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Pudendal Neuralgia Services

Pudendal Neuralgia - Dignity Health Medical Group (DHMG) Arizona
If you suffer from pudendal neuralgia, our specialists are here for you. The pudendal nerve is one of the major nerves in the pelvis, leading to the pelvic floor and external genitalia. Pudendal neuralgia is a severely painful neuropathic condition affecting the pudendal nerve. Patients with pudendal neuralgia experience pain in the clitoris, vagina, perineum and/or rectum. The pain feels worse with sitting and can improve with standing. Pudendal neuralgia may arise from injury to the pudendal nerve caused by impingement or entrapment that may require surgical release of the nerve.

Evaluation and treatment

Evaluation
Although pudendal neuralgia may be caused by nerve compression, we consider pudendal neuralgia to be multifactorial involving muscle spasms of the pelvic floor and nerve sensitization. Evaluation starts with a detailed history and physical examination, including a comprehensive evaluation by our physical therapist. An MRI of the pelvis is performed to evaluate for other causes of pain and for pudendal nerve impingement. A CT guided pudendal nerve block may be performed to confirm the diagnosis.

General Treatment
In general, treatment of pudendal neuralgia consists of conservative measures, pelvic physical therapy, medications, injections, and surgery. The first-line treatment is avoidance of nerve re-injury. Patients are asked to stop or decrease all the activities which aggravate pain, such as prolonged sitting. In patients with pelvic floor muscle spasms, physical therapy is recommended. Medications like Neurontin or Lyrica are also used to help decrease pain. If those treatment modalities are not successful, patients are offered a series of three CT guided injections six weeks apart. If there is no long-term relief of pain, patients are offered nerve ablation and surgery.

Surgical Treatment
Surgery designed to decompress the injured pudendal nerve is completed through three or four inch-long incisions on the buttocks. It is called transgluteal pudendal neurolysis. This transgluteal approach gives the best visualization of the nerve. It allows the placement of a nerve wrap to protect against future scar tissue and placement of a pain pump catheter to deliver a steady dose of local anesthetic around the nerve for 10 days after surgery.
After surgery, it is important to continue use of medications and physical therapy for at least one year. Please see the post-operation instructions.

Surgical Outcomes
Outcomes from pudendal nerve decompression surgery depend on multiple factors such as length, degree and cause of nerve injury. Approximately 33% of patients who undergo transgluteal pudendal decompression have significant improvement in pain, 33% of patients have some improvement in pain, 33% have no change in pain and 1% may get worse. It is important to remember that improvement is usually felt six months after surgery and maximum improvement is 12-18 months after surgery.