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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 disorders

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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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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's canal

  • Alcock's 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 criteria2

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

  • Exclude 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 the presence of paresthesia on clinical examination

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

  • 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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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, and 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 out of 10 patients are women

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Clinical Findings

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Signs and Symptoms3

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  • Pain along pudendal nerve distribution

    • Perineal

    • Scrotal/testicular

    • Peri-anal

    • 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 dryness, itching, sweating

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Functional Implications

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  • Difficulty sitting for prolonged periods

  • Sexual dysfunction

    • May lead to unwanted sexual abstinence

  • Difficulty with urination and defecation

  • Pain during voiding

  • Decreased tolerance for exercise

  • Inability to work or attend school

  • Inability to maintain relationships

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Possible Contributing Causes

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  • Mechanical pudendal nerve: compression, tension, direct trauma

    • Identifiable trauma in athletes 15 to 25 years old

      • Cycling, weight lifting

      • Sitting: job, long travel

  • PFM dysfunction: TrP, connective ...

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