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Urology/Penis pump nerve damage

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QUESTION: Hi Doctor.

I would be very grateful for your feedback on he following problem I have.

I used a penis pump for 3 months. I quit after noticing an alarming loss of sensation in penis (no pleasure during masturbation)

a week after I quit sensation returned. The sensation was weak at first, but as I continued to rub the penis the sensation began to return to normal...?
Normal sensation for two days ensued.
Then followed a week of numbness again.
Sensation spontaneously returned again one day and this lasted for four days.
Woke up the next day and I was numb again.

That was 3 months ago and the sensation hasn't come back for three months.
last week I noticed sensation returned along the top of the penis, this occurred after I carried on rubbing for a while but disappeared again.
I have contractions of the perineum when masturbating, but there is hardly any feeling in penis until the point I ejaculate.

I've seen many cases on this forum of guys in similar situation to me. But my question is, from a neurological point of view...what is causing this fluctuation in sensation in my penis?
I thought that once nerves regenerate they are fixed, so why the return to numbness again?


I would really appreciate your expertise in this matter doctor. I've been to my urologist but he can't explain the intermittent numbness.


Many thanks.

ANSWER: Michael, vacuum erection devices (VEDs) have been used for over 100 years as an aid to get an adequate erection for sexual performance.  Side effects include bruising, pain, no or painful ejaculation, pulling of scrotal tissue and numbness.  The medically approved VEDs are designed to produce a pressure between 200-250 mmHg.  Pressures lower than this may not produce adequate erection and those higher can produce a greater incidence of side effects.  Another possibility is excessive bruising of the nerves from the constricting band.  It is recommended that this not be left on longer than 30 minutes to decrease the likelihood of side effects.  The first thing I suggest is to find out the pressure range for the VED you own.  I am unaware of (and can find no reports in the literature) permanent or intermittent loss of sensation from VEDs.  In your case, the frequent "rubbing" may actually be detrimental by not allowing the bruised nerves to completely heal.  Therefore, I suggest you  discontinue this practice.  Another possibility is that you may have some type of neurologic disorder unrelated to the VED.  If you symptoms persist after you stop the "rubbing", consider consultation with a neurologist.  Good luck.

Michael, after reviewing my note, I would like to add a few thoughts.  Bruising of the sensory nerves of the penis invariably repairs itself.  However, the process of nerve healing is quite slow and can sometimes take up to a year.  During this time, it is important not to re-injure the area.  Therefore, in addition to discontinuing the frequent "rubbing" of the area, I would suggest that with sexual activity, you use a good quality lubricant (such as one of the "silk" lubricants), to further minimize the chance of further damage.  Good luck.



---------- FOLLOW-UP ----------

QUESTION: Dr Goldstein,
Thankyou for your response. Just to clarify,
The device I used was an actual water based penis
Pump that stretches the penis in the bath for
15 minutes each session.
However the fact I got my sensation back
To my penis on two occasions after quitting the
Pump, does that mean the nerves cannot
Have been (architecturally) destroyed?
It's been two months since the last time I recovered
Sensation to the penis. I woke up one day and it was
Numb again and has been so virtually since.

From this information, would you say the nerves
Are structurally intact but just not firing? Maybe scar tissue
Has now developed as its been two months without
Normal sensory function? Are there any tests I can
Have done which image the tissues and nerves that
Could shed some light on the problem?

I'm sorry to be so specific, but I'm just so confused and distressed.
Thanks for your help

ANSWER: Michael, sorry that I misunderstood you.  I though you were just using a VED to get occasional erections.  You apparently were using a water based penis pump (such as the Bath Mate) for the purposes of penile enlargement.  This is just a variation of the technique know as jelquing.  Although the water based devise states that there are no side effects, I do not believe this as all the other similar devices do indeed have side effects.  

On the internet there are many questionable medically substantiated claims of improving penile size & performance by a variety of techniques and gadgets.  This would include stretching, vacuum erection devices (including water based penile pumps), massage, jelqing, andropenis, penis extenders, etc.   These techniques may over time add perhaps at most 2 cm.(less than one inch) of penile length.   However, there are many reports  of complications such as erectile difficulty, burning and numbness of the penile tissues (due to damage to penile sensory nerves) , bruising, swelling & local discomfort from such practices, especially from jelquing.  In addition, there are many anecdotal reports of venous leak occurring in individuals who jelq, especially if done with an erect penis.  Therefore, if one decides to jelq, it should only be done in the flaccid state.   Most common of these complications is bruising of the penile nerves producing numbness.   In most instances, this clears on its own as long as the  technique is discontinued.  However, resolution may take just a few days for bruising but months for the numbness (up to one year).   However, if a  venous leak occurs it may not be reversible.  It is important to avoid further injury to the penis in the healing phase.  The use of a good lubricant during sex such as one of the silk lubricants is suggested.  Furthermore, in your case, stop the periodic rubbing of the injured site which may delay healing.  The only explanation I can think up regarding the intermittency of your problem is that you may be re-injuring the nerves by rubbing the area.

As far as tests are concerned, there really is no specific test as this is a clinical diagnosis.  If the numbness persists more than one year, I suggest a neurologic evaluation to be sure there is no other cause.  They can do specific specialized test to evaluate nerve damage but this is beyond the scope of urologic expertise.

“Normal” penile size is a common question.  The majority of men believe they were "short-changed".   When looking down at one’s penis from above, because of the perspective, the phallus appear shorter than it’s true size.  The average flaccid penis is 3.5-4 inches long, when stretched 4.5-5 inches and erect 5-6 inches in length. The average circumference flaccid is 3.5-4 inches and when erect 4.5-5 inches.  These statistics apply to 95% of men.   Interestingly, there is no direct correlation between the size of the flaccid and erect penis.

My best advise for men is to learn how to use what you were naturally endowed with to the maximum.  There are many excellent books available on how to become a terrific lover almost regardless of penile size.  You might consider consulting a urologist if for no other reason than reassurance about your probable  normality.  If  one is truly excessively small, there are operations available to increase the size of the penis. However,  there are significant potential surgical complications.  Because of this, the American Urological Association does not recommend this type of surgery be done routinely.  It is best reserved for the most extreme cases of penile deficiency   Good  luck.

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr Goldstein,

Just a couple of more questions if that is ok. Are the dorsal nerve endings directly under the outer skin of the shaft (the bit of skin which glides) , or are they protected by another layer of skin?

You mention the issue of venous leak- I am able to get morning erections so would this rule out a venous leak in my case?

Many thanks for your help.

Answer
Michael, this is the 3rd question you have submitted on this subject which is the maximum I can take in fairness to others who might ant to consult with me.  However, I will answer your questions.

The dorsal nerves of the penis are covered by skin, a loose layer of areolar tissue (the tissue over which the skin "glides") and a stronger layer called the superficial fascia.  There are varying degrees of venous leak.  Erections may be perfectly normal with mild leaks but difficult to obtain or maintain with more severe ones.  

The penis is composed of three cylindrical bodies called corpora. The single corpus spongiosum  contains the urinary canal (urethra) and the paired corpora cavernosa are the erectile bodies.  The latter each contain an artery that supplies blood and they are surrounded by an elastic membrane.  The corpora cavernosa contain vascular spaces that have the ability to expand with the inflow of arterial blood.  The act of  having an erection is dependent on many factors.  In its most basic form, however, sexual arousal (touch, thought, dreams, etc.) stimulate the nervous system to send information to the penis.  This causes the vascular resistance in the corpora to decrease allowing arterial  blood to flow in much easier.  Simultaneously, the outer elastic membrane stretches to accommodate the increased blood in the penis and an erection occurs.  While arterial blood is flowing into the penis, the veins of the penis tend to let the blood escape back into the circulation.  Normally, the pressure inside the corpora increases to a critical level, the corpora swells and passively compresses the veins, thus shutting off the outflow temporarily.  However, abnormal venous drainage can be present either congenitally or develop spontaneously over time.  In such a case, the blood may flow out of the penis too fast during attempted erection resulting in no or only partial tumescence.  This is  called a “venous leak”.  
The venous leak can be identified by performing a penile duplex color ultrasound or by a special x-ray of the the penis called a corpous cavernosogram.  It is not unusual for symptoms from a venous leak to be intermittent.  Therefore, the presence of some normal erections does not necessarily rule out this disorder.  Conversely, the presence of ED does not mean one has a venous leak as this is only one of many causes for erectile dysfunction.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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