Pudendal Neuropathy and Propecia
I read on one post that Propecia caused someone to have pudendal neuropathy which caused both sensory and motor dysfunction in the genital tissues. Is this a Post-Finasteride-Syndrome? Is pudendal neuropathy a side effect?
The term “neuropathy” means damage to a nerve… so “pudendal neuropathy” is damage to the pudendal nerve. I cannot imagine how Propecia can cause damage to this specific nerve. Damage to the nerve is usually from mechanical injury (bike riding, falling on your buttocks, etc) or inflammatory issues (infection) or chronic medical conditions that damage your nerve, such as diabetes or multiple sclerosis. Propecia is a drug that that partially blocks the conversion of testosterone to DHT. If someone is going to claim that there is some special DHT relationship to a pudendal nerve, we might as well be blaming Propecia for our economy or the color of the sky.
Stating that a drug (Propecia) caused a neuropathy to the pudendal nerve is questionable, because there is no difference in the pudendal nerve to a nerve that innervates your thumb. The pudendal nerve is one of many nerves in your pelvic area (for both men and women) and one segment of it innervates your penis or clitoris. I believe many readers may have heard of sciatica when doctors refer to certain back pain caused by the sciatic nerve. The pudendal nerve is a distal branch of a sciatic nerve. Patients with back problems or pelvic area problems/trauma/tumor/etc can have pudendal nerve issues. Pudendal nerve damage can cause erection problems, but it will also cause perineal numbness or pain (see here).
If there is an erection issue, the most simple test is a nocturnal penile tumescence (NPT) test. Imagine a roll of stamps wrapped around a flaccid penis and taped. If you get an erection, the stamps will stretch and break at the perforations. I assume there are better devices out there and better tests, but this test can sometimes be a good starting point to help delineate if erectile issues are psychological or physical. Normally, men will have involuntary erections during sleep (aka “morning wood”). It would be interesting to see if the 70 or so men that reported permanent erection problems can achieve nocturnal (involuntary) erections and if they ever underwent these tests, But from my reading I believe the erection issues were self-reported and no subjective testing was performed.
In matters of medical health, the Internet is not a place to self diagnose medical conditions or become armchair physicians. But alas, it is what many readers will continue to do and the urban legends will propagate.
I am a board-certified neurologist. This issue has been asked about in prior comments in this blog, particularly in response to one poster noting that he has pudendal nerve damage. While I concur totally with Dr Rassman’s comments, I have also never read a single case report in the scientific literature. If such an effect from a drug existed or was believed to have been caused by a drug, the scientific community benefits from such descriptions in medical journals. The absence of such reports – including related to much of the atypical stuff posted on the internet related to finasteride (shrunken penis, irreversible sexual side efects) – makes me very suspicious about the veracity and validity of these claims.
Since I am in medical research, I have access to much literature that is not available online. I was not able to find anything in the literature either. And, besides that, as Dr. Rassman has stated, it simply does not make any sense.
I dismiss this entire matter by stating that I believe Jeremy aggravated his pudendal nerve by the outrageous amounts of time that he sits in his chair (at the computer) trying to look up findings to prove to everyone that he is right and that everyone else is wrong. I am not kidding, by the way, either. This could easily have caused this new symptom of his to develop.
The mere fact that there haven’t been case reports of pudendal neuropathy in the medical literature does not mean that it is untrue. There are probably nearly an infinite amount of scientific phenomena that have not yet been published in the scientific literature.
You are also considering this from the wrong perspective. If this were a common illness like cancer, depression, or hepatitis you would expect to see plenty of information in the medical literature but for an orphan illness that effects a small number of total humans that is currently misunderstood, it is not far fetched to think that it could go under the radar of the medical community.
By the way, have you personally ever considered writing any case reports in your career? Given how time consuming it can be, especially when many of the patients are spread over the globe, it is very difficult to find a physician that is willing to undertake such an activity especially when they have little to gain from helping a small group.
It’s interesting to point out that the set of symptoms men are claiming from their finasteride use are more or less a unique. i.e., this ‘PFS’ condition has never been documented before in anybody that has NOT taken finasteride, including those that are naturally 5AR deficient. It’s interesting that ONLY finasteride (the root of all that is evil in the universe) can cause this particular set of symptoms, and there could be no other cause.
This is how some see it; the ones experiencing the symptoms and convinced of the cause. The rest of us see things differently. Tens of millions of men take a drug (which is the case for Finasteride) you will ALWAYS see a subset of the men experiencing sexual difficulties. If you take any group of ten million men, you will see the same subset regardless of which medications they are on.
Tex – You are guilty of forming a dishonest argument by oversimplifying the matter at hand. If you take a large enough random selection of men, you will likely find men who are suffering from psychogenic ED, but not the type that is common among PFS sufferers. You mentioned yourself that you were (possibly still are) a hypochondriac which caused your psychogenic problems. However, men with PFS have symptoms that are manifest in physical ways that are objectively measurable.
If you took a large enough sample size of guys, you will find a few hypochondriacs suffering from psychosomatic illness, but with almost close to a 0% prevalence you will find men with fibrotic penile tissue, loss of genital sensation, decreased ejaculate volume (along with very low levels of viscosity), and erectile dysfunction. You are oversimplifying the problem to include only the last symptom, but the inclusion of the others is what distinguishes Post-Finasteride-Syndrome from the ailments which you previously suffered.
Jeremy, as soon as you stop spending twelve hours a day at the computer trying to prove people wrong, your pudendal nerve will heal and your problems will go away. Get up off of that chair, boy.
hindsight 20/20
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