The pain after masturbation or sex is so extreme that I can barely stand up. Please help.

Hello doctor,

I am a 37-year-old male, and I am at the end of the line with chronic pain. Over the last approximately 12 to 14 months, I have increasingly quite high levels of pain and aching after masturbation or sex. Originally it started in my testicles, just feeling an ache, especially if it was a relatively long “session,” but it soon got worse and worse, traveling up in the inguinal and pelvic areas, as well as the lower back and abdomen. It is so extreme now that I can barely stand up or move around for several minutes to hours after even light touch. Last July and August, I had two separate ultrasounds ordered by highly regarded men’s health urologists here in my country, about eight weeks apart. Each showed considerable inflammation in the vas deferens, and some small epididymal lesions, and general inflammation. Prostate and kidneys are normal. Neither doctor offered much as a treatment, though - one course of antibiotics did nothing (and all tests for infections were negative). The only test I did not do is semen culture because, by that point, it was too painful. A nerve blocker did nothing that I could tell except make me sleepy. I am now more than a year into this getting worse and worse by the day. I have lost all sexual interest, adding strain to a relationship that has since ended. I have tried taking time “off” from masturbating at all, but that does not seem to change anything - using the toilet appears to cause the same symptoms now.

I quite literally have trouble walking sometimes afterward, and I can feel extreme tightness in my lower abdomen or pelvis if I try to stand up straight. My mobility is diminished. I cannot stretch my torso much in any direction without pain. My lower back is either sympathetic pain, or something has traveled there. I am still a relatively young and single guy, and I am beyond distraught at the fact that two top urologists did not seem to take my situation seriously, and despite having left time for some kind of treatment before I lost my coverage, they did not offer any. Every day is worse than the day before - today, I have had moments of breathlessness if I move too fast or put pants on, etc. The pain still begins in the testicles and radiates up from there. I have trouble even touching them enough to soap up in the shower. The few times I have been able to ejaculate, it is normal semen for me, which always depends on my hydration level, though the pain afterward is severe, especially lower abdomen.

As far as other info: I am HIV positive (undetectable, CD4 over 1200); depression and anxiety treated by Zoloft and Xanax (but the same dose for over 15 years, so I know how the Zoloft interacts with that system and this is new and unrelated); and I take Diovan HCT for very borderline hypertension (minor, just a precaution).

Hello doctor,

As I mentioned above, I have had full STD screening, just not semen, and have not had sex since. All other urine tests were done. I have attached it. Also, how can I help the pain in the meantime? It has destroyed my quality of life majorly and is causing emotional turmoil to add to the physical pain, plus my inability to be intimate due to pain when touched. How can I provide a semen sample when it is too painful to even touch? It normally takes me a long time even without this problem. I will make things worse.