Pudendal neuralgia: diagnostics and treatment
Keywords:pudendal neuralgia, blockade, ultrasound, cryoanalgesia
The article considers the main causes of the occurrence of pudendal neuralgia. The criteria for diagnosing this state are described in detail. We present basic methods of treatment of pudendal neuralgia starting with comprehensive preservative treatment (physical therapy, medication, blockade), which in most cases are effective. And in case of its ineffectiveness or relapse of the pain syndrome, issues of conduction of pulsed RF-frequency therapy of the nerve are examined. Currently, the possibility of using hyaluronic acid preparations, botulinum toxin for the treatment of sexual neuropathy, as well as cryoanalgesia is being studying. The surgical decompression of the sexual nerve is possible in case of inefficient conservative treatment.
Benson JT, Griffis K. Pudendal neuralgia, a severe pain syndrome. American Journal of Obstetrics and Gynecology [Internet]. Elsevier BV; 2005 May;192(5):1663–8. Available from: https://doi.org/10.1016/j.ajog.2005.01.051
Popeney C, Ansell V, Renney K. Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment. Neurourology and Urodynamics [Internet]. Wiley; 2007;26(6):820–7. Available from: https://doi.org/10.1002/nau.20421
Shafik A. Pudendal canal syndrome as a cause of vulvodynia and its treatment by pudendal nerve decompression. European Journal of Obstetrics & Gynecology and Reproductive Biology [Internet]. Elsevier BV; 1998 Oct;80(2):215–20. Available from: https://doi.org/10.1016/s0301-2115(98)00110-9
Labat J-J, Riant T, Robert R, Amarenco G, Lefaucheur J-P, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourology and Urodynamics [Internet]. Wiley; 2008;27(4):306–10. Available from: https://doi.org/10.1002/nau.20505
Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, et al. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surgical and Radiologic Anatomy [Internet]. Springer Science and Business Media LLC; 1998 Jun;20(2):93–8. Available from: https://doi.org/10.1007/s00276-998-0093-3
Schraffordt SE, Tjandra JJ, Eizenberg N, Dwyer PL. Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ Journal of Surgery [Internet]. Wiley; 2004 Jan;74(1-2):23–6. Available from: https://doi.org/10.1046/j.1445-1433.2003.02885.x
Hagen NA. Sharp, shooting neuropathic pain in the rectum or genitals: Pudendal neuralgia. Journal of Pain and Symptom Management [Internet]. Elsevier BV; 1993 Oct;8(7):496–501. Available from: https://doi.org/10.1016/0885-3924(93)90193-y
Amarenco G, Lanoe Y, Perrigot M, Goudal H. [A new canal syndrome: compression of the pudendal nerve in Alcock's canal or perinal paralysis of cyclists]. Presse Med. 1987 Mar 7;16(8):399.
Pisani R, Stubinski R, Datti R. Entrapment Neuropathy of the Internal Pudendal Nerve: Report of two cases. Scandinavian Journal of Urology and Nephrology [Internet]. Informa UK Limited; 1997 Jan;31(4):407–10. Available from: https://doi.org/10.3109/00365599709030631
Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta Neurologica Scandinavica [Internet]. Wiley; 1997 Apr;95(4):233–40. Available from: https://doi.org/10.1111/j.1600-0404.1997.tb00104.x
Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG. Bicycling induced pudendal nerve pressure neuropathy. Clin Exp Neurol. 1991;28:191-6.
RICCHIUTI VS, HAAS CA, SEFTEL AD, CHELIMSKY T, GOLDSTEIN I. Pudendal nerve injury associated with avid bicycling. Journal of Urology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1999 Dec;162(6):2099–100. Available from: https://doi.org/10.1016/s0022-5347(05)68116-5
Howard EJ. Postherpetic pudendal neuralgia. JAMA. 1985 Apr 19;253(15):2196.
Amarenco G, Ismael SS, Bayle B, Denys P, Kerdraon J. Electrophysiological analysis of pudendal neuropathy following traction. Muscle Nerve. 2001 Jan;24(1):116-9.
Diagnosis and Management of Pudendal Nerve Entrapment Syndromes. Contemporary Neurosurgery [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 May;30(9):6. Available from: https://doi.org/10.1097/01.cne.0000317129.20657.fd
Hill J, Mumtaz A, Kiff ES. Pudendal neuropathy in patients with idiopathic faecal incontinence progresses with time. British Journal of Surgery [Internet]. Wiley; 1994 Oct;81(10):1494–5. Available from: https://doi.org/10.1002/bjs.1800811032
Lefaucheur J-P. Neurophysiological testing in anorectal disorders. Muscle & Nerve [Internet]. Wiley; 2006;33(3):324–33. Available from: https://doi.org/10.1002/mus.20387
Amarenco G, Kerdraon J, Bouju P, Le Budet C, Cocquen AL, Bosc S, et al. [Treatments of perineal neuralgia caused by involvement of the pudendal nerve]. Rev Neurol (Paris). 1997 Jun;153(5):331-4.
McDonald J. Computed tomography–guided pudendal block for treatment of pelvic pain due to pudendal neuropathy. Obstetrics & Gynecology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Feb;95(2):306–9. Available from: https://doi.org/10.1016/s0029-7844(99)00520-7
Choi S-S, Lee P-B, Kim Y-C, Kim H-J, Lee S-C. C-arm-guided pudendal nerve block: a new technique. International Journal of Clinical Practice [Internet]. Wiley; 2006 Mar 8;60(5):553–6. Available from: https://doi.org/10.1111/j.1742-1241.2006.00836.x
Mauillon J, Thoumas D, Leroi AM, Freger P, Michot F, Denis P. Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia. Diseases of the Colon & Rectum [Internet]. Ovid Technologies (Wolters Kluwer Health); 1999 Feb;42(2):186–92. Available from: https://doi.org/10.1007/bf02237125
Beco J, Climov D, Bex M. Pudendal nerve decompression in perineology: a case series. BMC Surgery [Internet]. Springer Nature; 2004 Oct 30;4(1). Available from: https://doi.org/10.1186/1471-2482-4-15
Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003 Jul;6(3):345-60.
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License