I am a pelvic PT. I have been seeing a male patient for a few months with primary c/o: decreased/absent pleasurable sensation of glans penis and much of shaft. We initially theorized it was a blood flow issue. He has been undergoing pelvic PT, electromagnetic wave (?) therapy, had botox injections for his severely hypertonic pfms, and is now addressing some psychological trauma that we believe has been contributing to his severely upregulated ANS. Has anyone seen this before? Pelvic and Lumbar MRI findings are normal except for a L1 hematoma (unremarkable findings in the eyes of the radiologist). bulbocavernosus reflex latency testing was moderately delayed. We believe this to be a peripheral pathology. Has anyone seen this before? Ideas? Results? Thank you all in advance!
L1 hematoma is compressing the nerve root, upregulating the ANS trying to “find”the ilioinguinal nerve and iliohypogastric nerve creating weak transverse abdominis and pelvic floor muscle spasms at the root of the penis. That’s as up-regulated of a nervous system as it’s going to get.