Background Transverse myelitis (TM) associated with neuromyelitis optica (NMO) has many unusual characteristics compared with TM in Multiple Sclerosis (MS): long centrally located lesions that cause significant motor-sensory (including tonic spasms) and autonomic dysfunction. We wish to report a symptom not previously described in neurological literature, neuropathic post ejaculatory pain (PEP).

Methods We will present videos of 3 male patients with AQP4-IgG +ve NMO describing post-ejaculatory pain (PEP).

Results All patients were recovering from long thoracic TM and had autonomic dysfunction at nadir. None had preexisting urological symptoms. The pain occurred immediately after orgasm and ejaculation and was severe, brief (<1 minute) burning or searing, spreading down one leg. The pain responded to carbamazepine in one patient and subsided over few months in all. 50 MS patients with TM surveyed for PEP did not report it. PEP has hitherto been described rarely in urological diseases like ejaculatory duct stones or pelvic metastases only. We suspect that PEP in NMO-TM arises due to ephaptic cross talk between pain and autonomic fibers in the spinal cord similar to tonic spasms.

Conclusion PEP has not been described in neurological disorders and maybe a unique feature of NMO associated myelitis.