34M, Lap surgery, right Alcock canal 4 months ago. Anal/penis pain, hard flaccid, urinary urgency.

[HardCowboy33]

Hello, I wanted to share my case to see if anyone can give me a clue, please.
I am a 35-year-old man and I have been suffering this hell for the past 3 years.
It all started a few months after I began working as a driver, sitting for many hours, but the first strong pudendal pain I felt was while defecating. Suddenly, I felt a horrible burning pain in the anus that made me jump off the toilet, radiating to the penis.
I started having constant urges to urinate, my penis became hard and retracted in a flaccid state, and erections became difficult to achieve, tense and incomplete due to lack of relaxation of the corpora cavernosa (today I know this is called Hard Flaccid), anal pain when sitting, and a strong urge to ejaculate very quickly.
This lasted for 3 months and then, surprisingly, everything improved. The anal pain disappeared, my erections were perfect, and everything went back to normal.
8 months later, for no apparent reason, the nightmare returned — all the same symptoms — and from that moment on, I never improved again. 3 years have passed since that day.
My pudendal pain is clearly on the right side, from the anus radiating to the right corpus cavernosum.
I have had 2 MR neurographies of the pudendal nerve. In one of them, they reported increased signal and enhancement after intravenous contrast administration in the area of the right Alcock’s canal.
I have tried everything:
All kinds of exercises, stretching, DCT, labrum repair surgery in both hips without success. Later, investigating possible pelvic congestion, I underwent a venography and had pelvic veins embolized, with no positive effect.
I had an injection of 100 units of Botox in the obturator internus muscle with no effect at all. A CT-guided lumbar block also had no effect, which makes sense because my pain is very clear… inside the anus on the right side, in the area of Alcock’s canal.
I had 3 right pudendal nerve blocks at different times with lidocaine and corticosteroids, guided by CT into Alcock’s canal. They always produce the effect of greatly improving the completeness of my erections. The corpora cavernosa relax and can expand much more, and the pain decreases significantly as well.
So I decided to undergo right pudendal nerve decompression surgery via transperitoneal laparoscopy exactly 4 months ago, and I have not noticed any positive effect of any kind.
The surgery was performed by a neuropelveology surgeon with a lot of experience in this procedure in my country.
He said he cut the right sacrospinous ligament to release the nerve and also sectioned the fascia of the obturator internus muscle to fully release Alcock’s canal.
After 4 months, I feel the pain is somewhat worse than before surgery. I have no nocturnal erections, after defecating I have burning pain for many hours, and the penis remains in that hard, retracted state to the touch. I have frequent urges to urinate, and when I do, it burns. My anus/perineum hurts.
It is extremely frustrating.
Pelvic floor therapy, which in my opinion is overrated, makes me worse or does absolutely nothing.
I continue doing stretching consistently, yoga positions, and relaxation.
I notice that when I raise the leg on the affected side and rest it on a high table, stretching the obturator internus muscle on that side, and bring the leg toward my chest, the pain often decreases and the penis becomes soft. It only lasts a few seconds and doesn’t solve anything.
This has completely ruined my sexual, social, work, and family life, and I am constantly wondering whether it is worth continuing like this, losing my youth and the possibility of forming a family.
I am always thinking about whether the surgeon really released everything as he said. He also told me that the way he released it means it won’t be compressed again and there will be no fibrosis of the obturator fascia.
He showed me a video of the surgery, but I didn’t understand much of what I was seeing.
I don’t have many options left other than continuing with yoga positions.
He recommended another CT-guided block with corticosteroids and anesthesia, but I don’t want to receive more radiation — it’s been too much.
I keep thinking that the nerve may still be compressed, despite variations in symptom intensity, Hard Flaccid, and changes with stretching, rest, or positions.
I believe my surgery was in vain.
What do you recommend I do?
Thank you very much and best regards to everyone.

[Violet M]

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