Glans hypersensitivity after prostatitis/CPPS

[andyalp]

Hello everybody!

I'm 25 years old, and I've been dealing with this for almost 4 years.

Everything started shortly after I recovered from COVID. The first time I masturbated after being sick, I immediately developed a strange pulling sensation in my urethra after ejaculation. During the first week it was just a persistent discomfort that gradually became worse.

I went to a urologist. My urine tests came back normal. He told me that chronic prostatitis was extremely unlikely at my age (I was 22), so he didn't even examine my prostate. No semen analysis was ordered either.

I then saw another urologist. He took a urethral swab, which was also completely normal. Again, I was told that prostatitis was very unlikely in someone my age.

After that, things became a nightmare.

For several weeks I had severe pelvic pain that kept me awake at night. It felt like electric shocks throughout my pelvis. I developed almost every symptom of CPPS you can imagine. At the same time, I had none of the classic signs of an infection—no discharge, no blood in my urine, nothing obvious.

Eventually the acute phase settled down, but the condition became chronic.

My main symptoms were:

\- constant perineal discomfort;

\- pain and a feeling of tightness when pressing on the bulbar urethra;

\- severe glans hypersensitivity (allodynia);

\- intermittent urinary difficulties;

\- erectile dysfunction.

Sometimes the symptoms would improve, then flare up again.

One thing I found interesting: when the condition was becoming chronic, I drank alcohol for the first time since all of this had started, and my symptoms improved significantly for a while. It wasn't a lasting effect—alcohol never consistently helped afterwards—but at that time it made me wonder whether the problem was psychological or related to muscle tension.

Because of that, I spent the next few years believing it might be a functional or psychological problem.

I even had an MRI of my lumbar spine. It showed small disc protrusions, but a neurologist told me they couldn't explain my symptoms.

Later I started dating someone and was about to become sexually active again. Because I was worried about my symptoms, I saw another urologist. He also doubted prostatitis and only prescribed ProvEnor Forte.

To my surprise, within a few days I felt dramatically better. Most of my symptoms disappeared, and I was able to have a normal sex life. This improvement lasted for about two months.

After the relationship ended, I stopped taking the medication because I thought I had recovered. Some time later the symptoms came back. When I tried the same medication again, it no longer had much effect.

This year I finally decided to investigate the problem properly and went to a clinic that specializes in chronic pelvic pain.

For the first time, I had a prostate ultrasound, which showed that my prostate was enlarged.

I also underwent 10 sessions of focused shockwave therapy. After completing the treatment, the constant perineal discomfort disappeared completely. The only symptoms that remained were tenderness around the bulbar urethra and glans hypersensitivity.

For the first time in almost four years, someone finally ordered a semen analysis.

It showed elevated white blood cells. I was prescribed a 10-day course of antibiotics, suppositories, and medications for the urinary tract.

After finishing treatment, the tenderness around the urethra disappeared. Follow-up tests came back normal. I also noticed that excessive smegma accumulation, which I had struggled with for years, completely disappeared after treatment.

Right now my remaining symptoms are:

\- severe glans hypersensitivity;

\- poor morning erections and erectile dysfunction;

\- masturbation makes the hypersensitivity worse for several hours or sometimes an entire day;

\- when walking, I'm constantly aware of my glans rubbing against my underwear;

\- occasional difficulty urinating;

\- caffeine clearly makes my symptoms worse;

\- sometimes the uncomfortable sensation seems to radiate from my glans into my right big toe.

My urologist believes that the infection/inflammation has been successfully treated and that what remains is a neuropathic component. I took pregabalin 150 mg every night for one month without significant improvement, so he extended the treatment for another two months.

I have a hypothesis, but I honestly don't know whether it makes sense.

Could this have started with a prostate infection or inflammation after COVID, which then caused chronic pelvic floor muscle guarding and eventually neuropathic pain?

Or is the opposite more likely—that pelvic floor dysfunction came first, leading to urinary stasis and eventually prostatitis?

I know nobody can diagnose me over the internet, but I'd really like to hear from people who have experienced something similar.

Has anyone here completely recovered from glans hypersensitivity (allodynia) after CPPS or chronic prostatitis?

Did your erections and sexual function eventually return to normal?

And has anyone experienced symptoms radiating from the glans into the foot or leg?

Any advice or recovery stories would mean a lot to me.

Thank you for reading!

[Violet M]

Could this have started with a prostate infection or inflammation after COVID, which then caused chronic pelvic floor muscle guarding and eventually neuropathic pain?

Or is the opposite more likely—that pelvic floor dysfunction came first, leading to urinary stasis and eventually prostatitis?

That's a difficult question that many people have struggled with over the years on this forum -- which came first, the pelvic floor dysfunction or an irritated nerve that caused the pelvic floor tension. Sometimes there is an underlying problem such as a genetic predisposition to developing pudendal neuralgia such as a tight space for the nerve to pass through or a musculoskeletal anomaly that can contribute to the development of PNE but sometimes it is triggered by something like an infection. So I don't know if anyone can answer your question with 100% certainty. I'm sorry to hear you are going through this, especially at such a young age.

The big toe is innervated by a branch of the tibial nerve which comes off of the sciatic nerve. With pelvic pain, there can be crosstalk between the nerves in the pelvic region and tension in pelvic muscles, including the piriformis muscle which can affect the sciatic nerve. I can't say for sure, but this could be contributing to the sensation in your big toe. Since the glans is innervated by the dorsal nerve of the penis (a branch of the pudendal nerve), you have to be suspicious that something is irritating that nerve. Have you considered trying a pudendal nerve block for diagnostic purposes? I don't know of many people who have been helped long-term by steroid pudendal nerve blocks but an accurately delivered PN block containing an anesthetic to temporarily numb the areas innervated by the pudendal nerve can be a valuable tool in helping to determine a proper diagnosis.

Some people improve with lifestyle changes but it can take time. If your symptoms are related to pudendal nerve entrapment, it may require pudendal nerve release surgery for your symptoms to improve. The Nantes Criteria can be helpful in determining whether you might have an entrapment.
https://www.pudendalhope.info/wp-conten ... iteria.pdf
If you have a tight space for the nerve to pass through, once it gets irritated and inflamed it's difficult for the nerve to glide properly and it just keeps getting chronically irritated.

Not being a guy I can't answer your question about whether those specific symptoms got better, but I know many people who have gotten better and moved on with their lives including myself. So there is reason for hope especially since you are young and people who are young tend to heal better. Wishing you the best as you figure this out and search for answers on what is the right treatment.

Violet

[eraser]

Hi Andyalp,

I am very sorry to hear you're going through all of this. The problem with prostatitis is that only bacterial prostatitis can be tested for and there aren't any tests for chronic prostatitis, including CPPS. This is to the extent that many have questioned whether it even exists but apparently histology shows that it does. Prostatitis usually improves within six months and I appreciate you have described a fluctuation in symptoms but it doesn't sound as though it is prostatitis any more. Prostatitis is typically usually over diagnosed by Urologists, so for them to say it isn't says it all.

I think it's a bit of a cop out for them to them to say that you have had a treated infection and that you have residual nerve pain. It sounds to me as though they don't know the diagnosis.

Personally, I would have a pudendal nerve block and consider having a consultation with Dr Renaud Bollens, if you get complete or significant relief from the nerve block. https://pelvicinstitute.co/

If you have pudendal nerve entrapment, you should expect significant improvement in all symptoms as a minimum (i.e. you should be able to have sex). I was told most patients pain have improved by 80% in six months following surgery. Some get complete symptom resolution, others don't. It really depends person to person and is difficult to predict. However, most people are able to get on with their life even if it takes longer than six months following surgery.

Keep us updated and best of luck.