Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Pelvic painPudendal neuropathy (PN)Pudendal nerve entrapment (PNE) ++ 353.8 Other nerve root and plexus disorders ++ G54.8 Other nerve root and plexus disordersR10.2 Pelvic and perineal pain ++ Pattern 5F: Impaired peripheral nerve integrity and muscle performance associated with peripheral nerve injury1 +++ Description ++ Pain, burning, numbness, paresthesia in the gluteal, perineal, and/or genital areaEntrapment and injury to the pudendal nerve in Alcock’s canalAlcock’s canal (musculo-osteo-aponeurotic tunnel) between sacrotuberous and sacrospinous ligaments, in the absence of organic disease +++ Essentials of Diagnosis ++ Nantes criteria2Pain should be limited to the innervation territory of the pudendal nerveExclude any pain that is limited to the coccygeal, pelvic, or gluteal areasPain is predominantly experienced while sittingPain rarely awakens the patient at nightNo objective sensory impairment can be found, even in the presence of paresthesia on clinical examinationPresence of a sensory defect should prompt investigations to exclude diseases of the sacral nerve roots and cauda equina syndromePain should be relieved by anesthetic infiltration of the pudendal nerveThis is an essential criterion, but it lacks specificity as pain related to any perineal disease may be relieved by pudendal nerve block +++ General Considerations ++ Frequently misdiagnosedChronic pain conditionUrogenital pain disorders are frequently associated with pain and other musculoskeletal impairments in nearby body areas; especially back, pelvic, hip, and groin regions +++ Demographics3 ++ Few epidemiologic data found in the literatureMean time to diagnosis is 4 years, ranging from 1 to 15 yearsMore prevalent in women; 7 out of 10 patients are women +++ Signs and Symptoms3 ++ Pain along pudendal nerve distributionPerinealScrotal/testicularPeri-analSuprapubicPain with ejaculationPain elicited with pressing along the course of the nervePain aggravated by sitting, stair climbingPain relieved by standing or lying and with sitting on toiletAssociated symptomsVoiding dysfunction: urinary hesitancy, frequency, urgency, obstructive voiding, painful voidingObstructive defecation: difficult and painful bowel movementsSexual dysfunction: painful orgasms, persistent sexual arousal, erectile dysfunctionAutonomic dysfunction: sensation of dryness, itching, sweating +++ Functional Implications ++ Difficulty sitting for prolonged periodsSexual dysfunctionMay lead to unwanted sexual abstinenceDifficulty with urination and defecationPain during voidingDecreased tolerance for exerciseInability to work or attend schoolInability to maintain relationships +++ Possible Contributing Causes ++ Mechanical pudendal nerve: compression, tension, direct traumaIdentifiable trauma in athletes 15 to 25 years oldCycling, weight liftingSitting: job, long travelPFM dysfunction: TrP, connective tissue restrictionMyofascial entrapment along the course of the nerveSacrospinous and sacrotuberous ligamentsAlcock’s/pudendal canalSurgery: multiple case reports in the literature of new onset pudendal neuropathy following ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.