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What Is Pudendal Neuralgia?

by Allyson Augusta Shrikhande, MD, CMO

The pelvis is a massively important part of the body, involving complex interplay between muscles, joints, and nerves. When any part of the whole is not functioning properly, it can cause serious pain and impede your ability to enjoy sex or even get through basic day-to-day activities. The problem can be compounded when the source of the issue is difficult to talk about or not immediately evident. One relatively rare, but chronically under-discussed cause of pelvic pain is pudendal neuralgia (PN).

What Is the Pudendal Nerve?

The pudendal nerve is a major nerve located in the pelvis. It spans from the rear portion of the pelvis to the base of the penis or vagina. It is highly important to sexual function, being the component of the nervous system that relays pleasure signals from the outer genitalia to the brain. It also does some work on the back end (so to speak), being responsible for the opening and closing of the sphincter while using the toilet.

What Is Pudendal Neuralgia?

Pudendal neuralgia describes any situation in which irritation, inflammation or damage to the pudendal nerve causes discomfort. This can manifest as stabbing, burning, or aching pain, sensation of a foreign body in the pelvis or as numbness or tingling in the genitals or perineum. It may not be constant and is commonly aggravated by going to the bathroom or sitting for long periods of time. It can make sex difficult by causing pain to the genitals or in the case of men by causing painful erections, ejaculations or difficulty achieving an erection.

What Causes Pudendal Neuralgia?

One of the most common causes of pudendal neuralgia is when the nerve is pinched or compressed. This can result from a number of things, including trauma from a surgery or childbirth, scar tissue, repetitive stress to the area such as prolonged sitting or biking, and one of the most common causes is myofascial compression from spastic pelvic floor muscles.

How Is Pudendal Neuralgia Treated?

At Pelvic Rehabilitation Medicine, we always strive to find non-surgical treatment options for pelvic pain conditions. Pelvic floor physical therapy is a highly useful tool, and in some cases there may be exercises that will help loosen and lengthen the pelvic floor muscles, relieving tightness that can contribute to pudendal neuralgia. Any exercise regimen should be undertaken with the advice and approval of a pelvic health expert. One innovative treatment method that has proven effective in many cases is peripheral nerve blocks, in which fluid is injected into the tissue surrounding the nerves to relieve pinching or compression and give the nerves space to operate properly.

While we stick to non-invasive, non-operative treatment methods whenever possible, there are some situations where surgery may be necessary. Pudendal nerve decompression surgery may be performed laparoscopically to relieve pressure on the nerve. A pelvic pain specialist can refer you to an expert surgeon who specializes in pudendal nerve issues.

Diagnosing Pudendal Neuralgia

Pelvic pain and sexual dysfunction can be difficult to talk about, but if you are suffering these symptoms it is imperative that you talk to a pelvic health physician to get to the root of the problem. PN is diagnosed through a detailed review of your symptoms and medical history, as well as a complete physical exam. Once properly diagnosed, we can create a treatment plan personalized to the patient to improve function and reduce pain through a combination of lifestyle modifications, physical therapy, and traditional medicine.

Dr. Allyson Shrikhande, a board certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment.