Pgad after stopping Zoloft ( sertraline ).Need help

[Balenul]

Hello.



Sadly I think I developed Pgad and I am kinda lost.

Very few informations about this in males. I had a pituitary surgery 2 years ago that gave me diabetes insipidus and other hormonal issues , 2 months before this, I had a laparoscopic surgery for my rectal prolapse. It was made with an absorbable mesh. These 2 surgeries affected my pelvic floor. I developed chronic pelvic floor pain and my main symptom until last months was a constant urethral urge and penis / urethral pressure , finally this urge started to not be so intense anymore but after 2 weeks of joy, Pgad symptom started , first 2 days appeared when I was very stressed and had anxiety , I had this strange feeling in my penis like I have to masturbate / ejaculate but they dissapear after ejaculation. After that I had 5 days with no more Pgad. After 5 days when I was very calm and browsing my phone I had this feeling again this time unrelated with stress/anxiety.



My Pgad is 100 % not related with sex , no desire etc. First day when appeared when I was stressed I masturbated 2-3 times and I had a relief after each, my penis was not even erect, was semierect when I masturbated but the sensation started with my penis flasc.

Second day it happened for 2 times I masturbated and all was ok after for 5 days ....problem is after this 5 days sensations reapered and they are usually constant if I don’t ejaculate ( very rare I still feel them even if I ejaculate but most of the time I have 1 or 2 hours when I feel ok ).

Sometimes I was lucky and had some erection or semi and I managed to ejaculate in few minutes but sometimes I would struggle for 1 or 2 hours and ejaculation was impossible (sometimes is possible but very difficult cause I don’t have pleasure most of the time and my penis is totally flasc ). Problem is I was taking amitriptyline 50 mg , tramadol slow release 200 mg ( 1 in morning and 1 at night ) , Lyrica 300 mg and Zoloft 100 mg ( Zoloft I started it in January for anxiety and OCD.



Ocd I had even before my surgeries but not so bad and even if I had taken Zoloft or Paroxetine I was always able to stop them even directly with no problems ). I stopped Zoloft and Lyrica cause my pelvic pain and urinary symptoms got worse and my pain doctors told me to increase amitryptiline to 100 mg and change Lyrica with Gabapentin. This change helped me a lot, in a week I started to feel better and better ( I was taking Lyrica and 50mg amytriptiline for 1 year so I guess the increase of amytriptiline and switch from Lyrica to Gabapentin helped some how ).



I forgot to mention I did 2 months of internal therapy in Spain since in Romania no one can do this and this helped me considerably as long as I was in Spain and few months after but like I said in April I felt horrible and that’s why I changed meds. Like I said I was happy for 2 weeks cause Pgad started after ( all started after I stopped Zoloft not sure if Lyrica counted ), my psyhiatrist that only heard about Pgad told me to restart Zoloft 50 mg again ( I was only taking 75 amytriptiline cause 100 mg was too much for me, was feeling too tired to function ).

I started Zoloft 50 mg and nothing changed really I had 2 , 3 very bad days with non stop symptoms and let s say 2 days when I felt almost normal.

After 1 month he told me to take 100mg Zoloft and after this I felt good 2 more days ( my Pgad was like in cicles 2- 3 bad days 1 or 2 good days ) but in the 3rd day Pgad has become permanent every day ( for 5 days in a row , something new ). Also ejaculation was almost impossible and erection was gone totally ( was not able to obtain even a small semi erection ). Sometimes I ejaculate after hours of struggle. I told my psyhiatrist what increasing Zoloft to 100mg did and he told me to take 50mg again and to decrease to 25mg until we quit it for good . ( I already take 50mg Zoloft for 5 days (started it on 31 June ) but no change , I don t have good days anymore only bad days.



But I feel like I can ejaculate a bit faster now even if no erection. Is strange cause usually in some mornings I wake up with erection , but like I said my Pgad is rarely related to something sexual ). Last Friday ( 30 June , one day before taking again 50 mg of Zoloft instead of 100mg he told me to change Gabapentin with Lyrica again. For now I take 225 mg and will take 300mg soon. To be honest I felt Gabapentin even at 1200 mg that is basically a smaller dose than 300mg Lyrica helped me more for my pelvic pain but I did like he said ).



Is like a curse for me , finally after 2 years of huge urinary issues when they started to be better now I have this problem. Also now is not even related with stress / anxiety /OCD anymore some days I am not stressed and this sensations are present all the day ( if I don’t ejaculate and after 1 max 2 hours they are back anyway ). I am not sure if this is Pgad , my sensations are only in penis, very intense, like I am very close to ejaculation now, but my penis is flasc and almost all the time is not sexual desire , or very rarely is also a bit sexual related but even then, I have problem in obtaining erections .



I know my pelvic floor is tensed and press on my pudendal nerve and branches but in 2 years I never had Pgad and like I said all started when I was way better in term of pelvic and urinary problems. I also did a pudendal block in February and a ganglion of impar one but they did nothing for me. No help.



So even if I have pelvic problems (related to muscle and nerves ) I think the reason of all my Pgad sufferance is stopping Zoloft. Also not sure if changing to Lyrica again is helping me.

[Violet M]

Hi Balenul,

Sounds really difficult what you are dealing with. Are you able to sleep at night? Not being able to sleep was one of the difficult things for me because when you don't get enough sleep your mind starts playing tricks on you. Eventually I was able to get some medication for sleep -- first I used ambien and later clonazepam.

When you tried the nerve block that didn't work were you having PGAD at the time? When I had nerve blocks they never completely took the symptoms away - not even temporarily. But I had never taken SSRI's before PGAD, and I was 98% cured of PGAD by having PNE surgery so I know it was the pudendal nerve and not SSRI''s for me. It sounds like you have some PN involvement since you have other symptoms too. Have you had a dorsal nerve block?

Violet

[Balenul]

Hi Balenul,

Sounds really difficult what you are dealing with. Are you able to sleep at night? Not being able to sleep was one of the difficult things for me because when you don't get enough sleep your mind starts playing tricks on you. Eventually I was able to get some medication for sleep -- first I used ambien and later clonazepam.

When you tried the nerve block that didn't work were you having PGAD at the time? When I had nerve blocks they never completely took the symptoms away - not even temporarily. But I had never taken SSRI's before PGAD, and I was 98% cured of PGAD by having PNE surgery so I know it was the pudendal nerve and not SSRI''s for me. It sounds like you have some PN involvement since you have other symptoms too. Have you had a dorsal nerve block?

Violet

Not yet.also from what i read on other people posts...even with entrapment blocks don t take away urinary symptoms.....i never saw a person saying this.and after surgery worked for most.I did not had Pgad back then when i did pudendal block and never had a dorsal block.I remember a spinal anesthesia took all urinay symptoms in 1 min.Now a lumbar mri show l4 and l5 press on cauda equina.Also ice on my sacrum reduce Pgad....it seems is sacral roots plus pudendal and a tight pelvic floor.I guess zoloft stopping only triggered it.i feel very bad atm....btw pudendal block did not help Pgad at all ? Or liitle ? ( not sure if you talked about Pgad in above post ).About urinary i know pudendal blocks kinda fail...

[Violet M]

Pudendal block did not completely take away PGAD symptoms - just partially for a few hours.

Are there any treatment options for the pressure on the cauda equina? Did they rule out tarlov cysts? Those can cause PGAD.

[Balenul]

In Romania they know nothing.Will send Dvd to Goldstein and Hibner.I don t think is a tarlov but the disc is in contact with the area.Also ice on back take alot of symptoms so i guess there is the problem

[Violet M]

You want to ask specifically that they check for tarlov cysts because I've heard radiologists don't always mention them in the report.

[Balenul]

You want to ask specifically that they check for tarlov cysts because I've heard radiologists don't always mention them in the report.

But even with no problems on back ( sacral roots ) if i have pudendal neuralgia or entrapment Pgad is a common symptom ?

[April]

Hi Balenul,

You are asking if you can have pn with no signs of back problems on an MRI? If that is your question, yes, you can. Or, maybe you're asking if you can have pn with no back symptoms? If so, that is also true. You asked if pgad is a common part of pn? I wouldn't describe it as common but many people with pn have it.

April

[Violet M]

MRI's aren't always 100% accurate at giving you an exact diagnosis. You can have an abnormal MRI with no symptoms, or you can have lots of symptoms with a normal looking MRI. But they can be helpful in the diagnosis. Even if you have a radiculopathy that shows up on your MRI, you could still have pudendal neuralgia or pudendal nerve entrapment. It's not necessarily an either/or situation. But still the MRI can assist in helping your doctors figure out what's going on.

And yes, I agree with April that many people with PN have PGAD.

Violet