REDUCED PENILE SENSITIVITY (RPS):
Reduced Penile Sensitivity (RPS) refers to the condition of decreased sensation in the penis during sexual activity. Subjects with RPS report difficulty in stimulating the penis, maintaining erection, and/or achieving orgasm. The duration of intercourse is typically prolonged due to delayed orgasm. Additionally, inability to achieve orgasm, regardless of whether or not an erection is maintained, may result in negative personal consequences, such as distress, frustration, relationship problems, and the avoidance of sexual intimacy. Normal ejaculation is quantified and diagnosed by the time it takes a man to ejaculate from penetrating the vagina. Normal men will ejaculate between 4-8min following penetration of the vagina. Loss of sensation in the penis will cause men to ejaculate longer then 15min and it may take them up to 30min and some will not even ejaculate.
PREVELANCE OF RPS:
The prevalence of RPS is estimated to be over 500 million patients on a worldwide basis.
CAUSES OF RPS:
RPS is commonly associated with:
- Hernia Surgery and Nerve Entrapment
- Multiple Sclerosis
- Peripheral Neuropathy
- Use of Certain Prescription Medicine
Diabetic neuropathy is a complication of diabetes in which nerves are damaged due to long-term high levels of blood sugar or hyperglycemia. Diabetic neuropathy can affect many parts of the body including the legs, feet, bladder, heart, gastrointestinal system, and reproductive system including the penis. 50% of all diabetic patients have or will develop neuropathy (~200 million patients worldwide)
Ilioinguina & Pudendal Nerve entrapment: Nerve entrapment is the result of a variety of nerve entrapment syndromes. Nerve entrapment occurs when a nerve entrapment syndrome causes a nerve or nerves to become pinched or compressed. Nerve entrapment results in abnormal functioning of the nerve. Typical symptoms of nerve entrapment include numbness, pain, and loss of function of the affected area. The function of the nerves of the body is to transmit sensations and other information from the body to the spinal cord and brain and carry messages back from the brain to the body. There are a variety of conditions that can cause nerve entrapment and interfere with normal functioning of nerves. Common conditions that cause nerve entrapment include carpal tunnel syndrome and ulnar tunnel syndrome, which affect the forearm, wrists and hands. Pudendal nerve entrapment causes nerve entrapment in the pelvis, and affects that urinary system and reproductive system. Slipped disc, herniated disc, spinal stenosis, and spondylolisthesis can cause nerve entrapment in the spine. Most of the nerve entrapment cases are a result of hernia surgery mainly. There are over 20 million hernia surgeries a year and most are men. An estimate 15 million men undergo hernia surgery a year.
Multiple sclerosis commonly called MS, attacks the central nervous system and can cause significant nerve damage. The progression and severity of the disease varies greatly between individuals and it can result in a wide variety of effects, from mild to severe and disabling. These include muscle weakness, loss of balance, inability to walk, and paralysis. The causes of multiple sclerosis are not well understood. Researchers believe that the body's immune system begins to attack its own nervous system, specifically the myelin, a fatty material that covers and insulates the nerve cells in the central nervous system. Healthy myelin is vital to the normal, rapid movement of electrical impulses through the nerve pathways. In multiple sclerosis, patches of myelin in the brain and spinal cord become inflamed, swell, and develop lesions. Myelin and nerve cells become damaged, which wreak havoc with the normal transmission of electrical impulses. It is believed that this process may be triggered by a combination of genetic factors and environmental elements, such as exposure to a virus or some infections. Symptoms of multiple sclerosis can vary greatly between individuals. In the early stages of the disease, symptoms come and go, and people with multiple sclerosis can experience periods of remission, in which symptoms disappear and periods of relapse, in which symptoms reappear. Symptoms may worsen during relapses and complications can include seizures, changes in mentation, muscle spasms, and depression. Symptoms generally first appear between the ages of 20 and 40 years. Most often, the first symptom is visual changes. ~40% of all MS patients develop neuropathy (Martinelli Boneschi F et al. Mult. Scler. 2008 May;14(4):514-21) (~1 million patient worldwide)
Peripheral Neuropathy :
Peripheral neuropathy is an abnormal condition in which the peripheral nerves are damaged. The peripheral nerves spread out from the brain and spinal cord, and peripheral neuropathy results in unusual or abnormal sensations of the extremities including the penis. Peripheral neuropathy is a common condition and can result from certain metabolic disorders, infections, malignancy, inflammation, vitamin deficiencies, toxins, inherited conditions, and other abnormal processes. A very common cause of peripheral neuropathy is diabetes. Other causes of peripheral neuropathy include alcoholism, vasculitis, vitamin B deficiency, vitamin E deficiency, chemotherapy, and exposure to certain toxins, such as insecticides, lead, mercury, and arsenic. Peripheral neuropathy generally develops slowly over a period of months. Symptoms of peripheral neuropathy include a sensation of pain, numbness, tingling, or prickling that begins in the feet. In later stages of peripheral neuropathy, the hands can be affected as well.
Prescription Medicine causing RPS:
Several drugs have been associated with reduced penile sensitivity. The most described and reported cases are associated with the use of monoamine oxidase (MOA) inhibitors for the treatment of Parkinson disease such as Selegiline (Carbex Eldepryl, L-Deprenul ). Over 2% of patients using MOA report penile sensitivity.
With aging skin will become thicker due to friction and other physical contact. Thickening of the skin results from an increase in keratin production, which reduces sensation. Studies have shown that the rigidity of the erection and the ability to ejaculate decreases significantly with age. As shown in the figure below.
Circumcision is the surgical removal of the foreskin (prepuce) from the human penis. In circumcised men, the glans of the penis is continuously exposed leading to excessive keratinization and decreased sexual stimulation. Neuropathy associated with diabetes may also account for a higher incidence of RPS in diabetic populations. Circumcision is a practice having diverse medical, socio-cultural, and religious roots, with broad, though highly differential distribution around the globe. The prevalence of circumcision is highest in the United States, Canada, Australia, Middle East, Philippines, Indonesia, South Korea and East Africa. Rates in other regions are much lower. Recent research indicates that while circumcision reduces the transmission of STDs (per American Academy of Pediatrics 2012 guideline), RPS may occur as an unintended side effect in a mans later life. Although the studies are not conclusive, they suggest that penile sensitivity in the glans may be significantly impaired in men who have been circumcised as compared to uncircumcised men1 [footnote below:1Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T'sjoen G, Vlietinck R, Hoebeke PB. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int. 2013 Feb 4)] Reduced sensation in this area is caused by two factors. First, surgical removal of the foreskin may damage the nerve tissue around the crown and glans of the penis. Second, the exposed skin is subject to constant friction, which leads to toughening of the outer dermal tissue (stratum corneum). Urologists report that it is common for circumcised patients to experience diminished feelings of sensation and sexual satisfaction.