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CONDITION/DISORDER SYNONYMS

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  • Pelvic pain

  • Pudendal neuropathy (PN)

  • Pudendal nerve entrapment (PNE)

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ICD-9-CM CODE

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  • 353.8 Other nerve root and plexus disorder

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ICD-10-CM CODES

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  • G54.8 Other nerve root and plexus disorders

  • R10.2 Pelvic and perineal pain

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PREFERRED PRACTICE PATTERN

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  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated With Peripheral Nerve Injury1

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PATIENT PRESENTATION

A 56-year-old woman reports that she has been experiencing burning pain, tingling, and vibration sensations in the vaginal area. Pain is worse when she is sitting. Sometimes it feels like her tailbone hurts. Symptoms began after she completed a150 mile bicycle ride for charity.

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KEY FEATURES

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Description
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  • Pain, burning, numbness, paresthesia in the gluteal, perineal, and/or genital area

  • Entrapment and injury to the pudendal nerve in Alcock canal

  • Alcock canal (musculo-osteo-aponeurotic tunnel) between sacrotuberous and sacrospinous ligaments, in the absence of organic disease

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Essentials of Diagnosis
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  • “Nantes Criteria”2

    • Pain should be limited to the innervation territory of the pudendal nerve.

    • Excludes any pain that is limited to the coccygeal, pelvic, or gluteal areas.

    • Pain is predominantly experienced while sitting.

    • Pain rarely awakens the patient at night.

    • No objective sensory impairment can be found even in thepresence of paresthesia on clinical examination.

      • Presence of a sensory defect should prompt investigations to exclude diseases of the sacral nerve roots and the cauda equina.

    • Pain should be relieved by anesthetic infiltration of the pudendal nerve.

      • This is an essential criterion, but it lacks specificity as pain related to any perineal disease may be relieved by pudendal nerve block.

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FIGURE 278-1

The pudendal and coccygeal plexuses. (From Waxman SG. Clinical Neuroanatomy. 26th ed. www.accessmedicine.com. Copyright © TheMcGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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General Considerations
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  • Frequently misdiagnosed

  • Chronic pain condition

  • Urogenital pain disorders are frequently associated with pain and other musculoskeletal impairments in nearby body areas; especially back, pelvic, hip, groin regions

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Demographics3
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  • Few epidemiologic data found in the literature

  • Mean time to diagnosis is 4 years, ranging from 1 to 15 years

  • More prevalent in women; 7 of 10 patients are women

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS3

  • Pain along pudendal nerve distribution

    • Perineal

    • Scrotal/testicular

    • Perianal

    • Suprapubic

    • Pain with ejaculation

    • Pain elicited with pressing along the course of the nerve

  • Pain aggravated by sitting, stair climbing

  • Pain relieved by standing or lying and with sitting on toilet

  • Associated symptoms

    • Voiding dysfunction: Urinary hesitancy, frequency, urgency, obstructive voiding, painful voiding

    • Obstructive defecation: Difficult and painful bowel movements

    • Sexual dysfunction: Painful orgasms, persistent sexual arousal, erectile dysfunction

      • Autonomic dysfunction : Sensation of ...

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