Workup for Numbness During Ejaculation
The appropriate workup for a patient experiencing numbness during ejaculation should include a detailed sexual history, medication review, and physical examination focusing on neurological assessment of the genital region, as this symptom may indicate either a side effect of topical anesthetics or an underlying neurological condition.
Initial Assessment
Sexual History
- Determine if numbness is present only during ejaculation or also affects other aspects of sexual function
- Assess timing of symptom onset and relationship to specific activities or medications
- Evaluate for concurrent erectile dysfunction, as ED should be treated first before addressing ejaculatory issues 1
- Determine if the numbness is causing distress to the patient or partner
- Assess for relationship to specific partners or sexual practices
Medication Review
- Identify use of topical anesthetics (lidocaine/prilocaine) which commonly cause penile numbness when used for premature ejaculation 1
- Review current medications, particularly:
- Antidepressants (especially SSRIs)
- Antipsychotics
- Antihypertensives
- Alpha-blockers
Physical Examination
- Focused neurological examination of genital region and lower extremities
- Assessment of penile sensation (light touch, pinprick)
- Digital rectal examination to assess prostate and pudendal nerve sensitivity
- Evaluation of pelvic floor muscle tone
Differential Diagnosis
Medication-induced numbness
Neurological conditions
Psychological factors
- Anxiety or heightened focus on performance
- Relationship issues affecting sexual experience
Diagnostic Testing
First-line Testing
- Basic metabolic panel and HbA1c to screen for diabetes
- Morning testosterone level as recommended by AUA guidelines 1
- Consider lipid profile to assess for vascular disease risk factors
Second-line Testing (if indicated)
- Pudendal nerve conduction studies if pudendal neuropathy is suspected
- MRI of lumbosacral spine if neurological symptoms suggest spinal pathology
- Referral for specialized neurological testing if peripheral neuropathy is suspected
Management Approach
If Related to Topical Anesthetic Use
- Adjust application time to 20 minutes maximum 2
- Ensure thorough washing of residual anesthetic before intercourse 1
- Consider alternative formulations (spray vs. cream) that may provide better control 5
- Reduce concentration or amount of anesthetic used
If Related to Neurological Issues
- For pudendal nerve entrapment, consider pudendal nerve block as diagnostic and therapeutic intervention 3
- Address underlying conditions (diabetes control, alcohol cessation if relevant)
- Consider referral to neurologist or urologist with expertise in sexual medicine
If No Clear Physical Cause
- Consider referral to a mental health professional with expertise in sexual health 1
- Explore behavioral interventions to enhance arousal and sexual satisfaction 1, 6
- Discuss modification of sexual positions or practices to increase arousal 1
Important Considerations
- Numbness during ejaculation may significantly impact quality of life and sexual satisfaction
- If concurrent erectile dysfunction exists, this should be addressed first before focusing on ejaculatory issues 1
- Partner involvement in the evaluation and treatment process may improve outcomes 1
- Shared decision-making is fundamental in managing disorders of ejaculation 1
Common Pitfalls to Avoid
- Failing to thoroughly wash off topical anesthetics before intercourse, which can cause numbness in the partner 1
- Overlooking the psychological impact of ejaculatory disorders on the patient and relationship
- Missing pudendal nerve entrapment as a potentially curable cause of ejaculatory dysfunction 3
- Neglecting to assess for medication side effects as a common cause of sexual dysfunction