From the Guidelines
Penile pain can be associated with spinal levels S2-S4, which provide sensory and motor innervation to the genital region, and damage or compression at these levels can cause pain, numbness, or other sensory disturbances in the penis. According to the study by Fairbank et al 1, the most common cause of cauda equina syndrome (CES), which can lead to penile pain, is lumbar disc herniation at the L4-L5 and L5-S1 levels. The sacral nerve roots, specifically S2-S4, form the pudendal nerve, which is the main nerve supplying the penis.
Some key points to consider:
- The pudendal nerve, formed by the sacral nerve roots S2-S4, is responsible for the sensory and motor innervation of the genital region, including the penis.
- Damage or compression at the spinal levels S2-S4, such as from a herniated disc or spinal stenosis, can cause penile pain, numbness, or other sensory disturbances.
- The lower lumbar segments, particularly L4-L5, may also contribute to penile sensation and could be implicated in some cases of referred pain, as discussed in the context of cauda equina syndrome 1.
- Problems at the T10-L2 levels might also cause penis pain through sympathetic nervous system pathways, although this is less directly related to the specific spinal levels associated with penile pain.
It is essential to note that if penile pain is accompanied by neurological symptoms like weakness, bowel or bladder dysfunction, or pain radiating down the legs, immediate medical attention is necessary, as this could indicate a serious spinal condition requiring prompt treatment, such as cauda equina syndrome 1.
From the Research
Spinal Level and Penile Pain
- Penile pain can be associated with various spinal levels, particularly those involving the pudendal nerve, which is responsible for sensation in the genital area.
- The pudendal nerve originates from the S2, S3, and S4 sacral nerve roots 2.
- Studies have shown that Tarlov cysts, which can cause chronic lumbosacral and pelvic pain, are often located in the distribution of the pudendal nerve origin at the S2, S3, and S4 sacral nerve roots 2.
- The bulbocavernosus reflex (BCR), which is mediated through the pudendal nerve, can help determine the integrity of the S2-S4 spinal reflex arcs and distinguish between upper and lower motor neuron lesions 3.
- In patients with low spinal cord lesions, the remaining function of the dorsal nerve of the penis can play a role in restoring penis sensation, and the BCR can be used to select patients for a unilateral or bilateral TOMAX procedure 4.
- While the provided studies do not specifically mention the spinal level at which penile pain might occur, they suggest that the S2, S3, and S4 sacral nerve roots are involved in the transmission of sensation to the genital area, and therefore, penile pain might occur at these spinal levels 5, 2, 3, 4.