### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 48 year old Male 2 years removed from an open appendectomy and subsequent pyogenic liver abscess. My surgical incision for the appendectomy healed by second intent and my issues with the Liver abscess were resolved through drainage and long term administration of antibiotics.  My only other surgery was a vasectomy approximately 10 years ago in which my only subsequent complication was a sperm granuloma that developed and resolved over a few weeks.  Now to the present.  Since my abdominal surgery I have developed numbness in my outer left thigh which occassionally cause a tingling / prickling sensation.  I have also developed some sexual issues including difficulty getting and maintaining an erection a reduction in the volume and intensity of ejaculation, and many times, I will have a pain in my lower abdomen at the moment of ejaculation.  I have noticed a decrease in sensation in my penis such that I have difficulty obtaining an erection even through masturbation.  I have explored these issues with my family physician, but it is difficult to know where to head with it based upon whether I am dealing with separate issues and causes or maybe just one cause.  For example, I thought that maybe the issue was nuerologic due to a compressed nerve, but an MRI failed to reveal any such problem.  I thought my problem may be related to trauma to one of my abdominal nerves during surgery, but my physician seemed to think this was unlikely.  I had tests done for my testosterone levels and prostate and all revealed that I was well within normal limits.  I even treated on antibiotics to see if the condition might be prostatitis but it really had no impact.  I am really not looking to circumvent my own doctor, but rather searching for ideas on what the best course of action, process of elimination or method of obtaining a differential diagnosis might be.  Can you help?

### output:

Hi, Id agree with your surgeon. It's unlikely your pelvic nerves were affected during the surgery or the liver infection, as the nerves in this area don't travel to the penis. Are you diabetic? This can sometimes have an effect on nerve function, and diabetics can have neuropathy, which causes nerve dysfunction. Another possible cause is this could be a delayed complication of the vasectomy.  If an MRI showed no issues, then it could simply be due to primary erectile dysfunction. Another possibility is Erich syn Chat Doctor.  This is due blockages in the internal Iliad arteries, which give blood supply to the pelvis.  A CT Angiogram would help diagnose this. (MRI would not show any potential blood supply symptoms). This would particularly be a problem if you have a history of high blood pressure, coronary artery disease, or any smoking. I hope these other ideas are helpful. Please let me know if you have any further questions.