Penile Numbness and the TOMAX Procedure

Overview:
Damage to the spinal cord, such as from spina bifida (open spine), a spinal cord injury, or cauda equina syndrome (for example, following a failed hernia surgery), can disrupt the transmission of signals between the body and the brain. This results in the inability to control muscles below the level of injury, leading to paralysis. Conversely, sensory signals from the body may not reach the brain, resulting in numbness.

In men, spinal cord damage can lead to penile numbness. While sexual activity is technically possible—these men can often achieve an erection and ejaculate—the sensation in the penis is absent, affecting the overall enjoyment of sex.

The TOMAX Procedure:
Dr. Max Overgoor, a plastic surgeon at Isala, has developed a surgical technique called the TOMAX procedure to restore sensation in the penis. This procedure involves redirecting nerves from the groin to the penis. Over time, this can lead to partial or complete recovery of sensation.

How the TOMAX Procedure Works:
By connecting the groin nerve to the penile nerve, many men with a spinal cord injury or open spine can regain sensation in their penis. This is because the groin nerve exits the spinal cord at a higher level than the penile nerve. The nerve from the groin needs to grow into the penile nerve, a process that takes time. Sensation may return after four to six months. Initially, the sensation might not be pleasant, but with brain training, sensation can improve. Some men may regain only touch sensation and awareness of the penis as part of their body, while others may find it easier to maintain an erection or enjoy sex more. Men with spina bifida may experience more significant changes, as they may never have had sensation in the penis.

Eligibility for the TOMAX Procedure:
The surgery is suitable only for individuals who still have sensation in their groin and whose spinal cord injury is relatively low in the back. If a patient meets these criteria, the TOMAX procedure can be successful.

Portfolio Addition:
I have created an animation illustrating the TOMAX procedure. This animation visually explains the surgical technique and its benefits, providing an engaging and informative resource for understanding how sensation can be restored. This animation can be found in my portfolio.

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