Could Chronic Pelvic Pain Syndrome With Neuromuscular Features Benefit From Neurological Evaluation?

Posted on Sun, 10 May 2020

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 11 May 2020 Answered on

Mon, 24 Nov 2025 Last reviewed on

Question : Hello I am struggling for 4 years with a neuromuscular condition called chronic pelvic pain syndrome. My nerves and muscles in the area get very irritated when I have sexual activity, intense physical activity or a very stressful event. at first I tought I had a prostate infection but I saw several urologist and the problems havent been solved so I am looking at other professionals and I am pretty sure my condition is neuromuscular when I look at the symptoms.

Pain Symptoms:
-Pelvic pain
-Lower stomach pain (around belly button)
-Pelvic/Lower stomach pain (relieved about an hour after emptying bladder or having a bowel movement)
-Discomfort urinating or during bowel movement (sometimes yes sometimes no)

Sexual Symptoms:
-Weaker/less frequent erections
-Premature ejaculation (not when using xatral + elavil before sex with a partner)
-Pain after ejaculation (perineum/base penis)

Solutions tried:
antobiotics, alpha blockers, anti inflammatory, anti depressant, healthy diet, internal pelvic massage, yoga, pelvic stretching, spa relaxation, increased sexual activity or less sexual activity

What helps:
-alpha blocker and anti depressant worked for premature ejaculation and pains but it comes back full force when medication wears off after sexual activity.
-internal pelvic massage increased erectile strength and relaxed muscles but different stigning pain appear after so I stopped and did not solve pe.
-pelvic stretching I feel that it helps a bit for the pains but they come back and I still have pe if I dont use the drugs.
-not ejaculating 2x in a row or more/not waiting to long to ejaculate 3 days is the best interval.

Lifestyle:
good friends & family,
no financial trouble,
Physical activity cardio weight training.

I was in perfect health before this problem occured physically and mentally. The reason I seek advice from a neurologist is because the 2 medications that help me for pain and pe during sex affect the nerves... So I would like to know what is your opinion on this and what tests/treatments could be done by a neurologist to help me with this problem ?

Thank you!

Answered by Dr. Sudhir Kumar (16 hours later)

Brief Answer:
Investigations are needed to clarify the diagnosis.

Detailed Answer:

Hi,

Thank you for posting your query at 'Ask a Doctor' service. I have noted your clinical details.

I would recommend the following investigations to understand the issue in greater detail:
1. MRI lumbo-sacral spine and pelvis
2. Nerve conduction studies including sphincter EMG

MRI would show if any structural issues such as infection or tumors are there, which are compressing the nerves in the pelvic region.

NCV/EMG would help us in detecting any nerve or muscle disorder.

If the above tests return normal, then, our focus is usually on pain relief with medications such as Pregabalin or Duloxetine.

Alpha blockers and anti-depressants do cause minor adverse effects, however, if they are beneficial they may be continued.

I sincerely hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information.

Regards,
Dr. Sudhir Kumar
Internal Medicine and Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (40 hours later)

Yes I will need to do the test and I will write to you the results and see what you recommend after.

In your opinion why do alpha blockers and anti depressant help me with pain and with sex? I saw online that those drugs have negative sex symptoms but for me they help its curious..

How does pregabalin affects muscles, nerves body any dangerous side effects?

Thank you for the help

Answered by Dr. Sudhir Kumar (3 hours later)

Brief Answer:
Sure, please get back with the reports.

Detailed Answer:

Hello,

I would be pleased to advise you after seeing the reports.

Regarding alpha blockers and anti-depressant medicines helping you, exact mechanism is unknown. However, alpha blockers may improve blood flow to the nerves. Anti-depressant medicines also have an effect on nerves via their influence on neuro-transmitters. Regarding adverse effects of these drugs on sex, they are not common (seen in less than 5% of users).

Pregabalin has a beneficial effect on pain or discomfort of nerve origin.

Take care. Let me know if you have any further clarifications. Thank you.

Regards,
Dr. Sudhir Kumar
Internal Medicine and Neurologist

Above answer was peer-reviewed by : Dr. Kampana