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Sexual Dysfunction with Lower Back Pain?

Hello. One month ago I hurt myself helping a friend move, and the MRI (thankfully) showed that there were only minor protrusion at L4-L5 and L5-S1 that two spine specialists said were nothing serious. However, ever since the injury I slowly began to realize that, while the pain wasn't that severe (some radiculopathy in the right leg that recently switched to the left, but seems to be getting slowly better), I hadn't been waking up with morning erections. Now, I can still get erections and ejaculate; I have a history of psychologically-induced ED when I'm in the sack, but it usually clears up once we get into it. In addition to the lack of morning erections, there seems to be some reduced sensitivity/sensation down there as well; it feels as if someone took my "genital sensitivity dial" and turned it from a 10 to a 6 or 7. My first thought was cauda equina syndrome (CES), but my physiatrist said that the lumbar MRI i took looked fine, and I wasn't at risk; the other spine surgeon looked at the MRI and said I'd be fine with physical therapy and perhaps some injections later on (although I didn't bring up CES with him). In light of all of this, I have a few questions that I'd appreciate some insight into if at all possible:

1) Can it they be missing cauda equina syndrome? My bowels and bladder are fine, I don't have the saddle loss of sensation, nor do I seem to have any other of the classic symptoms except the lack of morning wood and the reduced penis sensitivity/sensation. What, then, could be causing it? Just nerve irritation from L4-L5/L5-S1?
2) Could it be an issue with my sacrum? I know the cauda equina extends below L5 into all of the S points; my MRI was, if I'm not mistaken, only in the lower back. Is it possible that there's CES in the sacrum where the MRI didn't scan, or something else affecting the sacral plexus?
3) I also noticed last week (three weeks into the injury) that my left foot that went without pain began to tingle infrequently, but it wasn't too severe. However, yesterday, I started feeling pain in my left leg and left side of my lower back, with my right feeling MUCH better. It feels as if the radiculopathy has actually left my right leg and went to my left. While the pain last night was uncomfortable, it seems to have gotten better. Can that be a sign of something more serious?

Again, since the injury began to heal, all of the pain associated with it has never been severe; it's always been irritating and uncomfortable but nothing requiring any pain meds. There has never been any numbness or loss of motor control. I'll sometimes feel pain with the radiculopathy that will induce a feeling of being squeezed in my leg, but never enough to make my legs weak or buckle. The only place there seems to have been a reduction in sensitivity has been the groin, but again, I'm perfectly capable of achieving an erection and ejaculating, it just feels less sensitive and somewhat less pleasurable.

I know this was an information overload, but if anyone can address any of these concerns I'd be extraordinarily grateful. Thanks!


  • sensitivity in the genital area. It is not just the Cauda Equina that can cause issues , it is also the nerve roots , and compression or inflammation can cause the problems you are experiencing. It would be wise to talk to your surgeon regarding the less sensitivity and failure to obtain an erection , if the lack of it is something different than your normally experience. Believe me, they have heard it all so it won't come as a surprise to them.
  • following fusion .its common in men due to the nerves being damaged during certain surgery and is permanent you can take drug to correct this but it's just the drug doing what should come naturally .I did not bother as the level of pain I am in all the time prevents me from even thinking about sex .I watched a youtube video about this topic very interesting ..if you are worried see your consultant
  • At one time I did experience an issue with my sacrum and though I had none (that I could tell) of the other symptoms I did for a while loose control of my bladder. Several treatments, injections/adjustments/PT/etc later I am left with a severe herniation at L4-5. Very much like you I have no saddle numbness or the other typical symptoms, not even bladder control issues at least not anymore. But I do have pain in the same areas you've described and like you it seems someone turned down the sensitivity dial. At first I thought the lack of interest was due to the pain it caused, I am female so the movement/position is somewhat different. Then after a great deal of my pain was relieved and this particular issue did not resolve I had a talk with my surgeon. According to her, at least as I understood it, the herniation at L4-5 could be causing that and should resolve once the nerves are no longer compressed. Sex is somewhat difficult and frustrating but still possible and no longer causes me pain and it seems until I am done with my treatment program, thats about as good as its going to get. Dont be shy about talking to your surgeon about this, mine being female as well totally understood what I was trying to explain to her and not only explained it to me but recommended some pillow placement changes and "online purchases." Although not as much as I would like, I have noticed some rather pleasant improvement.
  • so this is something he needs to discuss with his doctors and make them aware of, the sooner the better. If these symptoms appeared post op, it is also something that he needs to discuss with his doctor. It is not an expected normal result, although it can happen to some patients post op.
  • ChappsCChapps Los AngelesPosts: 11
    edited 09/19/2015 - 12:13 PM
    Yeah, anyone who has lumbar or other spinal surgery has to remember that the nerves will almost certainly be damaged afterwards. At the low end, the nerve roots can simply be irritated, due to handling during the surgical process, and after surgery these same nerves can continue to be irritated due to inflammation. At the high end, the nerve roots can have permanent damage, either due to issues that occurred before or during surgery. Many of us get a combination of these two types of nerve issues, or something in between.

    In my case, my L4-L5 microdiscectomy left a large portion of my left lower leg and foot numb, with continued sciatica. After that surgery, I had two more in rapid succession, due to a staph infection from the first surgery. Three months later, after finally ending all antibiotic therapy, I was back in the hospital for an emergency fusion, since the staph had come back and literally dissolved my disc.

    But there was one silver lining to this horribly dark cloud - something got corrected that I didn't even know was related to my spine. Ten years ago, almost overnight I lost the majority of my ejaculatory power. Frankly, I used to have a far above average volume and power behind my ejactulations, so when that almost completely ended, I was devastated. I had initially blamed some medication that I had been taking at that time. Imagine my shock when - due to my surgeon's urging - my old ejaculatory power had returned after the first of my recent surgeries. My surgeon wanted to see if everything was 'OK' in that respect after surgery, and I was overjoyed to report this unexpected fix. He thought that I had sustained spinal pressure in the L4-L5 and L5-S1 areas, starting a decade ago. Not surprising, since I have ankylosing spondylitis, an autoimmune arthritis which attacks and frequently wreaks havoc on the spine and SI joints (and can cause damage to the organs, including the heart and eyes - and even spread to the other joints in the body, as is the case with me). Perhaps the disc had bulged out and I hadn't been aware, since no MRI or CT scans were performed.

    Shockingly, this fix to my ejaculation has remained even through all four surgeries. It's certainly a nice bonus, but I'd honestly trade it for a clean, staph-free spine and the promise of no more surgeries. In most cases, I tell people to avoid spinal surgery unless there are no other options for a serious condition. I have kept to that mantra, but I did recommend that a friend speak to a surgeon after he confessed to an identical issue. At the very least, I told him to get scans done and have a surgeon look at them - and see if a steroid epidural could help. I wish I had been able to take that route. Good luck with your ED/ejaculation issues - hang in there!
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