Please help, chronically COLD penis and scrotum

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Please help, chronically COLD penis and scrotum

Postby eddy88 » Sun Jun 04, 2017 9:31 pm

Hello everyone,

After endless googling of symptoms, I was led here. At the ripe old age of 28, I started experiencing erectile dysfunction for the last 16 months. However, 8 months into the ED (Oct 2016), the feeling in my penis and scrotum had changed. Mainly when I sit, within seconds my penis and scrotum become cold and sometimes VERY cold like ice to the touch. Just sitting here, I can feel the temperature difference against my scrotum and the inside of my thighs and it has a cold, wet feeling to it. When I actually go and feel down there, it is definitely much colder than rest of the area. For the longest time I thought it was prostatitis, but I have no problems with urination or frequency of urination, no bacteria in urine, no bacteria/yeast in stool test etc. So finally I saw a physiatrist who told me that it was an entrapment of my genitofemoral nerve that causes strange sensations and it's not an issue of blood flow (thankfully). However I think he misdiagnosed me and got the wrong nerve, since 4 weeks of treatment did absolutely nothing. Then I read about the pudendal nerve, and it makes more sense because it innervates the penis and the genitofemoral does not. Plus it is much closer to be impacted by sitting down. He refuses to order any MRI/MRN so I dropped him because I don't like paying money to not fix the problem.

So how did this happen to me? Not a clue! My only guess would be that I was jogging on the street when it was raining and I slipped and fell on my butt. It knocked the wind out of me but the pain from the fall disappeared after a few minutes and I did not bruise. I have been through WAY worse accidents years before this while snowboarding and one time thought I was going to dislocate my hip, and never had any problems following that, so I have no idea if this one fall caused it.

So I appeal to you guys! Has anyone experienced the same thing? I mainly just experience this horrible coldness and not much else. I do experience very short episodes of sharp pain in the area and any random time, maybe 3-5 times a week, but they last for only a few seconds and occur at any position - sitting, standing, walking, lying down, etc. Is this pudendal nerve related? How can I intelligently seek an accurate work-up that will leave nothing out and finally just get to the bottom of it? I am SICK of wasting my time away from work going to idiots who do not run tests, make a guess "diagnosis", and charge me for useless treatments. I need this done right once and for all.

Also is there a chance this could be hormone or nutrition related? I have low testosterone (resulting in the ED) and recently discovered deficiencies in my zinc and calcium levels, which I know have an effect on the nervous system.

Thank you so much for any help!
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Re: Please help, chronically COLD penis and scrotum

Postby Violet M » Mon Jun 05, 2017 5:56 am

Hi Eddy,

Unfortunately, the diagnosis of neuropathies in the pelvis is not an exact science at this point, but you are correct -- the dorsal nerve of the penis is a branch of the pudendal nerve, so since you are having sensory issues in that area, it is possible the dorsal penile nerve is affected. The perineal branch of the pudendal nerve innervates the skin of the scrotum. Since both of those areas are affected in your case, you have to wonder if the main trunk of the pudendal nerve is affected, especially since you have issues when sitting. There are sensory nerve fibers and motor nerve fibers and I can't say for sure why you would just feel coldness but not pain, other than to say that symptoms can depend on which nerve fibers are affected. At least that is how it was explained to me by one of the PN specialists I saw. The other possibility is that rather than the peripheral pudendal nerve being affected, that the nerve roots at S2,3, 4 are affected. That's why an MRI of the lumbosacral area might be important.

What I find confusing about your symptom descriptions is that your symptoms are induced by sitting which, according to the Nantes criteria, ( ... iteria.pdf) is suggestive of a peripheral nerve entrapment, but your symptoms are similar to what could be described as a sensory deficit which is more suggestive of a problem stemming from the sacral nerve roots. So, I think at this point you need to consider more diagnostics to narrow this down. Another thing to consider would be an evaluation by a pelvic PT specialist or manual therapist who can determine if the falls you experienced have caused any pelvic misalignments or sacroiliac joint dysfunction that could be contributing to the neuropathy. Also, an evaluation of your pelvic floor might be important, to evaluate for any tension in the pelvic floor muscles that might contribute to your symptoms. They could also check that hip for hidden problems such as femoral acetabular labral tears. How did that physician determine there was no blood flow problem? Did they do any dopplar/ultrasound studies to check the blood flow?

I can't say whether it's hormone or nutrition related but if it is, it seems like you could expect neuropathies to be more widespread than just those 2 areas innervated by the pudendal nerve.

Unfortunately, I don't know of any doctors who are going to do every test in the book to get to the bottom of this. Often, pudendal neuralgia has more than one trigger and it's like piecing a puzzle together to get a complete picture of what is really going on. I wish you all the best in finding a doctor who can help you sort this out and help you find the correct treatments.

PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: Please help, chronically COLD penis and scrotum

Postby Andy_Pablo » Mon Jun 05, 2017 1:10 pm

Yes, I recognise those symptoms, although I had pain & sensory issues too. They have improved after surgery, although surgery has not helped overall.
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