Magic Bullet for Post Ejac Pain/Testicular Heaviness?

[lookouth]

After having chronic prostatitis / chronic pelvic pain syndrome for 5 years and having, through the SP protocol and cognitive behavioral therapy, gotten rid of almost all of symptoms, I still had one nagging quality of life issue: post ejaculatory pain. Usually this would come on within an hour or so after ejaculation and last for upto a day- a dull bruised aching feeling in the shaft of the penis along with soreness in the perineum and heaviness in the testicles. If I kept my frequency down to around 2 times a week I could manage these symptoms OK with the help of celebrex, baths, bed rest, etc. But for someone my age (any age!) this is not ideal when we are talking about sexual activity- the pain was one thing, but the constant fear and frustration of knowing it would limit my sexual life was the worst.

A week ago I saw Stacy Flutterman at Beyond Basics PT in NYC, and after having years of SP based PT fail to help this problem at all (or find any trigger points which referred this pain) she was able to instantly locate the source of my pain: spasms and paradoxical contractions/clenching of the bulbospongiosus muscle (that's the main muscle that wraps around your whole urethra). Basically, she recognized that ejaculation (and urination to a lesser degree) causes this muscle to contract and that I was unable to relax that muscle and thus it would stay constricted until it fatigued itself and unclenched (up to a day later) and this protracted clenching was leading to my pain.

She advised me to massage this area for 3-5 minutes after ejaculation with light to moderate pressure (hands on, not Theracane) alternating between moving with the muscle fibers (up and down) and against them (horizontally). I cannot tell you how much this has improved this aggravating symptom, while it's too early to tell exactly how much it has helped in the long term, I can tell you in the last week my post-ejaculatory pain and associated symptoms has been WAY WAY down with this simple technique- I've been able to increase frequency to 4+ times a week and have much less restriction in my activities afterwards. It is very easy to feel a difference in the taughtness of the muscle post-ejaculation in terms of before and after I do the massage, so there is little doubt in my mind this is actually working. I recommend all those out there suffering from similar pain (or post urinary symptoms...which can be caused by the same mechanism) to try this massage. Let me know how you do and what you find that works for you.

[webslave]

Could you describe the technique more fully? Is this on the shaft of the penis or behind the testicles?

[lookouth]

Sure- the idea is to massage the entirety of the bulbospongiosus muscle pictured in red here: http://upload.wikimedia.org/wikipedia/c ... s-Male.png

in practice you can feel it as a sheath about an inch wide running from the center base of the perinuem up behind the testicles and into the base of the shaft. I basically start at the base of the perineum in the middle and work my up raising my my testicles to continue massaging up through the first inch or so of the shaft. I do this vertically for a while and then with horizontal motions. The bulbospongiosus is a fairly superficial muscle, so it doesn't take that much pressure to manipulate it and if you press too hard you are just going to mash it into your pudendal nerve/urethra and be counterproductive..you have to develop a feel for it so I would advise using your fingers and not a massage device (like a Theracane). Just as evidence to this theory- for all those with post ejac/urination pain- try just lightly palpitating this muscle before and then after urination or ejaculation...if you have the same problem(s) I do you will immediately recognize how much stiffer and harder this muscle is after these activities, and you will be able to easily notice the difference after an effective massage. This is also a good muscle to focus on for moment-to-moment and paradoxical relaxation if you have this type of pain, because much of the long-term inappropriate contraction of this muscle is a function of the basic inability to detect a holding or clenching in this muscle (refer to the "clenched fist" analogy in AHIP)

[graeme]

Very interesting, I will be giving this a try.

[robertpagen]

I went to Beyond Basics in NYC on August 14 and I found the consultation to be a disappointment. The PT seemed distracted or disinterested and really added no particular observation or useful course of action. The fee was 300 dollars. I don't think Stacey Futterman still works there.

[redondo21]

Who did you see?

[robertpagen]

I saw Rosa. I had asked for Amy Stein but they said she was not seeing patients. Amy was in the office, seeing patients and chatting with her staff.

Rosa seemed very uncomfortable and rushed. I had to remind her to check external muscle trigger points. It definitely was not worth the 300 dollars.

I too have questions about the bulbospongiosis muscle, but Rosa was clearly uncomfortable with that area as it is on penis. Just really unprofessional. No value added.

I could not see why that place has a reputation for excellent pelvic pain treatment.

I sent the therapist a polite note the next day with a request for more guidance. I realize that all persons can have an off day and I am empathetic. The response was just laden with excuses and not much in unique actionable suggestions.

Beyond Basics was an expensive disappointment. Move on.

Please tell me more about your results with the Bulbospongiosis.

Be well,

Robert

[redondo21]

I saw Roseanne fairly recently as well. They told me that Amy was not available in the near future so I figured Roseanne was the next best choice as she's gotten pretty good mentions on this board in the past. It is super early in the process for me and while I have no idea whether this will do anything for my uncomfortable symptoms (pelvic tightness, frequent urination and urgency feeling), I had a fairly positive experience. It probably helps that my insurance told me they will cover a portion (of course it is out of network so the reimbursement isn't that great) and that subsequent appointments are $195 rather than $295. It would be harder to justify the full price.

As far as the appointment, I didn't find her rushed at all - she gave me the full hour. She did a brief exam and noted (correctly!) that I am extremely inflexible and identified a ton of tightness. She also walked me through a stretching regimen and did some initial internal work. I felt noticeably better in the few days after, though it might have just been psychological as I'm feeling a bit worse today. In any case, I figure it takes more than one appointment and I plan to go back for weekly appointments for at least a few more times and continue a twice-daily stretching routine.

[robertpagen]

Please articulate what the stretches are which she told you to do.

[redondo21]

She gave me five different stretches - (i) hamstring wall stretch, (ii) hip adductor: knee fall out (like a lying down butterfly stretch), (iii) modified squat on back with bent knees (labeled "pelvic floor relaxation"), (iv) sort of a supine pigeon pose, and a (v) hip flexor stretch. The stretches were probably customized for my situation, which is that on top of my "prostate"/pelvic issues I also have terrible flexibility. So, certainly not necessarily the right regimen for anyone else.

Other than (iii), it's not clear whether the other are meant to directly address the main problems, but all of them seem to at least address the fact that I am ridiculously inflexible, especially for someone my age. It was the first visit and we did internal stuff as well, so we'll see how it goes. I'm religiously doing this stuff twice a day. Obviously I am quite early in this quest and it's possible that none of this will do anything. But I feel more optimistic about it than the courses of Cipro I've been through or the Flomax I've yet to start taking. And I guess even if none of this works I'll at least be more flexible.

[Caedar]

To add some more anecdotal evidence, I too have had a lot of success with hands-on massage of the bulbospongiosus muscle after ejaculation. Right now I'm riding on a weeklong streak of absolutely no post-ejaculatory pain or urethral pain and very little discomfort while the penile muscles are tensed during erections.

[robertpagen]

Good. She seems like a sincere woman. Everyone can have a rushed day on occasion.

[davyboy]

This is my final lingering symptom. I'll give it a try!

[Cree]

Hi guys: the bulbo is one of my problem areas, I have a lot of trigger points there and my PT (coincidentally a DPT at Beyond Basics) does a lot of work on that muscle. If you are having trouble finding the bulbo in my experience you should take a hot bath and then locate it when seated on a toilet. It seems much easier to find that way since the muscle is relaxed from the heat of the bath and being in a seated position on a toilet lends itself to relaxation of the pelvic muscles. I would think this would be a great time to perform that bulbo massage.