Man's years of premature ejaculation had a rare cause

In an unusual case, a man's premature, painful ejaculations turned out to have a rare cause: a cyst interfering with nerves near the base of his spinal cord.

According to a description of the case, published in February in the journal Archives of Sexual Behavior, the 32-year-old man went to the doctor after roughly two years of experiencing premature ejaculation (PE), broadly defined as a condition in which a person orgasms and releases semen sooner than desired — generally, in less than one minute after starting intercourse. Estimates for the condition's prevalence vary, but research suggests that between 30% and 40% of men experience PE at some point in their lives, according to the Cleveland Clinic.

Causes of PE vary widely and may be physical — for example, they may be tied to levels of certain hormones involved in sexual function. Or, they may be psychological, related to stress or performance anxiety, for example. But in this patient's case, a body scan revealed that a cyst near his spinal cord was the likely culprit.

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In his time experiencing PE, the man's condition had slowly worsened and was eventually accompanied by prolonged erections in the absence of stimulation — a phenomenon medically known as priapism. He also started experiencing pain in his pelvis, as well as pain during ejaculation.

Doctors scanned the man's lower back with magnetic resonance imaging (MRI) and revealed "one oval lesion" around the bottom of his lumbar spine and the start of his sacrum, the fused bones at the base of the spine.

The lesion was a so-called Tarlov cyst, a type of fluid-filled sac that sometimes forms around the sacrum. These can emerge for various reasons, such as inflammation or physical trauma in the spine, although the case report didn't note the exact cause of this patient's cyst. Typically, the sacs appear among the roots of the nerves that grow out of the spinal cord.

Often, these cysts cause no symptoms. However, in this case, the man's oval-shaped cyst was compressing the root of his sacral nerves, which, among other functions, relay movement instructions to and receive sensory information from various structures in the pelvis. Such compression can lead to sexual dysfunction.

The doctors assessed the severity of the man's PE with questionnaires about his symptoms, as well as his pelvic pain. Based on these assessments, "the patient had obvious PE and severe pain around the pelvis," his doctors wrote in the report. Therefore, they determined that "prompt surgical treatment" was necessary.

After the cyst was completely removed via surgery, "PE and pain around the pelvis were significantly relieved," the doctors reported. The man was assessed six months post-surgery and reported significant improvements.

In general, when a patient sees a doctor because of PE, "nerve symptoms and effective image-assisted examination are often ignored during diagnosis and treatment," the report authors added. "In our opinion," examinations of the spine and surrounding structures should be considered after doctors rule out other potential causes in otherwise healthy males who have recently developed PE, they wrote.

If a PE case is tied to a Tarlov cyst, surgical removal of the lump may help, they concluded.

This article is for informational purposes only and is not meant to offer medical advice.

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