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Erectile dysfunction due to neuropathy

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Neuropathy : I did an electrophysiological bulbocavernous reflex test and got abnormal results (87 ms latency). I also did an evoked potential test from penis to head and got normal results (36 ms).
The doctor said this meant that I lesion in the motor part of the nerve in the sacral part and that it was not worth it to do anything else because it has no cure. I feel absolutely no symptoms of neuropathy except for: erectile dysfunction (for 6 years) and a slight disconfort in the perinium. If I manually look for the source of the disconfort by slightly grabbing pinching i feel that it seems to be directly the top part of the urethra, confined to the region adjacent to the anus. Like if there was an inflamation above the urethra about half an inch from the anus.
I would like to know if there is a way of precisely knowing what sort of neuropathy is this, if it is likely to be getting worse, if it can be from sitting or cycling or a desease. And finally what treatment options exist. I already take 10 mg of cialis daily to allow me to have some erections and a sex life (about a very poor one). The doctor told me that in the future the only option might be first caverjet injections and then an implant.


Category: Neurologist, Medical

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Category: Pediatric Neurologist
 24 Doctors Online

Expert:  Dr. Sudhir Kumar replied 4 Days ago

Hi,
Thank you for posting your query at DoctorSpring.com.

You have undergone detailed investigations to diagnose the neuropathy and I agree with the findings, your doctor's observations and recommendations.

At present, no further tests are available to localise the neuropathy any further or establish its cause.

Also, the location is not amenable to nerve biopsy (as we would do for neuropathy in other locations).

Other causes of erectile dysfunction have been excluded by doing penile doppler, MRI limbo-sacral spine and psychological assessment.

I also agree with your current treatment plan.

I hope it helps. Please get back if you have any further queries.

Best wishes,

Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

Thank you for your quick reply. I have 2 follow up questions:

- I reckon neuropathy due to compression is a possibility. In this case is there physical therapy or specific care that can be useful ? I encountered references to a phenomenon called "pudental nerve entrapment". Can this be excluded?

- Lifestyle changes: Should I refrain from cycling, get special orthopedic cushioned seats for working? Does moderate drinking worsen the problem ?


Expert:  Dr. Sudhir Kumar replied 3 Days ago

Thank you for getting back.

Back extension exercises would be useful.

Pudendal nerve entrapment would have been excluded by nerve conduction studies.

Cycling for short distances is fine. Prolonged cycling may cause more pressure in the perineal area leading to some nerve damage.

Similarly, moderate alcohol intake may adversely the nerves. However, occasional or small amounts of alcohol is fine.

Best wishes


Patient replied :

Dear Sir . The MRI report, which I haven't shown to any doctor yet, refers "stenotic dimensions of the raquidian channel". Could this be the cause? How would it have been excluded ?


Expert:  Dr. Sudhir Kumar replied 2 Days ago

Thank you for getting back.

I am not sure of this finding. If possible, please upload the complete MRI report, then, I can give my opinion.


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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