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Pudendal Neuralgia: Chronic Pelvic Pain Caused by the Pudendal Nerve

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Updated April 28, 2014

What Pudendal Neuralgia is:

The pudendal nerve runs through the gluteus muscles (the buttocks) and into the perineum (think of the perineum as any part of the body that touches a bicycle seat). Pudendal neuralgia is a disorder of the pudendal nerve that can lead to chronic pelvic pain. It may be caused by pudendal nerve entrapment, when the nerve becomes compressed, or by damage to the pudendal nerve itself. It is also known as pudendal neuropathy.

Causes of Pudendal Neuralgia:

Chronic pelvic pain from pudendal neuralgia can be caused by any of the following:
  • diabetic neuropathy
  • trauma to the buttocks or pelvis -- including childbirth
  • excessive sitting (cyclists often have pudendal nerve entrapment)
  • thickening of ligaments around the pudendal nerve
  • bony formations pushing against the pudendal nerve

Pudendal Neuralgia Symptoms:

Pudendal nerve pain may be described as burning, numbness or pins and needles, stabbing or cramping. It may present in any of the following ways:
  • pain in the perineum or anal region
  • in men, pain in the penis or scrotum
  • in women, pain in the labia or vuvla
  • pain during intercourse
  • pain when urinating or having a bowel movement
  • pain in sitting that goes away when standing
Because the symptoms are often hard to distinguish, pudendal neuropathy can often be hard to differentiate from other types of chronic pelvic pain, such as prostatitis and vulvodynia.

Treating Pudendal Neuralgia:

Pudendal neuralgia can be treated with rest, if the cause is excessive sitting or cycling. Nerve blocks may help relieve pain caused by pudendal nerve entrapment. Anticonvulsants such as Neurontin, and antidepressants such as Elavil may be prescribed for help controlling pudendal neuropathy pain. Nerve decompression surgery may be required.

If you have chronic pelvic pain caused by pudendal neuropathy, your doctor may use any combination of these treatments.

Coping with Pudendal Neuralgia:

Because pudendal neuralgia is so difficult to diagnose and treat, learning to cope can be key to increasing your quality of life. Try these techniques:

Sources:

Hough David M, Wittenberg Keith H, Pawlina Wojciech et al. Chronic Perineal Pain Caused by Pudendal Nerve Entrapment: Anatomy and CT-Guided Perineural Injection Technique. American Journal of Roentgenology. 2003; 181:561-567

McDonald, John S. MD; Spigos, Dimitrios G. MD. Computed Tomography-Guided Pudendal Block for Treatment of Pelvic Pain Due To Pudendal Neuropathy. Obstetrics and Gynecology. February 2000. 95:2. pp 306-309.

National Pain Foundation. Pelvic Pain: Causes. Accessed 8/17/09. http://www.nationalpainfoundation.org/articles/717/causes

University of Rochester Medical Center. Pudendal Neuralgia. Accessed 8/17/09. http://www.urmc.rochester.edu/smd/Rad/Pudendal.pdf

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