The American Urogynecologic Society/The Society of Gynecologic Surgeons
Pudendal neuralgia, a severe pain syndrome

https://doi.org/10.1016/j.ajog.2005.01.051Get rights and content

Objective

To describe the clinical and electrodiagnostic findings, therapies, and outcomes of patients with pudendal neuralgia.

Study design

A retrospective, descriptive study of 64 patients from March 19 to December 22, 2003.

Results

Clinical findings included pain along nerve distribution (64, 100%), pain aggravated by sitting (62, 97%), pain relieved by standing or lying (57, 89%), and misdiagnosis (53, 83%). Neurophysiologic findings were normal (23, 35%), demyelination (17, 26%), axonal loss (5, 7.5%), and demyelination with axonal loss (21, 32%). Therapies were conservative (64, 100%), nerve injection (38, 59%), neuromodulation (2, 3%), and decompression surgery (10, 15%). Slight or moderate pain improvement with therapies included conservative (64, 100%), nerve injection (12, 31%), neuromodulation (2, 100%), and decompression (6, 60%).

Conclusion

Pudendal neuralgia is poorly recognized and poorly treated. Improvement is gained with conservative therapy. Injections and decompression benefit one half and one third of patients, respectively. Neuromodulation needs further evaluation.

Section snippets

Material and methods

All patients presenting with the complaint of pain in the distribution of the pudendal nerve, from March 19 to December 22, 2003, had systematic review of charts to record clinical and electrodiagnostic findings, therapies, and outcomes. This study was exempted from the institutional review board because all information was extrapolated from patients' charts, and no individual patient identification was directly or indirectly made.

Evaluation included a directed questionnaire (Table) and

Results

Sixty-four patients were studied: 18 males and 46 females, ranging in age from 30 to 71 years. The hallmark of pudendal neuralgia is the symptom of pain in the pudendal nerve distribution, which is aggravated by sitting. In 57 (89%) patients, pain was less with sitting on a commode and was relieved by standing or lying. It is important to note that 55 patients (86%) were diagnosed and treated for other conditions prior to a correct diagnosis of pudendal neuralgia. These patients had seen other

Comment

The etiologies of neuralgias generally are considered to be nerve trunk compression, faulty nutrition, toxins, and inflammation. The anatomical course of the pudendal nerve makes compression a likely factor, with the majority of cases of pudendal neuralgia.

The pudendal nerve arises from sacral nerves 2, 3, and 4 and passes in close association with the sciatic nerve between the piriformis and coccygeus muscles. The nerve crosses the ischial spine as it first leaves and then re-enters the pelvis

References (16)

  • B. Rydevik et al.

    Effects of graded compression on intraneural blood flow. An in vivo study on rabbit tibial nerve

    J Hand Surg

    (1981)
  • C.J. Fowler et al.

    Clinical neurophysiology

  • S.J. Boniface et al.

    How does neurophysiological assessment influence the management and outcome of patients with carpal tunnel syndrome?

    Br J Rheumatol

    (1994)
  • D. Thoumas et al.

    Pudendal neuralgia: CT-guided pudendal nerve block technique

    Abdom Imaging

    (1999)
  • R. Melzack et al.

    Pain mechanisms: a new theory

    Science

    (1965)
  • J.T. Benson et al.

    Pudendal nerve stimulation therapy for urinary urge incontinence and urgency-frequency syndrome: a pilot study

    J Pelv Surg

    (2003)
  • J.D. Stewart

    Peripheral nerve fascicles: anatomy and clinical relevance

    Muscle Nerve

    (2003)
There are more references available in the full text version of this article.

Cited by (0)

Presented at the Joint Scientific Meeting of the Society of Gynecologic Surgeons and the American Urogynecologic Society, July 29-31, 2004, San Diego, Calif.

Reprints not available from the authors.

View full text