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

Abstract

Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women’s health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options. We review the anatomy and methodology on when and how to perform pudendal blocks in the office to better inform the general gynecologist on how to implement offering this treatment in the outpatient clinical setting.

Efficacy of Pudendal Nerve Blocks and Ultrasound-Guided Superior Hypogastric Plexus Blocks for the Management of Refractory Interstitial Cystitis: A Case Series

“…Due to the mixed motor and sensory components, damage to or overactivity of these nerves can lead to visceral pelvic pain and urinary dysfunction. In this context, peripheral nerve blocks of the pudendal nerves may be an ideal target to reduce pelvic pain [ 6 , 18 ]. A retrospective study of 84 patients with IC/BPS demonstrated significant improvements in pain and function after six weeks of weekly pudendal and posterior femoral cutaneous nerve blocks, in combination with pelvic floor trigger point injections and physical therapy [ 19 ].…”

Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain

“… 42 , 103 , 112 Patients with neuroproliferative vulvodynia may experience a temporary pain abatement with anesthetic blocks of the pudendal nerve, which innervates the vestibule. 20 Protein gene product 9.5 positive nerve fibers in the vestibule of patients with LPV express elevated levels of vanilloid receptor 1 (VR1), which recognize TRPV1. 102 TRPV1 signaling has been previously implicated in the vulvodynia mechanism, but definitive evidence for targeting TRPVs in vulvodynia has not been demonstrated until now.…”