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Twitching testicle. Diagnosed as chronic nonbacterial prostatitis. Feeling pain during and after ejaculation. Any ideas?

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General & Family Physician
Practicing since : 2008
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I am a 47 year old male. When I was 19 I felt a twitch in my right testicle. Followed by pain. Dr. prescribed antibiotics. This is a long story almost 30 yrs. I will try to summarize as best as I can. At that yound of an age it scared me and my parents. Went to several Urologists of the next few years. Took every antibiotic ever made. Took every test you could think of. The pain continued. I had to change my life. My activities. I found that I could not do heavy lifting, boating, cycling, running etc. I becamed very depressed, anxious and stressed. i was told by all the Dr's I had chronic non-bacterial prostatitis. I went to the Mayo Clinic in Scottsdale. The XXXXXXX White clinic in Temple, TX had every exam and test ran you could think of . Never found any bacteria or a swollen prostate even when I felt like there was a balloon up there. I didn't like it but I leaned to live around it and change things and activities to lesson the pain. When I was around 30+ the pain changed. It would be more of a fullness in my rectum and pain and inflamtion between the rectum and scrotum. The perineam. I feel as though I could be a urologist at this point. I found a urogist who put me on hytrin and diazapam and and an anti-depressant, which I still take all 3 and it got better. I would have flare ups a few times a year that would last from a few days to a few weeks, but would always cause me anxiety because I didn't know how long each flare up would last. This made me shy away from females. I felt inadequate as a male. I saw pyschiatrists and psycologists. It was nice to have someone to talk to but it did not change the symptoms. I found swimming to be an outlet. It was non compact and I swam for years until tearing my rotator cuff. Over the last 6 months I have developed new symptoms. Almost everytime I ejaculate I feel a very severe almost crampy, spasm like pain in my rectum that lasts from a few seconds to several minutes. It is so severe I do not want to move an inch of my body and then the next few days to weeks I get the perineam pain. I sit at a desk all day which doesn't help and the times that I do not get the severe pain when or after I ejaculate I still get the aching perineum pain for the next few days to weeks and the stress, depression and anxiety return. You would think I would have learned to deal with all this, but obviously I haven't and now I do not even want to have sex or ejaculate due to this new severe pain I am getting. I do not have frequent or burning urination. The urologist wants to do a hydro-cystoscopy of my bladder, but my family physician who I have seen for years doesn't think that would help. He wants to check for Intertestinal Cystitis, but I do not have the frequency symtoms that is known for. I know that CPPS and Non-Bacterial prostatitis is almost used synomynously these days. I don't want sympathy. I just would like your opinion of my story and espescially the new symtoms of the ejaculatory pain during and after. I am now taking Elavil but am afraid to ejaculate because I do not want to feel that type of pain again.

Thank you so much for listening. Your response would be greatly appreciated.

Posted Wed, 18 Jul 2012 in Men's Health
Answered by Dr. Raju A.T 4 hours later

Thanks for your query.

Also I do appreciate your history above there, which is really informative and also makes me realize the amount of pain you have gone through.I shall try to my level best and share my knowledge.

I , as your GP says do not agree with the cystoscopy being of any help here.Cystitis of a grade producing such severe pain would not go without presenting with symptoms of urinary urgency or post maturation aggravation in pain.

Also prostate problems cannot be missed as its not a complex organ where tests can miss what suspected . If your ejaculate appear good in amount and appearance the consideration of proastate being affected is not reasonable though you experience pain typically seen in prostatitis.

I would like to know whether in past or recent the doctors who examined have worked to rule out torsion in the testis.Here due to mild ischemic changes in the testis and structures around it would be inflamed chronically and present with typical episodic pain and post ejaculatory pain.Also due to overlapping of the nerves you may experience the pain either in the perineum of groin.

A Doppler scan is what all you need to rule the torsion of testis and it has to be done during the episode of severe pain.If this is confirmed the treatment would be surgical but do not alter any of your normal physiology and provide you life time relief.

Do share with me the reports of a Doppler scan done during the pain episode if done.

Also do try to attach here the recent test reports if you have any.

Anticipating your response.
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Follow-up: Twitching testicle. Diagnosed as chronic nonbacterial prostatitis. Feeling pain during and after ejaculation. Any ideas? 5 hours later

I have had ultrasounds of the testicles and prostate done. It was many years ago and I do not have the reports or images. Everything was normal. They did say at one point the seminal vesicles looked to be somewhat large but they were the same on both sides and otherwise normal. I have also been told before I had epididymitis of the right testical before upon testical examination and pain. That was the early years. I do not get that as often over the last several years. Yes, I have heard of testicle torsion and have asked. No testicle torsion. Sometimes I just wonder If I have such a low tolerance for pain. At first I was scared because I was young and had no clue what was going on. I had never heard of the word prosatitis at 19 years old. Obviously as you can tell, I have done tons of research on this. They even injected a nerve block on a couple of occasions into the right spermatic cord with no relief. I used to have to sit on a pillow when I drove because if I hit a bump in the road I would get the pain in the right testicle. But like I said the symptoms have changed over the years and the recent symptoms of the spasm like pain in the rectum is new. It did not happen last night during or after ejaculation, but today my perineam is aching and when I urinitate it is somewhat hard to start. You mentioned amount of ejaculation. I have noticed it used to shoot out, now it just kind of slowly comes out. The amount of semen seems to be less than it used to be. I used to take uroxatrol and it seemed to somewhat help, but due to my insurance, they do not cover it. I have tried flomax. I am currently taking doxazosine and have been for a couple years so I don't think the change in medicine would have caused it. I have read so many articles. Checked out so many websites. Read so many books. Tried prostate massage. In everything I read I have a lot of the classic symptoms of chronic non-bacterial prostatitis. So when I read "pain during or after ejaculation" almost in every article regarding non-bacterial prostatis, what type of pain are they refering to. I have taken supplements, herbs, minerals. Hot sitz baths. Is it possible at all that it could have anything to do with stress/muscle tension. I always have it in my neck/upper back. I am a worrier, always anxious. Could I somehow be tightening the muscles in the anal/rectal/prostate when I ejaculate that would cause this? But then I get the perineam pain for days and weeks afterward so I don't know that that makes any sense. It seemed that swimming, getting in a pool and walking, swimming, getting in the sauna, whirpool etc. on a regular basis made things at least seem somewhat better when I would have bad episodes, but this is a different kind of pain. Like nothing I have felt before. I am rambling and asking way too many questions. My apologies. As you can tell, I am frustrated, irritable and stressed. Whenever this type of pain or the other prostate pain I feel comes on, it feels as though a veil of depression comes over me. I have read that that is very normal for any man who suffers from this. It is not like a wound someone can see or a broken arm. It is just me that knows and those I may tell. I just wish I could at least ejaculate without the severe spasm like pain in the rectum or if that does not happen not have to suffer with the pain that follows the next weeks and it does not happen every time. I waited a month this time. I did not have the severe spasm like pain during or after, but now I feel the perineam pressure and discomfort while sitting especially. I did not expect you to diagnose me after all these years. Sometimes it is easier for me to type it or write it than speak it. I seem to start to cry when I really talk about it to someone. I know I seem selfish and others have it much worse than I. I suppose I should feel blessed and just deal with it. But it is not easy mentally or physically.

So much more for you to digest and comprehend and get back to me. Thank you for all your help and look forward to your response.

Very appreciated.

Answered by Dr. Raju A.T 41 minutes later
Hi ,

Thanks for writing back.

A good history leave a doctor in better knowledge about the problem.I really can now feel the pain and agony you are through al these years.

I still feel you have to be worked for ruling out the torsion.Torsion is a condition which most often presents atypically.This condition is diagnosed by a Doppler during an painful episode which is usually missed by many.

Well, there could be a chance where you pain threshold has decreased but undergoing this one last procedure is worth.

The medications you mention like uroxatrol and the semen abnormalities do point at a prostate problem , but this will again lead you on a never ending journey.

Also similar semen problems as you mentioned are encountered in torsion too,Do go for it and rule it out at ones.

Wish you good health.
Above answer was peer-reviewed by
Follow-up: Twitching testicle. Diagnosed as chronic nonbacterial prostatitis. Feeling pain during and after ejaculation. Any ideas? 37 minutes later
My last follow up. Currently my main concern is not testicle pain. It is a sharp, spasm like, cramping type pain that takes your breath away, makes you not want to move your body until it stops and is centered up inside the rectum, presumably where the prostate is located. It lasts for seconds to minutes. Then over time, days weeks etc. the pain will immediately make the perineam sore, make the anal/rectal area feel somewhat full as if you may need to have a bowel movement and make me hesistate upon urination. I have had all the symptoms before other than the first one. The spasm like, cramping like severe pain that feels as if it is located in the prostate gland itself, most definetly centered somewhere up inside the rectum. I just don't know. Maybe it will eventually stop happening, I am just afraid to test it out. I don't think this is testical torsion. I have read the symptoms of testicle torsion and these are not them. I am not questioning your opinion, maybe I should go see another urologist than the one I have been seeing for the last few years. I have not had to go see him often over the last few years, but when I saw him for this he wanted to do the hydro-cysto. I don't know that another urologist would have any answers. I have seen where pelvic floor disfunction can cause this. What do you think?
Answered by Dr. Raju A.T 20 hours later

I shal agree with you as your symptoms do match to a pathology concerned with prostate or urinary bladder.

But I have gone through some cases of torsion which presented atypically.

Well, you can consult a specialist(Urologist) in our panel too.You can ask the same query and get an opinion over it.

Wish you good health.
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