- Pelvic pain
- Pudendal neuropathy (PN)
- Pudendal nerve entrapment (PNE)
- 353.8 Other nerve root and plexus disorders
- G54.8 Other nerve root and plexus disorders
- R10.2 Pelvic and perineal pain
- 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
- 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
- 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
- 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
- Pain along pudendal nerve distribution
- 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
- 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
Possible Contributing Causes
- 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 tissue restriction
- Myofascial entrapment along the course of the nerve
- Sacrospinous and sacrotuberous ligaments
- Alcock’s/pudendal canal
- Surgery: multiple case reports in the literature of new onset pudendal neuropathy following surgeries for urinary incontinence
- Sacral iliac dysfunction...
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