This book describes Pudendal Neuralgia, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic

Pudendal neuralgia is a disorder characterized by chronic pain in the pudendal nerve, which is a major nerve that supplies sensation to the genital area, perineum, and anus.

Pudendal neuralgia is long-term pelvic pain that originates from damage or irritation of the pudendal nerve which supplies areas including the:

Lower buttocks

Area between the buttocks and genitals (perineum)

Area around the anus and rectum

Vulva, labia and clitoris in women

Scrotum and penis in men

Simply put the pudendal neuralgia is a pain in the butt!

Pudendal neuralgia can occur in male and female even though about 67% of patients are female.

Internationally there is no racial or ethnic group preference observed.

Causes:

Pudendal neuralgia can take place if the pudendal nerve is injured, irritated or compressed.

Nerve entrapment:

Compression of the pudendal nerve by nearby muscles or tissue (Alcock canal syndrome)

Nerve irritation or injury:

Trauma, repetitive strain, childbirth, or surgery in the pelvic area can lead to nerve irritation or injury.

Inflammation:

Disorders like pelvic inflammatory disease or chronic inflammation of the pelvic organs can cause pudendal neuralgia.

Idiopathic:

In some patients, the cause may not be known.

Risk Factors:

Pelvic trauma and surgery

Prolonged sitting

Repetitive activities

Other risk factors are:

A non-cancerous or cancerous growth pressing on the pudendal nerve

Excessive physical exercise

Past pelvic or perineal trauma

Straining

Musculoskeletal issues

Posture

Stress

Pudendal neuralgia pain may:

Have a burning, crushing, shooting or prickling sensation

Develop gradually or suddenly

Be continuous but may become worse at some times and better at others

Be worse when sitting down and disappear when standing or lying down

Additional symptoms are pain during sex and needing to urinate frequently and urgently.

Pinprick sensation is examined at each branch bilaterally:

Dorsal nerve (clitoris and glans penis),

Perineal nerve (posterior labia and posterior scrotum) and

Inferior anal nerve (posterior perianal skin).

Diagnostic criteria are often used.

Pain limited to the region of innervation of the pudendal nerve

Pain predominant during sitting

Pain does not awaken the patient from sleep

No objective sensory defects

A positive effect of anesthetic infiltration of the pudendal nerve

Unfortunately there is no “cure” for pudendal neuralgia.

At present the medical treatments of pudendal neuralgia involve drug therapy, pudendal nerve block, and nervous regulation by the implanted pulse generator, radiofrequency ablation, spinal cord electrical stimulation, pudendal nerve decompression.

Physical therapy with specialists in pelvic floor therapy is often the first line of treatment.

Patients are also given exercises and lifestyle modifications to use at home.

Manage the sitting position with coccyx-cut-out memory foam cushions

Proper the bladder or bowels emptying

Other conservative treatments involve heat, massage, rest, TENS, muscle relaxants and anti-inflammatory medicines

Injection of local anesthetics or steroids around the pudendal nerve can provide temporary relief.

Surgical intervention, such as pudendal nerve decompression or neurectomy, may be indicated in severe or refractory cases

TABLE OF CONTENT

Introduction

Chapter 1 Pudendal Neuralgia

Chapter 2 Cause

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Occipital Neuralgia

Chapter 8 Trigeminal Neuralgia

Epilogue