L4-L5 and penile numbness

[alalaniz]

Dear Dr,

My MRI revealed :
L1-2 mild facet hypertrophy with no central canal or neural foraminal narrowing
L2-3 same as above
L4-5 moderate bilateral facet hypertrophy, moderate ligamentum flavum hypertrophy, with no central canal or neural foraminal narrowing
L5-S1 moderate facet hypertrophy with no central canal stenosis or neural foraminal narrowing. No herniated or bulging discs.

For twenty years (I'm 42) I've run 20 miles weekly with sprints, as well as punched/kicked a punching back, curled 50 lb dumbels, done pullups and stomach crunches. Until 1 month ago, I've had no spinal issues.  For 2.5 years I've been diagonosed with chronic prostatitis. DRE was boggy in 2005, and TRUS revealed a small prostate with an irregular lobe. PSA was low. Avodart has returned my prostate to normal under TRUS, DRE feels normal, and PSA velocity is low.

What began as discomfort in sitting, and a painful penis in ‘05 has steadily progressed to ever more severe pelvic pain.  Sitting is unbearable.  Six months ago, I was experiencing severe pelvic pain, hypersensitive skin in the lower abdomen, buttocks, penis, as well as partial numbness in the head of the penis.  A month ago my feet began going numb when running.  This has rapidly progressed to my legs, arms, and penis. I now have severe lower back pain.  I’ve little to no penile sensation during sex.

Until the MRI, I believed I had CPPS as discussed in Dr. Wise's "A Headache In The Pelvis".  I now assume there is pressure on my pudendal nerve due my spinal issues, perhaps pudendal nerve entrapment. If so, is any damage already permanent?  If not, can the damage become permanent, and if so, how long does it take to become permanent?  Should I see a spine specialist and a neurologist? Do a nerve conduction study?  What kind of treatment might I expect?  Steroid injection? Surgery?

Should I give up high impact exercises? What exercises can I substitute? Stationary or recumbent bike? Pull ups? Push-ups? A treadmill?

Thanks

[Kevin Pho, MD]

I cannot comment on whether the damage was permanent without evaluation  I agree with the workup thus far, and further testing with a nerve conduction study or EMG can be done to exclude further peripheral nerve damage.  

A neurologist is definitely recommended to exclude this possibility.  The treatment would depend on what the cause of the nerve damage is.  If a surgical option is needed, a referral to a spinal specialist may be considered.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[Servy]

A related discussion, Penile Numbness was started.