Pudendal Neuralgia

Abstract

Pudendal neuralgia is a painful, neuropathic condition involving the dermatome of the pudendal nerve. This condition is not widely known and often unrecognized by many practitioners. The International Pudendal Neuropathy Association (tipna.org) estimates the incidence of this condition to be 1/100,000; however, most practitioners treating patients with this condition feel the actual rate of incidence may be significantly higher. Currently, there is fair paucity of medical literature and scientific evidence in the diagnosis and treatment of pudendal neuralgia. Diagnosis of this condition is based on the utilization of Nantes Criteria, in conjunction with clinical history and physical findings. CT-scan guided nerve blocks are also employed, by this author, to provide additional information. Subsequent treatment of pudendal neuralgia is medical and well as surgical, with Physical Therapy a key component to all aspects of treatment. The goal of this paper is to present evidence based information, as well as personal clinical experience, in treating approximately 200 patients with pudendal neuralgia.

Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia

“…The pharmacological strategies include topical preparations, such as local anesthetics and/or the submucosal infiltration of local anesthetics associated with steroids (triamcinolone and local anesthetics); drugs that act on the pain mediator, such as tricyclic antidepressants, anticonvulsants, selective serotonin reuptake inhibitors and selective serotonin and noradrenalin reuptake inhibitors (15)(16)(17)(18)(19). The non-pharmacological strategies are represented by rehabilitation of the pelvic floor muscles and/or biofeedback techniques involving particularly the levator ani, transcutaneous electrical nerve stimulator, vaginal dilators, and cognitivebehavioral therapy (20)(21)(22).…”

Radiofrequency and Neurolysis for the Treatment of Chronic Visceral Abdominal Pain

“…The three most common causes of pudendal nerve entrapment are surgical injury, pelvic trauma, and child birth. In terms of diagnosis, the "Nantes Criteria" are widely used and accepted to help diagnosis and treat pudendal neuralgia [ 31 ]. Because of motor and sensory function, neurolysis of the pudendal nerves is often seen as a "last resort", with possible consideration for PRFA techniques (Fig.…”

Current Uses of Surgery in the Treatment of Genital Pain

“…This diagnostic algorithm has been derived from research conducted in the last 15 years that has helped to identify the underlying pathophysiology of different causes of vulvovaginal pain (vulvodynia). Specifically, this research has help to recognize myofascial, hormonal, neuroproliferative, inflammatory, and neuropathic causes of vulvar pain [4][5][6][7][8]. This algorithm helps practitioners to differentiate between different causes of vulvodynia/provoked vestibulodynia and, in so doing, allows them to select appropriate treatments.…”

“…The transgluteal approach is often used Fig. 1 Algorithm for diagnosis and management of vulvar pain because it allows for a blockade at the ischial spine and directly in Alcock's canal [8]. Various imaging techniques are used to ensure accuracy of the injection.…”