Q. What treatment is advised for post-ejaculation muscle spasms and nerve irritation?

Answered by
Dr. Karthik Rajan
and medically reviewed by iCliniq medical review team.
Published on Nov 21, 2018

Hi doctor,

I have been struggling with chronic prostatitis or CPPS for the past five months. A big issue I have been having is the post-ejaculation muscle spasms or nerve irritation. I am currently in physical therapy to work out the muscle tension or spasms and hoping that helps with the nerve irritation. Unfortunately, a new and frightening issue has emerged, which is what my question to you here is related to. A month back, I masturbated to ejaculation. The ejaculation was very painful, specifically in the perineum area. After that, from the next day to the month end, I had no erection whatsoever at any point. The whole pelvic or penis area felt kind of just dead or numb. It is very unusual for me to go that long without ejaculating and especially without so much as an erection. When I woke up the next day, I had an extremely weak erection and it was a little bit painful. It was at this time I noticed a bend curve to the left near the top. This was extremely alarming and scary for me to see.

I decided to masturbate that night. The whole time the penis was very numb and had very little sensation. It was erect, but there was no pleasurable sensation, and the curve to the left was still very alarming (pictures are attached). When I ejaculated (first time in two weeks), the ejaculate fluid had some trouble coming out. It made it out, but it kind of just leaked out (as opposed to shooting out) and there was absolutely no pleasure or sensation with it. It was less sensational than urinating. I still had a feeling. I could feel something was happening but it was very dead or numb feeling. Another piece just to throw in here, whenever I get aroused, but do not get an erection (so pretty much always), I have a very uncomfortable tingling in what feels like my perineum (although it is a radiating type of tingling, so it is possible it is coming from somewhere else in the same area). This tingling is relieved if or when an erection occurs.

So my point is that I am very concerned about this leftward bend near the top of the penis. I have never had this before. I have read about Peyronie's disease. It looks to me from a visual standpoint that that could be it. However, I have to say that I am having a difficult time feeling or identifying any plaques or bumps or anything of that nature. The only thing of interest, which I believe you can see in the pictures, is that there is a big visible vein in pretty much the exact spot where the curve occurs.

So my question is that, based on everything I have told you, what could this be? Could it be Peyronie's disease? Could it not be that, but rather a blood flow issue (vein in the exact spot of the curve). A nerve irritation issue? A muscle dysfunction issue? Again I am certainly not a doctor, but my intuition is telling me it is a blood flow issue. At the same time, the curve looks significant to me, so I do not know if poor blood flow could cause a curve of this nature? One more thing I almost forgot. I have been on Alfuzosin ER 10 mg tablets once per day every day for the past three months. I have also been taking Methocarbamol 500 mg post masturbation to help with muscle spasms and nerve pain. Could any of those have caused this? I did some research and came across an alpha-blocker called Flomax that can cause symptoms that mimic Peyronie'sdisease but could not find any specific evidence on Alfuzosin. If Alfuzosin could have caused this, what would the outlook be? If this is Peyronie's disease, what is the outlook on that? What should I feel to confirm Peyronie's? What can I do to help this? Of course, I will be seeing a urologist as soon as possible, but with my insurance and urologist availability, it could be up to a week before my next appointment.

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome to icliniq.com.

I have gone through your query and the images that you have sent (attachment removed to protect patient identity). There is definitely a curvature that is appreciated on the images, but I cannot confirm whether it is Peyronie's disease without actually examining you myself. It is however among the few possibilities that can cause your present condition.

I would like to know a few more details about the last time you masturbated. Did you find any sudden loss of erection or swelling of the penis after ejaculation? Did you feel a popping sensation in your penis at that time? Immediately after did you have any partial erections, and were these erections painful?

The usual cause of this type of problem is a tiny injury to the layers covering the penis which give it stiffness. This could also explain why you did not have erections for sometime immediately after. The important thing is to rule out Peyronie's disease which can be progressive, the others are not. If it is just a curvature, without Peyronie's, it is necessary to check whether you are able to have normal erections, from the images it does appear that your erections are normal (needs to be confirmed during an examination). If it does not interfere with penetration, then usually we do not intervene unless the patient specifically requests for cosmetic purposes. So, to summarize, it is not likely to be Peyronie's, but I would definitely want to rule out with an examination and maybe an ultrasound if necessary. Such a slight curvature would usually not require any further treatment unless it interferes with penetrative intercourse.

Hi doctor,

Thank you so much for your prompt response. I did not notice anything unusual about post ejaculation. I have been struggling with muscle spasms, but that has been happening for the past six months, and it is in the perineum and does not really effect the actual penis. And furthermore, I did not notice any unusual penis swelling or any sudden erection loss other than the normal gradual erection loss. The ejaculation was painful, but not in the penis, it was in the perineum. However, it was a few weeks ago, and I cannot say with 100 % certainty that there was no penis pain, but there was nothing I can recall that stuck out unusually in the penis specifically.

I do not recall a popping sensation, so I am going to say no. Again though it is possible it was there and unnoticed due to my attention on perineum or pelvic floor muscle pain. There were no partial erections immediately after. And just overall, besides the pelvic floor muscle pain during ejaculation, there was nothing overly unusual happening, and the penis itself did not alarm me in any way that I can recall. But if you meant immediately after meaning the next day(s), then, in that case, I had either no erection or very partial erections. To clarify when you say normal erections, I just want to point out that I have not had a normal erection since that first day of the issue. I basically had none until around the month end, at which point I noticed the bend. Still to this day, so tonight, for example, after watching something that typically would be sexually stimulating, I am only able to get a very mild erection (the penis size grows a bit but stays relatively soft). During this time tonight, I have not noticed the curvature, but then again I was not fully erect. Which leads to my next point of the curve is only visable if I am fully erect. Which only happened during the month end masturbation and that morning and another morning or two since.

Also, it just so happens that I had an MRI of the pelvis done on the same exact morning I noticed the curvet. I am going to upload the results to you now. I wonder if this could rule anything out? I have no idea if this particular MRI would include the penis or not, I only received the files a few days ago and have not reviewed with a doctor yet. It would be great if you could offer your feedback on the MRI and if by any chance the penis is included, perhaps it would rule out Peyronie's or help make a better guess as to what the issue is? And to further clarify, the issue was in effect at the time the MRI was taken so if the MRI is such that it could show the penis, this issue was currently happening at the same time period (first noticed the curve a few hours before the MRI). And if it is not Peyronie's, what could it be? A blood flow issue? Nerves or muscles? I have not had sex yet since this started (I currently cannot see myself having sex due to lack of erection) so I do not know if it interferes or not, but based on the curve that you see, how significiant of a curve is it? Would watchful waiting be appropriate? Or seeing a urologist soon?

Dr. Karthik Rajan

Andrology Urology
#

Hi,

Welcome back to icliniq.com.

I asked the questions just to make sure there was no obvious injury to the penis. Most of the times, these are not noticeable, but just wanted to make sure. Unfortunately, the MRI report that you have sent had not included the penis (attachment removed to protect patient identity), the images could have included the penis, but as your complaints were related to the prostate they have not maybe reported on that. You will have to check with the radiologist to confirm regarding this.

As I said, the curvatures are due to the tissues that surround the penis, which give it the stiffness. Any small defect in it can cause curvature. More often than not the cause is unknown, it is assumed to be some slight injury during intercourse or masturbation, which goes unnoticed initially. Peyronie's is one of the known causes, that your urologist will definitely rule out. Whether or not it interferes with sexual function, is entirely subjective and it is only you who can tell us about it. I can see your present situation makes this difficult but unfortunately there is not any other alternative to check. As I said before, it does seem mild but it is entirely your opinion that matters.

Regarding waiting, as a rule, we do not intervene in these cases immediately, it is necessary to ensure that the curvature is stable and not progressive. So waiting would be the best option, but seeing a urologist is necessary before deciding.

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