1.5 years of penis pain and pelvic pain. No improvement, looking for advice

Male, late 20s. 1.5 years ago I had a day combining 30 minutes of cycling, a short session with a water-based penis pump (something I had used regurarly for a year and was accustomed to, using only light pressure that day), alcohol, and sex. Symptoms started the morning after and have never resolved.

Symptoms:

• Aching, stinging, pins and needles and mild burning pain in left side of penis, perineum and anus, mostly left side of perineum and anus, radiating up the left side of the penis.
• The pain is mostly in my penis, mostly on left side and left underside, but sometimes get mid shaft/base/right side stinging/pins and needles, burning pain, especially during/after masturbation
• Sometimes radiates down left glute and hamstring/thigh
• Pain is felt in varying degrees always when erect, during masturbation/sex, after masturbation/sex or day after masturbation/sex. Sometime mild ache, sometimes worse.
• Pain often mild or absent at rest if abstained for sexual activity a few days, but comes back every time I have an erection.
• Reduced penile sensitivity and pleasure, Dry glans.
• Significantly worse erections, low libido.
• Morning erections happens sometimes, but only at 60-70%, previously almost always 90-100%
• Occasional spasms in pelvic floor and glute area.

What I've ruled out:

• STIs negative
• Two urologists found nothing significant. First one did no examination, told me it was nothing he could do or help me with anyways, and said it was probably just stress. Second suspected prostatitis and prescribed antibiotics and NSAIDs, but with no urinary symptoms, no bacterial confirmation, and 1.5 years of completely unchanged symptoms, bacterial prostatitis seemed extremely unlikely. Seemed like he was guessing. Taking a long antibiotic course with side effects for an unconfirmed diagnosis that doesn't fit the clinical picture didn't seem justified.
• No structural abnormality found on ultrasound.
• No urinary problems.

What I've tried without meaningful improvement:

• Pelvic floor stretching, reverse kegels, relaxation exercises. Haven't been super consistent. But have had a few months of consistency that didn't improve symptoms that much.
• I am physically very fit and strong. Lift heavy weights which might make pelvic floor more tense, but this is important for my mental and physical health and I do not want to give this up. Have tried avoiding heavy deadlifting and squatting for 1 year and also had a couple of weeks away from the gym that didn't seem to give any improvements.
• Avoided cycling entirely for 1.5 years
• Daily Cialis 5mg
• Nerve supplements — ALCAR, ALA, PEA, high dose B12, benfotiamine, citrulline
• Peptides — BPC-157, TB-500, MK-677, ipamorelin/CJC for months
• Good diet, meditation, low stress
• I've tried multiple periods of no masturbation/edging/porn/sex, but never more than 2-3 weeks. When I return after a break the pain comes back immediately, sometimes worse than when I'm more regularly active, which makes me question whether complete abstinence is even the right strategy. On one hand 2-3 weeks is probably not enough and I haven't been consistent. The nerve needs time to calm down without being repeatedly provoked by mechanical stimulation and the pelvic floor contractions that come with orgasm. On the other hand I worry that complete abstinence means less blood flow to the area, which may actually slow healing. I also wonder whether if I never use it, the brain keeps interpreting any erection or sensation as a pain signal, essentially the nerve never gets a chance to relearn normal signaling. There's also the practical reality that abstinence is genuinely very hard to maintain long term. Urges build up and I end up relapsing.

What I suspect: The left-sided distribution, perineum → left side of penis → glute/thigh — strongly suggests pudendal neuralgia or CPPS with a nerve component. Pain is consistently triggered by erection and mechanical stimulation but often absent at rest when abstaining from triggers, which points away from bacterial or structural causes.

What I'm now considering and changing:

Longer abstinence from all sexual stimulation.

More consistency with stretching/pelvic floor release routines.

Low-dose amitriptyline (10mg) for 3+ months — at this dose it acts as a nerve-calming agent rather than an antidepressant, reducing hyperactivity in sensitized nerve fibers over time. The goal is breaking the chronic pain cycle rather than just masking symptoms.

Referral to a pain clinic for pudendal nerve block, both diagnostic and potentially therapeutic.

Shockwave therapy with a specialist pelvic physiotherapist. Expensive, so last resort.

Has anyone experienced similar symptoms or have advice on any of these approaches, the abstinence strategy, low-dose amitriptyline, or pudendal nerve block?

Any experience, advice or guidance appreciated.