Health Organization for Pudendal Education

Hello everyone,

I'm a 23 year old guy and for the past two months I have had constant numbness in my penis, scrotum, and buttocks. I can't think of anything that would have caused this. If I pinch hard I can feel it, but I have no touch sensitivity down there. Also, my buttocks sometimes feels ice cold to the touch. I went to a doctor 2 weeks after it started and they x rayed my lower back because I have been having an occasional low back ache since this started. The x ray showed nothing. Then they said its probably just a pinched nerve and prescribed me some methypredisolone along with rest and said to come back if it didn't go away. So about a month passes and I had no improvement whatsoever with the numbness. I went back to the doctor a week ago and she prescribed me a muscle relaxer and is scheduling me to have an EMG nerve test done.

The doctor never mentioned the pudendal nerve, but is that what this could be? Should I have an MRI? I'm really lost on what to do.

The EMG sounds like a good idea because it is designed to be specific in pinpointing which nerves are not conducting properly. Even if she didn't mention the term "pudendal", only a few nerves enervate the area so the EMG will probably be checking the pudendal nerve. I would suggest going through with the EMG first and then getting a copy of the report to see what nerves were examined. Or, make some calls and find out ahead of times which nerves will be covered by the test. Then decide based on EMG results, what further diagnostic testing is needed.
Faulty nerve conduction can lead to any change in sensation, so numbness and coldness vs. pain is not unexpected. It will register on an EMG exactly as if it were pain.
I'm actually pretty impressed at the medical care you have gotten so far. Many of us have not been ignored, insulted, and not offered any objective diagnostic testing. When you get your results, let us know how the EMG was interpreted and what advice you were given by the doctor: It's a good idea to run every step of your diagnostic and treatment decisions by this audience to get the benefit of collective experience.

...actually I just re-read and saw that you didn't say you had a cold sensation, but that your buttocks actually feels cold to the touch, am I reading this properly? If so, there might be a circulatory vs. neurologic problem, and it might be more urgent to get interventional care. While I think that topic is outside of the realm of pudendal neuralgia and I for one am not familiar with such a condition, if you have an objective drop in skin temperature you might want to return to your doctor or seek a second opinion sooner than you can access the EMG.

HerMajesty wrote:...actually I just re-read and saw that you didn't say you had a cold sensation, but that your buttocks actually feels cold to the touch, am I reading this properly? If so, there might be a circulatory vs. neurologic problem, and it might be more urgent to get interventional care. While I think that topic is outside of the realm of pudendal neuralgia and I for one am not familiar with such a condition, if you have an objective drop in skin temperature you might want to return to your doctor or seek a second opinion sooner than you can access the EMG.

Thank you so much for you opinion HerMajesty. I'm sorry if I didn't make myself clear, but yes my buttocks is cold to the touch. My butt is numb, but when I touch it with my hand it feels very cold. I didn't mention this to my doctor because I didn't really notice it until this week. My genitals are just as numb, but they don't feel cold like my buttocks does. I'm hoping that's a good thing. Do you happen to know of anything that could cause this type of circulatory problem?

I keep worrying that I might have cauda equina syndrome, but that makes you lose control of you bladder and bowels right? My doctor kept asking me if I lost any control with either and I said no not really except I'm not having bowel movements as regularly. A bit constipated too when I do go. Is it possible to have cauda equina without complete loss of bowel and bladder control?

Anyway, I'm a bit more worried now about the circulatory thing you mentioned. I'm gonna try and get a second opinion on this as soon as I can.

I'm not aware of any such circulatory problem but there are a lot of conditions i have no knowledge of, so that doesn't mean anything. I still am concerned that cold skin is more likely circulatory than neurologic, and circulatory issues need more prompt intervention to prevent tissue damage.
Assuming your issues are neurologic, i don't think the symptoms you describe are any more likely to be cauda equina than just plain pudendal. The pudendal nerve is essential for bowel and bladder control (that's why we never get it cut even when it causes debilitating pain). Cauda equina syndrome tends to produce more global symptoms, such as sciatic leg pain and loss of ankle reflexes. It is not an impossibility; but there is nothing about the location of your current symptoms that would lead me to jump to the conclusion that "more" nerves are involved than just pudendal. That doesn't mean you have pudendal neuropathy though. there are a lot of differential diagnoses for penile numbness; and once again the skin temperature change does not really fit with neuropathy to the best of my knowledge.

Snowman, it seems like an MRI, preferrably 3T could tell you more than just a plain x-ray. Have you had that yet? If not, that is definitely something I would be asking for.

Since you are having low back pain it seems an evaluation by a physical therapist or manual therapist who is familiar with pelvic issues such as pudendal neuralgia and sacroiliac joint dysfunction would be a good idea too. An x-ray is not going to show some of these things.

So, in answer to your question -- could this be the pudendal nerve? -- I agree with HM that some of your symptoms are similar to PN type symptoms but there could be more going on than just PN. The typical EMG may test the nerves in your leg but likely will not test the pudendal nerve unless you go to a specialist who knows how to test the pudendal nerve. EMG of the pudendal nerve is a very specialized test so you may have to do some research to find someone in your area who knows how to do this.

According to this website http://www.medicinenet.com/cauda_equina ... a_syndrome
you can have partial cauda equina syndrome.

"Partial cauda equina syndrome is the terminology that applies when there is incomplete compression of the nerves of the lower spinal cord. This can elicit various degrees and combinations of the symptoms listed above."

According to WebMD http://www.webmd.com/back-pain/guide/ca ... e-overview you can have varying symptoms that do not necessarily include incontinence.

"Symptoms of Cauda Equina Syndrome

It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. If you have any of these symptoms, see your doctor right away:

Severe low back pain.
Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair.
Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse. You may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia).
Recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence).
Sexual dysfunction that has come on suddenly."


So, while I think it's possible you have pudendal nerve involvement I think the more immediate issue is to make sure they have adequately ruled out cauda equina and I don't think a simple x-ray is an adequate diagnostic test based on what I'm reading. My understanding is that nerves control vasoconstriction so if nerves are misfiring it could affect your circulation.

Best,

Violet

Violet M wrote:Snowman, it seems like an MRI, preferrably 3T could tell you more than just a plain x-ray. Have you had that yet? If not, that is definitely something I would be asking for.

Since you are having low back pain it seems an evaluation by a physical therapist or manual therapist who is familiar with pelvic issues such as pudendal neuralgia and sacroiliac joint dysfunction would be a good idea too. An x-ray is not going to show some of these things.

So, in answer to your question -- could this be the pudendal nerve? -- I agree with HM that some of your symptoms are similar to PN type symptoms but there could be more going on than just PN. The typical EMG may test the nerves in your leg but likely will not test the pudendal nerve unless you go to a specialist who knows how to test the pudendal nerve. EMG of the pudendal nerve is a very specialized test so you may have to do some research to find someone in your area who knows how to do this.

According to this website http://www.medicinenet.com/cauda_equina ... a_syndrome
you can have partial cauda equina syndrome.

"Partial cauda equina syndrome is the terminology that applies when there is incomplete compression of the nerves of the lower spinal cord. This can elicit various degrees and combinations of the symptoms listed above."

According to WebMD http://www.webmd.com/back-pain/guide/ca ... e-overview you can have varying symptoms that do not necessarily include incontinence.

"Symptoms of Cauda Equina Syndrome

It may be hard to diagnose cauda equina syndrome. Symptoms vary and may come on slowly. They also mimic other conditions. If you have any of these symptoms, see your doctor right away:

Severe low back pain.
Pain, numbness, or weakness in one or both legs that causes you to stumble or have trouble getting up from a chair.
Loss of or altered sensations in your legs, buttocks, inner thighs, backs of your legs, or feet that is severe or gets worse and worse. You may experience this as trouble feeling anything in the areas of your body that would sit in a saddle (called saddle anesthesia).
Recent problem with bladder or bowel function, such as trouble eliminating urine or waste (retention) or trouble holding it (incontinence).
Sexual dysfunction that has come on suddenly."


So, while I think it's possible you have pudendal nerve involvement I think the more immediate issue is to make sure they have adequately ruled out cauda equina and I don't think a simple x-ray is an adequate diagnostic test based on what I'm reading. My understanding is that nerves control vasoconstriction so if nerves are misfiring it could affect your circulation.

Best,

Violet

Thanks for replying Violet. I haven't been able to see my doctor or any other yet, but I called my doctor's office and asked if I could have an MRI on my lower back and pelvic region and they told me its a little too soon for my insurance company to authorize that. They told me they will try, but they couldn't guarantee that I would get it. I guess they're gonna see what the EMG shows first and if that turns up nothing then maybe try for the MRI. They're reassuring me that they don't believe its cauda equina syndrome so hopefully they're right.

Anyway, my low back pain isn't so much of a pain, but more of an occasional annoying ache. It seems to come on after sitting for too long. I'm having no trouble or pain while moving around, bending, or anything of that matter so my doctor didn't prescribe any physical therapy yet. And also, concerning the circulatory problems, I can still get erections, but they are just much harder to get because of the lack of sensation.

Now, I do have a question about this EMG test. I really have no idea if they are going to do an EMG on my pudendal nerve or not. But my question is, how do they test the nerves in my penile and buttocks regions? I didn't ask my doctor how they did it, but I've looked at videos of this test and most of them show people getting the test done on their hands, arm, or legs. I can't seem to find any info of the test being done on the genital region. Is it done by just simply putting the electrodes on my penis and butt?

Yes, it involves electrodes or tiny needles and electrical stimulation in the anal/perineal/genital area.. Not fun but if the tester knows what they are doing it doesn't take very long.

Violet