Non-venous Pelvic Pain and Roles for Pelvic Floor PT or Pudendal Nerve Blocks

When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia

“…PN symptoms can also result from compression, inflammation, stretchy injury, downward displacement, or an underlying nerve disorder such as multiple sclerosis or small fiber polyneuropathy. In these situations, the nerve becomes irritated, and subsequently, the nervous system becomes sensitized, so pain becomes amplified 5. PNE may occur due to prior gynecologic surgery, particularly vaginal surgery for pelvic reconstructive procedures and mid-urethral sling in which there can be direct stretching or entrapment of the nerve or compression due to hematomas 4.…”

“…The exact cause of MPP is still unclear, but proposed mechanisms include metabolic imbalance at the peripheral tissue, centralized pain phenomenon, neuromuscular microtrauma, endometriosis, irritable bowel syndrome, bladder pain syndrome/interstitial cystitis, sexual abuse, anxiety, obesity, and other physiological factors 5…”

“…Another theory is that the pain stems from a more general genital or even central pain sensitization process. This is due to the overlap in women with vulvodynia and having oversensitivity in other organs 5. There is also likely a psychological component that may contribute to vulvodynia as well.…”

“…The pain may also be elicited with tampon insertion, painful orgasms, postcoital pain, and low back pain. 5 Treatment is aimed at identifying the underlying causes and treating pelvic floor pain. Pelvic floor physical therapy is often helpful to improve sexual dysfunction as well.…”

“…The prevalence of vulvodynia has been reported as high as 16%. 5 The pain can be episodic, occur before onset of menses, intermittent, or may be unremitting.…”