What is Pudendal Neuralgia?

Pudendal Neuralgia, is an uncommon source of chronic pain in which the pudendal nerve is irritated or compressed. The pudendal nerve runs from the back of the pelvis to near the base of the vagina, where it branches off into other nerves.

A compression or irritation of this nerve often causes pain, discomfort, or numbness in the pelvis or genital area.

Pudendal Neuralgia Symptoms

The main symptom of pudendal neuralgia is pain. This can be highly variable. Even if some symptoms vary, women often experience a burning, electric shock, shooting, aching, itch or a raw feeling in the vagina, groin, perineum, anus or rectum. Sitting also might be difficult because of the pain.

Those affected can also experience bladder and bowel irritation and sometimes a feeling as though there's swelling or an object in the perineum – often described as feeling like a golf or tennis ball.

In addition to physical complaints and pain, pudendal neuralgia often results in psychological problems and anxiety that are triggered by hopelessness and a feeling of desperation when therapies don’t have the desired effect or no medical cause for the discomfort can be found.

Course & Diagnosis of Pudendal Neuralgia

Doctors will primarily ask about symptoms and may examine the area to check for any obvious causes of the pain. When doctors conclude that irritation or compression of the pudendal nerve might be the cause, they can assess whether previous medical conditions or the patient's medical history has impacted the symptoms.

Specialists usually do further tests like a pelvic exam, MRI scan, nerve studies, – where a small device is inserted into the rectum to stimulate nearby nerves with mild electrical impulses to check how well the nerves are working, – or nerve block injections where painkilling medication is injected around the pudendal nerve to see if the pain improves.

The duration of pudendal neuralgia can vary from person to person. In some cases, the symptoms disappear at some point by themselves for unknown reasons. However, for some sufferers, a pudendal neuralgia diagnosis can last for several years.

Causes & Difficulties of Pudendal Neuralgia

Pudendal neuralgia can happen if the pudendal nerve is damaged, irritated or trapped but usually, there is no one cause of pudendal neuralgia. Often, it is a combination of a few factors.

Possible causes might include prolonged sitting, cycling, horse riding or constipation, damage to the pelvic area, a previous surgery, childbirth or other.  But often a specific cause is not found.

The main difficulty is that the treatment has to be administered in an interdisciplinary manner by different specialists at the same time, and single physicians often lack the time or capabilities for such a holistic approach.

Pudendal Neuralgia Treatment

In recent years, the prognosis has improved greatly, with promising chances of healing using a multimodal treatment.

Today, science supports a combination of physical therapy for pelvic floor such as stretches and techniques to release overtensed muscles in the pelvic, bladder, or anal area (trigger points); psychological therapy such as paradoxical and progressive relaxation techniques to reduce causative stress; and neuropathic irritation, which can help to cure or reduce causes and symptoms.

Therefore, the main difficulty lies in the patient's persistence and the will to change something, because often an interdisciplinary therapy is needed which requires the active participation of the patient over a longer period of time.

But if the patient is willing, the chances of a cure are very promising.