Persistent Orgasm and Bladder Neck Surgery: A Urology Perspective

Persistent orgasmic sensation bladder neck surgery

Hello Doctor: I would like to briefly summarize my past symptoms and treatments:
1.
Incomplete urination, burning sensation in the urinary tract, pain and itching when pressing near the base of the penis close to the perineum, narrow urine stream, and nocturia - symptoms fluctuate.

2.
Frequent sensations of uncontrollable orgasm (without erection or stimulation, with an itchy feeling in the rectum), which worsen with pelvic floor or core exercises involving the left leg or sitting upright.
During severe episodes, there is a sharp pain near the right iliac bone, which is slightly relieved after ejaculation, but the urge to ejaculate returns after resting.

3.
History of hematuria.

4.
Nodules in the left epididymis.

5.
History of pelvic compression from heavy objects.

Previous diagnoses and treatments:
1.
Blood and urine tests showed no sexually transmitted infections.

2.
Two cystoscopies - the first showed no findings; the second, a year later, diagnosed bladder neck stenosis, with possible abnormal muscle contractions compressing the prostate, leading to inflammation, and ruled out bladder cancer.

3.
Testicular ultrasound and PSA blood tests were normal, ruling out prostate cancer, but confirming the presence of epididymal nodules.

4.
Took antibiotics for a total of three months on two occasions with no effect; tamulosin helped with urination, but the orgasmic sensation persisted.
Amitriptyline helped with sleep and resolved nocturia issues.

I apologize for the inconvenience as I am currently abroad and have difficulty understanding the medical terminology explained by the local doctors.
It takes several months to schedule an appointment, and the only treatments available here are bladder neck surgery and prescriptions for tamulosin / amitriptyline.

I would like to ask:
1.
My most troubling symptom is the persistent sensation of orgasm (occasionally accompanied by sharp pain near the iliac bone).
Will bladder neck surgery help with this, or are there other possibilities or specialists I should consult?
2.
What type of bladder neck surgery is the safest, and what is the expected recovery time?
3.
Is there an online paid consultation service for urology in Taiwan?
Thank you very much.

A Quan, 20~29 year old female. Ask Date: 2021/02/25

Dr. Xu Wencang reply Urology

Consultation is recommended for further evaluation by a physician.
Bladder neck incision is irreversible and requires careful assessment.
Botulinum toxin injection can also be considered as an option.
It is advisable to first conduct urodynamic studies to determine if surgery may be beneficial.

Reply Date: 2021/02/25

More Info

Understanding Persistent Orgasm and Bladder Neck Surgery: A Urology Perspective
The symptoms you are experiencing, particularly the persistent sensation of orgasm without sexual stimulation, along with urinary issues, can be quite distressing. This condition, often referred to as "persistent genital arousal disorder" (PGAD), can be complex and may not have a straightforward solution. Your history of urinary symptoms, including burning sensations, incomplete voiding, and previous episodes of hematuria, suggests that there may be underlying urological issues that need to be addressed.

1. Impact of Bladder Neck Surgery on Persistent Orgasm Sensation: Bladder neck surgery, particularly for conditions like bladder neck obstruction or bladder neck stenosis, aims to alleviate urinary symptoms by improving urine flow and reducing bladder pressure. While this surgery may help with urinary issues, it is uncertain whether it will directly address the sensation of persistent orgasm. The sensation you describe could be related to nerve pathways that are not solely influenced by bladder function. It may be beneficial to consult with a neurologist or a pelvic floor specialist who can provide insights into whether your symptoms might be related to nerve irritation or pelvic floor dysfunction.

2. Types of Bladder Neck Surgery: The most common procedures for bladder neck issues include bladder neck incision (BNI) and transurethral resection of the bladder neck (TURBN). Both procedures are minimally invasive and typically have shorter recovery times compared to more extensive surgeries. BNI involves making a small incision in the bladder neck to relieve obstruction, while TURBN involves removing tissue from the bladder neck. The choice of procedure will depend on the specific nature of your condition, and this should be discussed in detail with your urologist.

3. Online Consultation Options: Many healthcare providers now offer telemedicine services, including urology consultations. In Taiwan, you can look for urology clinics that provide online consultations. Websites of major hospitals or private clinics often list their telemedicine services. It’s advisable to check if the urologist you wish to consult has experience with your specific symptoms and conditions.

In addition to surgical options, it may be worth exploring other non-surgical treatments. Medications such as anticholinergics or neuromodulators may help manage bladder overactivity and associated symptoms. Physical therapy focusing on pelvic floor rehabilitation can also be beneficial, especially if there is a component of pelvic floor dysfunction contributing to your symptoms.

Lastly, it’s essential to maintain open communication with your healthcare providers. Given the complexity of your symptoms, a multidisciplinary approach involving urologists, neurologists, and possibly pain management specialists may provide a more comprehensive treatment plan. Keeping a symptom diary can also help your doctors understand the frequency and triggers of your symptoms, aiding in diagnosis and treatment planning.

In summary, while bladder neck surgery may help with urinary symptoms, its effect on persistent orgasm sensations is uncertain. Exploring other medical opinions and treatment modalities is advisable, and seeking online consultations can provide you with the necessary guidance while you navigate your health concerns.

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