to help me. Prescribed spermioculture and Stamey test (all negative), prostate echo normal (some calcification). For the past two years I have been taking prostate supplements, anti-inflammatories, muscle relaxants, PEA etc without success. I tried acupuncture, ozone therapy, craniosacral osteopathy, TENS, pelvic floor physiotherapy (identified and treated contracted "triggers"), without success. A neurologist hypothesized muscular causes possibly related to a tempomandibular dislocation (hypothesis ruled out by maxillofacial surgeon) and prescribed Mutabon Mite 2 cpp/day which I took for three months, without success. A psychologist specializing in chronic pain has suggested nociplastic (psychogenic) pain and is helping me to manage the distress this problem causes me, but unfortunately not to reduce it as I had hoped. Thanks to her, however, I was able to accurately track the point of origin and course of the pain (so-called "somatic tracking"). On the advice of the GP I went in February to the Niguarda Hospital Pain Therapy where, with hypothesis pudendal neuropathy, I was prescribed pelvic MRI (resulted adductor enthesopathies), lumbosacral MRI (resulted disc dehydration, asymptomatic), pelvic EMG (no abnormalities), physiatric examination (no abnormalities). I have follow-up visit in September to evaluate nerve block, but in light of the negative EMG I don't know what they will say. In the meantime I have been prescribed Pregabalin 25+25 and then 50+50, which makes me sleep very well but has no effect on the disorder, so I will insist a little longer and then I think I will discontinue. I am very frustrated, I am asking if anyone reading me has any idea, if not of a treatment, at least of a diagnosis that I've never been given. Thank you.
Answered by Dr. Neeta Verma
The pain you experience in your penis and scrotum after ejaculation is understandably uncomfortable. You've consulted many doctors and tried various treatments, but the cause of your pain remains elusive. Your proactive approach to seeking help and trying different therapies is commendable. While doctors are considering possibilities such as pudendal neuropathy, a clear diagnosis has yet to be made. Unfortunately, I cannot provide a definite diagnosis or solution at this moment, but you must continue to follow up with your urologists.

Urologist
Questions & Answers on "Urology" (1175)
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