Aa
Problem
I know this sounds urological but I have reached a dry spell in treatment as the urologists I have seen don
This is some great advice!! Excuse my cheerleading...
Dear Bobby:
I am afraid that I do not know the answer to your problems. But I can offer some thoughts and maybe where to start. First, the ability to have an erection is parasympthetic nervous system (S2/3,in your case sounds okay) and the ability to ejaculate is sympathetic nervous system (where some of your problem may lie). You can ejaculate so most of your problem likely is somewhere proximal to this physiological event. The sensory roots to the penis is in a dermatome distribution of S3). Ejaculation is partially voluntarily controlled by the rhythmic contraction of bulbocavernousus and ischiocavernosus muscles. In your neurological exam, where the dermatome sensations of S2-S4/5 okay? If not, then a caudia equina lesion may be occurring. The MRI should be able to pick this up, but one never knows who read the films. Then there are autonomic lesions that may be at play. I would first see if there is an autonomic problem, get autonomic testing of the Sacral plexus area neurons. A temporal lobe problem is extremely unlikely but theoretically could be a partial source of the problem, as well as a cervical cord problem. Sorry, I wish I could help more. I do hope you find the answer.
Sincerely,
CCF Neuro MD
I am afraid that I do not know the answer to your problems. But I can offer some thoughts and maybe where to start. First, the ability to have an erection is parasympthetic nervous system (S2/3,in your case sounds okay) and the ability to ejaculate is sympathetic nervous system (where some of your problem may lie). You can ejaculate so most of your problem likely is somewhere proximal to this physiological event. The sensory roots to the penis is in a dermatome distribution of S3). Ejaculation is partially voluntarily controlled by the rhythmic contraction of bulbocavernousus and ischiocavernosus muscles. In your neurological exam, where the dermatome sensations of S2-S4/5 okay? If not, then a caudia equina lesion may be occurring. The MRI should be able to pick this up, but one never knows who read the films. Then there are autonomic lesions that may be at play. I would first see if there is an autonomic problem, get autonomic testing of the Sacral plexus area neurons. A temporal lobe problem is extremely unlikely but theoretically could be a partial source of the problem, as well as a cervical cord problem. Sorry, I wish I could help more. I do hope you find the answer.
Sincerely,
CCF Neuro MD
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