Pudundel Nerve Pain Specialist

What is the pudendal nerve?

The pudendal nerves are a major peripheral nerve that runs from the back of the pelvis to near the base of the penis or vagina. It is the main nerve of the perineum( area between the genitals and the buttocks).  The pudendal nerve is responsible for motor, sensation, and autonomic functions. The nerve communicates sensation information of your genitals, anus, and other pelvic regions.  It also controls the opening and closing of the sphincter muscles both the urthral sphincter used during urination and the external anal sphincter used during defecation. There is one pudendal nerve on each side of your body.  It branches out of the sacral plexus and contains nerve roots of the S2, S3, and S4. The sacral plexus is the bundle of nerves located at the lowest area of the spine at the back of the pelvis. The sacral plexus communicates sensation and movement messages to your upper and lower legs, feet and part of the pelvis.

The pudendal nerve traverses anteriorly between the sacrotuberous and sacrospinous ligaments and then travels through the pudendal canal or Alcock canal and branches into the perineal nerve, the dorsal nerve and the inferior rectal nerve. 

What are the causes of pudendal neuralgia?

Many things can damage the Pudendal Nerve.  These may include:

• Trauma or Injury(fracture of pelvis, or spine)
• Surgery such as prostatectomy, hysterectomy or prolapse repair,transvaginal mesh surgery, pelvic sling surgery.
• Childbirth
• Tumor
• Infection (herpes simplex)
• Entrapment or compression(pressure on pudendal nerve)
• Exercise (squatting, cycling, horseback riders)  
• Prolonged sitting ( computer operators, pianists, pilots, vehicle drivers)  

What are symptoms of pudendal neuralgia?

The discomfort of pudendal neuralgia is usually felt unilaterally(on one side) in the lower body, specifically in the pelvis, buttocks, genitals or perineum. Symptoms may worsen in a sitting position and be alleviated when standing or lying down. The symptoms are less in the mornings and tend to increase as the day progresses.

Symptoms of pudendal neuralgia include:

• Burning sensation
• Sharp pain
• Sensitivity
• Numbness or 
• Pins and needle or tingling
• Swollen
• Feeling the need to urinate frequently
• Painful ejaculation

What are treatments for pudendal neuralgia?

As with any condition, correct diagnosis of the condition via  thorough history and examination is critical.  Imaging such as an MRI may be needed to correctly rule out other conditions.  Management of pudendal neuralgia comprises of nerve protection, medication, and interventional modalities.

If the condition is a result of a repetitive aggregating motion, patients must be educated on self-care. A cushion can be purchased or made so that the perineum area is cut out to reduce pressure.  Stopping hip flexion exercising such as cycling, squats, horseback riding are essential to preventing further pudendal nerve damage or injury.

Medications can also be used to control nerve pain as well as reduce the hypersensitization of the nerve.  Medications may need to be titrated to maximize benefit over side effects. 

Pudendal nerve blocks or injections are often used as a first line treatment. Injections are done with an anesthetic and optionally a steroid under x-ray guidance or fluoroscopy.  The blocks can be repeated after 3-4 weeks as needed to control pain.  Often pain is immediately achieved.  Other intervention injections may be needed depending on the nerve impairment location such as epidural injections, ganglion impar blocks, superior hypogastric nerve blocks, and sacral nerve root block to s2, s3, s4.

For more information about pudendal neuralgia or other pelvic pain, call the Bellevue Pain and Wellness or request an appointment. We are happy to serve Bellevue, Seattle, Tacoma and the surrounding PNW area.