American Society for Peripheral Nerve

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Restoration of Sensation to the Penis in Cismen, and Clitoris in Ciswomen, Who Sustain Injury to the Dorsal Branch of the Pudendal Nerve
Kevin M. Klifto, PharmD, Johns Hopkins University School of Medicine, Baltimore, MD and A. Lee Dellon, M.D., Ph.D., Dellon Institute for Peripheral Nerve Surgery, Towson, MD; Plastic Surgery, Johns Hopkins, Baltimore, MD

Introduction: Loss of penile sensation, related to cycling or direct injury to the perineum or pelvis in cismen, and heightened clitoral sensation, related to persistent genital arousal disorder (PGAD) in ciswomen, remain clinical problems for which a surgical approach to the pudendal nerve may offer relief. The purpose of this report is to review our experience with recovery of sensation in cismen and ciswomen after decompression of the dorsal branch of the pudendal nerve.

Materials & Methods: Retrospective chart review from 2014 through 2018, included cismen and ciswomen who had decompression of dorsal branch of pudendal nerve. Patients were included if over the age of 18, had loss of penile sensation, or a painful penis, or PGAD in women. Comparisons between pre-operative and post-operative groups were performed. Primary outcome measures for cismen were patient reported changes in penile symptoms (erection, ejaculation, ejaculatory pain, erogenous sensation, numbness, pain) and for ciswomen were resolution of PGAD symptoms (arousal and pain). Complete relief (CR) was defined as a resolution of penile or PGAD symptoms.

Results: Eight cismen and 8 ciswomen were included in the study (n=16), with a mean age of 45±15 years and follow-up of 63±38 weeks. Of the 8 cismen included, 6 (75%) had surgery bilaterally.

Of 7 cismen with loss of penile sensation, complete recovery of erogenous sensibility occurred in 6/7 (86%). Of 3 cismen who had erectile dysfunction, normal erections were restored in 2/3 (67%). Of 2 cismen unable to ejaculate, 1/2 (50%) regained ejaculatory function. Of 5 cismen with ejaculatory pain, CR of pain occurred in 3/5 (60%). Of 6 cismen with penile pain, CR of pain occurred in 3/6 (50%). Of 4 cismen with numbness, 1/4 (25%) had a complete return of feeling.

Of 8 ciswomen included, 7 (88%) had surgery bilaterally with CR of arousal symptoms, and 1 (12%) surgery unilaterally with PR of symptoms. Of 7 ciswomen that had pain, 6/7 (86%) had CR after bilateral surgery, and 1/7 (14%) had partial relief (PR) following unilateral surgery. Of 6 ciswomen unable to perform intercourse without pain, 5/6 (83%) were able to perform intercourse without pain after surgery.

Conclusion: In both cismen and ciswomen sustaining an injury along the inferior pubic ramus, neurolysis of the dorsal nerve to the penis/clitoris has the potential to relieve pain and restore sensation.

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