Genital Numbness

On March 10, 2011, in News, by JonHyman

About 20-25 % of patients( 1 out of every 4 or 5 patients) seem to experience some transient numbness in the genital / perineal area after hip arthroscopy. Patients are sometimes not even aware of this but if they are aware of it, it can be surprising or worrisome.

We have seen this many times and educate patients before hand about the possibility of having some limited decrease in sensation around the genitals after surgery. This numbness may last for a few minutes, hours, or days. It rarely lasts more than a few days but there are a

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few cases that have lasted a few weeks. We are not aware of any instances in which it did not resolve fully.

Females seem to be more affected than males. It is very important for all patients, that they are well padded during surgery,

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to protect the genital region, both for privacy and safety. If you have any issues that you think need special consideration in that area: numbness when on a bike seat, erectile dysfunction, impotence, menstruation, etc, be sure to let your doctor know before your procedure.

 

32 Responses to Genital Numbness

  1. darrell says:

    i had hip surgery on march 7th and i am still numb in my penis and scrotum area. I would like to know is this normal or should i be seriously concerned?

    • JonHyman says:

      Darrell,
      Thank you for your inquiry. You should be concerned to the extent that its worth having a conversation about it with your surgeon. There are a variety of causes of numbness in this setting and one cannot just assume that it is due to positioning. While that may be the most likely cause, you and your doctor need to have a frank conversation about this. Such numbness generally resolves after properly performed hip arthroscopy, and I am very hopeful that your numbness will go away as well. That said, please have an open conversation with your physician about this if you have not already done so.

      Dr. Hyman

  2. Hip says:

    I am two weeks out from hip arthoscopy with numbness in the penis. It has improved but it is still not right. I remain very anxious about this. Nocturnal erections have returned but not like what I would normally follow to the bathroom in the middle of the night. It now seems to be mostly the front and the end. I spoke to my surgeon and a urologist who thought it may be 1 – 3 months but should pass. There is a good bit of talk about this out there but no real good data collection. One study on femoral nailing that followed patients. My fear is that this is under reported and there are a number of guys out there whos lives have been changed. There was another blog with a guy who is 2 years out!

    • JonHyman says:

      Thanks for your comment. We have not had that experience in our male patients. Numbness has been extremely infrequent and to our knowledge has resolved in all cases. We remain hopeful for you. Please let us know if your circumstances do not improve so that we may further educate ourselves and our patients.

  3. Hip says:

    20 – 25 % and extremely infrequent seem to be contradictory statements?

    • JonHyman says:

      Genital numbness is extremely infrequent in males and significantly more common of an occurrence in females.

  4. Hip says:

    This is a followup to the March 25 posting. I am now over 6 weeks out from hip arthroscopy. The genital numbness has resolved and everything is back to normal! It was very close to normal but still not 100% at 5 weeks. During the 6th week it seems that the residual numbness slowly faded away. For about one month I had an aching sensation around my left ischial tuberosity. I assume this might be the area that was crushed by the peroneal post. I am so happy to be putting this behind me as it was a very difficult and anxious time. I would reach a plateau point in recovery of sensation and worry that it was not going to resolve beyond that. I hope this helps others who experience this. As part of my PT protocol I coped with the stationary bike portion by standing on a block of wood with my left leg and clipping my right (operative) foot into the left pedal of my stationary bike so that I would not spend any time on my perineum. I now have something called a BiSaddle mounted to the trainer that I purchased online. A very adjustable bike saddle so you can have a custom fit. It was utilized in a very unique study on NYC bike cops. Good luck all !

  5. Jamie says:

    I also experienced genital numbness which I would describe as severe. My symptoms were 100 percent resolved around the 6 week period.

  6. Shelley says:

    I just had surgery yesterday 9/26/11. When I used the ladies room after surgery, I noticed the numbness instantly. Today, it is still numb; NO SENSATION at all! This is my second Arthoscopy to this hip and the first one went without a single problem. Having loss of sensation in that area surely doesn’t help with the love life. I think it’s especially bad for a female. I don’t mean to minimize what a male might go through, but it’s a whole lot different with a female. Is there anything I can do to speed up the return of any sensation I might regain?

    • JonHyman says:

      Sorry to hear of your symptoms, but they are actually fairly common…and fortunately, temporary. Intimacy soon after surgery may be a bad idea for several reasons. Discuss this with your physician if you have concerns. Numbness can last from minutes to a few weeks, and the recovery of normal sensation internally happens a lot faster than externally, from what we’ve heard. Patients report that their sensation comes back to normal in essentially all cases we’ve encountered, but the rate of return is multifactorial.

  7. John says:

    I had hip arthroscopy surgery on 10/07/11. Afterward in recovery I had to
    have a cath to remove the urine. That eve my penis was darkish blue on the head. Controled urination took several days with some leaking. This is now normal but I still dont always feel my urination today, 10/24/11, I still have very little sensation in the penis shaft and head (17 days).
    I used a 1/2 tablet of Viagra after 15 days . Erection was fine but sensation low and was so painful on the head upon entry into my wifes vagina. I could not
    do it for 2 seconds.

    My penis feels deflated or less full in it’s non-erect status. Could my blood vessels
    also be bruised ?

    My doctor told me the sensation aspect may take about 12 weeks and he has never had one case not regain fully. Please any comments will help

    • JonHyman says:

      Consider consulting a urologist. Sensation changes are not uncommon, but changes in color and urinary dysfunction are fairly uncommon. Sensory changes come from nerve compression. Skin color changes often come from abnormal blood flow/perfusion. Likely this is all related to traction/compression during the case. Hopefully it was not too long. Sensation often does come back to normal. Certainly that’s what we’ve seen, but every case is different and needs to be assessed carefully. There may be other factors causing dysfunction: diet, stress, medications, medical issues, anatomy, etc, and its worth getting checked out. Hopefully its all back to normal now!

  8. Michelle says:

    I am 7 days post op from by hip arthroscopy for FAI. My clitoris is comletely numb. Having had a hysterectomy 2 months ago and coming through with all “working” parts this is very upsetting. When I discussed this with my physician yesterday he said it was common and more or less blew me off – then why didn’t he inform me before the surgery? What causes the numbness, is it nerve damage?

    • JonHyman says:

      Not sure why he didn’t inform you. Maybe he forgot, or hasn’t really seen as a problem or patients haven’t felt comfortable letting him known when they have had this issue. It is a known risk and not an uncommon one. When it happens, it is essentially always temporary in a properly done hip scope, and resolves usually within hours or days. Sometimes it does last a few weeks, getting better slowly. The numbness is from compression to the nerves in that area, generally. It has been reported that some women have had numbness from swelling from small cuts in the labia or clitoral area, but that is rare and should also heal. Please let your doctor know your concerns and also let them know how long it takes to resolve. That will help them better educate future patients and set better expectations pre-operatively. Sorry you had to be surprised and understandably concerned about it.

  9. Julia says:

    Hi,
    I’m 19 & had the hip arthroscopy done on May 23…7 days ago. When I came out of recovery my gentals were swollen & numb… The nurse said it could be positioning or/and the numbing meds they shot into the nerve system the goes down the leg/hip that was getting worked on. The swelling has left but feeling is still no where to be found. KINDA worried.

    • JonHyman says:

      Sorry for your anxiety Julia. Definitely worth letting your surgeon know. Feedback from patients is often how we are able to educate and advise patients about how long it takes for things to resolve…..b/c patients tell us what they are feeling and when it goes away. The good news is that your sensation will likely fully recover, and soon.

  10. Karen says:

    I had right hip arthroscopy for labral refixation and FAI, cam and pincer impingement on January 12th 2012. Today is June 7th and I still have ZERO sensation during intercourse, next to no sensation to the clitoris and zero orgasms since surgery. I also have numbness and decrease sensation to the right medial and posterior thigh. I was sent to neurology who said I had no problems. I went to my GYN who did a FULL exam and found (as I complained about it) almost complete lost of sensation to the point he could put a Kelly Clamp at the vaginal orifice on the right and I felt nothing! I am currently waiting for an upcoming appointment with a second neurologist…. Is this nerve trauma generally due to the traction applied during surgery? I also has 2 nerve blocks done in PACU and wonder if they could also cause injury? To be honest, I would have prefered to live the rest of my life with the hip pain rather then never feeling sex again. My surgeon states he has never had a patient who’s symptoms did not resolve after 2-3 weeks. Well it’s been 5 months and I am still waiting. Has any surgeons ever reported accidently cutting or impinging the nerves?

    • JonHyman says:

      Sorry for the delay. Your comment went into spam b/c it had a facebook.com website listed. Your symptoms are quite troubling for sure. Sorry to hear of your difficulty. There are anectodal reports of women experiencing such problems, as doctors have occasionally discussed in meetings/conferences…but I’m not aware of any published report of this particular problem. Numbness in the genital area is actually fairly common, and probably occurs more than patients report and more than doctors are aware. It is almost always temporary and resolves in a few days, or a few weeks at most. I have heard of a couple of cases lasting beyond a month, but never longer than that. Even those long cases eventually resolved and got fully restored to normal. I am not aware of numbness inside the introitus or vagina and could not tell you anatomically why that would be so. Nerves would not likely be cut or impinged upon during surgery. It may be pudendal neuralgia.

      I am very concerned about you, but I can’t envision your problem not resolving. I understand your fears about the future. I would ask the gynecologist/neurologist what nerves supply sensation inside the vagina and whether or not they think those nerves can be tested for recovery. Many cities have physical therapists who specialize in female pelvic floor problems, dyspareunia (painful intercourse), nerve disturbances etc. Seeing such a therapist might be of value. Of course I cannot give you medical advice through this medium, and I’m not, but I can tell you what considerations I might have if I was facing this situation.

      Melissa Kubic, PT is one such therapist, as an example: here’s a link you may find useful: http://www.pelvicpainrehab.com/professional_resources/publications_media/Vision_PN_1.pdf

      • Karen says:

        Thank you for the reply. I will keep you posted after I see neurology on June 21st. I guess one up side is there is no pain. Occasional tingling sensation but no pain.

  11. Karen says:

    Just a quick up-date. I sought a second neuro opinion last week. He feels because of the extent of the area of decrease sensation that more then just the pudendal nerve is involved. He is leaning more towards an injury to the lumbar plexus related to the nerve block. I am scheduled for a MRI this week and hoepfully this will provide some answers. Solutions would be nice but we are not holding our breath. Almost 6 months post-op with zero return of sensation does not provide a very good prognosis.

    • JonHyman says:

      Thank you so much for the update. Hope your MRI yields and answer and possible solution. Zero return of sensation does bode poorly, but maybe there is some minor nerve recovery that is going on undetected. Anyway, that stinks, but we are still hopeful for you. Good job on getting another opinion and thanks again for sharing your experience.

  12. Karen says:

    Well as expected the MRI was completely normal…. After reviewing anesthesia records, I received a fascia iliaca compartment block in PACU for pain control. This block effects the lumbar plexus which seems to be the source of my nerve involvement. I’ve been told peripheral nerves do regenerate, over time…. So I could be looking at months to years before a full recovery may be acheived. My surgeon is going to speak to anesthesia this week to see if they have any input….

    • JonHyman says:

      Thank you. It would be very interesting to hear what anesthesia has to say about it. I’d also be curious to know which anesthetic they used: ie 1% Lidocaine, 0.25% or 0.5% Bupivicaine, Ropivicaine, etc. Some are longer lasting and may have had a deeper effect on the nerves.

  13. Charles Beuttel says:

    I am a 32 year old male who had hip arthroscopy of the left hip 8/3/12, for Cam impingement, I believe. I woke up with immediate and complete genital numbness that scares me like nothing else. I KNEW beforehand that I had alot of nerve (pain) involvement of the genital region so I told the doctor to do an open incision if it would spare my nerves any trouble. He said he had done 3500 surgeries without having a case of a “stretched” nerve.

    I am SO glad I declined the offer of a nerve block- doctor tries to put a needle near your nerves and push chemicals at it- just sounds terrible/dangerous to me.

    I suspect my nerve damage is caused by compression of the pudental nerve around the obturator muscle/ischial tuberosity during the “traction” where the hip joint is pulled out of socket. Icing that area can help (wish I had known to ice it earlier, was more worried about the hip)

    My question for the Doctor is this, what would you ask of your physician if you had to have your right hip done next, to prevent this pudental nerve damage? Ice the area before and after surgery? More pads for the pole used for traction (still cant visualize this part in my mind)? Request a different angle for traction?

    To Karen I would say look at supplements that improve nerve regeneration while you wait on your neurologist. Acetyl L carnitine (2grams), Lipoic Acid (200mg with food), methyl B 12 via injection or under the tongue (~2mgs), B vitamin complex, benfotiamine (form of thiamine, 200mgs), methyl folate (800mcg), lithium orotate (390mg or 14.4mg elemental lithium), green tea, vitamin c, beta carotene, natural vitamin E, zinc, Dhea, pregenolone, resveratrol, gingo biloba all have research result articles related to documented nerve repair and promoting regeneration.

    • JonHyman says:

      The pudendal nerves can be compressed with traction. They should recover in 7-21 days, and only rarely take longer. Even then, they should still recover. For the next hip, just make the surgeon aware of it and remind him/her to be focused on keeping your traction time as short as possible. There really isn’t a good way to do it without traction on that nerve…other than in some countries people use an external fixator frame in the pelvis and femur, but that isn’t commonplace. Other surgeons use an inflatable bubble in the hip, to keep traction, but that isn’t commonplace either. Short answer, even using more padding on the pole or changing the angle of traction can’t totally avoid it. It’s mainly about pressure and time. Use extra padding if possible, but don’t expect it to make a huge difference. Alternatively, you could try doing the surgery in a lateral decubitus position (on your side) as opposed to supine (on your back)…but you might have to change surgeons, as most of us only do it one way or the other.

      • Charles Beuttel says:

        I appreciate you giving me some technical details. For some reason most people are scared of asking their Doctors technical questions and when I ask technical questions it often makes people (like nurses) angry.

        Of those methods you listed, external fixator frame, or inflatable bubble in the hip, is one of them considered “the best” or at least better than “regular” traction? Do they have better success rates with less complications, like pudental numbness?

        Also, are there long term considerations, like scar tissue buildup, from the pudental nerve compression? Since I got pudental compression from the 8/3/12 surgery, will doing the right hip the same way increase the chance of permanent injury? On that note (pudental injury) how long should I wait between surgeries?

        • JonHyman says:

          Success rates/complication rates by technique are not published. A urologist would be the person to give you more guidance about pudendal nerve problems and recovery.

  14. Dan says:

    I had hip arthriscope October 29 and penis still has very little feeling (24 days down). Will keep you all posted.

  15. Jean-Pierre says:

    I had a penis fracture and and my urologist did a Chordee repair 3 weeks ago and he cut in the the same place where I had my circumcision. I get erections like before and the penis is now straight but the glans is completely numb and I feel no sexual stimulation. Is this normal and when can I expect for the numbness to pass. I cannot recall having any numbness when I had my circumcision so i am rather concerned,

  16. Tim says:

    I too had arthroscopic hip surgery 3 weeks ago. Still no full feelings in mid to upper penis. Can still get erections, but they don’t last due to a lack of stimulation! From what I have learned online, the average recovery time is 2-3 months in some cases! It seems like there is a bit of improvement every week. But not much to “write home about”. Lol. Anyway, just trying to stay positive! What else can you do, right?!

  17. jassimran says:

    hi sir

    i am 25 years old,And i have done a circumcission two months ago and still i m facing a numbness in my penis my doctor he is a urologist says everything is ok but i m still facing a numbness my work is a sitting job.if you have any solutions to this please let me know sir.

    thanks

  18. jasonlouis says:

    Greetings to you,
    Just wanted to let you know that even they do not say it this is pretty common after this surgery. Don’t be afraid and waste time going crazy because it will get better. this usually lasts 2-4 months, I am beginning to feel much better now.
    Good luck and there is light at the end of the tunnel.

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