Page Updated on Apr 2, 2020 by Dr. Reyfman (Pain Management Specialist) of Pain Physicians NY

Pain Physicians NY (Brooklyn, Queens, Manhattan, Bronx NYC) is one of the first practices in New York to offer a Stem Cell Therapy, Platelet Rich Plasma (PRP) injections, and Interstitial Laser Therapy.

What is Pudendal Neuralgia?

Pudendal neuralgia is a neuropathic condition, affecting both men and women, which affect the pudendal nerve. Pudendal neuralgia leads to pain in the genital area like in the clitoris and vulva in women, penis, and scrotum in men, as well as in the perineum and rectum in both men and women. The pain gets worse usually when sitting.

Pudendal Neuralgia Causes

There are different causes of pudendal neuralgia, like:

  • Direct injury to the pudendal nerve
  • Compression of the pudendal nerve by pelvic floor muscle spasms
  • Injuries to the pudendal nerve due to infections and various diseases,
  • Compressions of the spinal cord or nerve roots where the pudendal nerve originates.

The most common causes of pudendal neuralgia include:

  • Childbirth
  • Constipation
  • Prolonged sitting
  • Bicycle riding
  • Pelvic trauma
  • Pelvic surgery
  • Anal intercourse
  • Excessive masturbation, etc.

Signs and Symptoms of Pudendal Neuralgia

Pudendal neuralgia as mentioned leads to pain in the genital area, affecting both men and women. The pain can be present along the entire dermatome or it may only affect a branch of the pudendal nerve. In women, the pain is usually localized in the clitoris, labia major, labia minor, vagina, and vulva. In men, the pain is usually localized in the penis and scrotum, without affecting the testes.

The signs and symptoms of pudendal neuralgia are usually unilateral, however, sometimes it could be bilateral.

The pain is described as an itching, burning or tingling sensation. Rarely the pain spreads to other parts outside of the zone of the pudendal nerve, like in the lower back, posterior thigh or even in the lower abdomen.

The signs and symptoms of Pudendal neuralgia get worse while sitting and they tend to get better while lying down or standing up. However, as the disease progresses the pain becomes constant regardless of the body’s position but gets even worse while sitting down. In many cases, patients suffering from pudendal neuralgia are not able to sit at all. Others, however, are able to sit for just a couple of minutes, until the pain becomes unbearable.

Another characteristic symptom of pudendal neuralgia includes a sensation of a foreign body in the vagina, perineum, and rectum. Urination and defection also cause pain. Pain while having sexual activity is so intense, that these patients suffering from pudendal neuralgia are not able to engage in sexual activity at all.

How is Pudendal Neuralgia Diagnosed?

It is very difficult to diagnose pudendal neuralgia, as there is no specific diagnostic test to confirm it. The diagnosis of pudendal neuralgia is based on the history, anamnesis and physical examination of the patient.

Pudendal Neuralgia Treatment

Treatment for pudendal neuralgia is usually conservative. If the pain is caused by cycling or sitting for a long period of time, the signs and symptoms usually get better with the change of the lifestyle.

Medications are recommended for patients who can’t change their lifestyle. The most used medications for treating pudendal neuralgia include muscle relaxants, analgesics, and anticonvulsants.

In cases when the cause of pudendal neuralgia is muscle spasms of the pelvic floor, physical therapy is a treatment option. The role of physical therapy is to relax the pelvic floor muscles.

When there is no improvement after physical therapy, injections of botulinum toxin into the pelvic floor are another treatment option.

Steroid injections, as well as local anesthetics around the pudendal nerves, are another treatment option for patients suffering from pudendal neuralgia. In women, these injections can be performed unguided and transvaginal, or even guided by ultrasound, CT – scan or fluoroscopy in both men and women.

Surgical decompression of the pudendal nerve is a treatment choice in patients with pudendal nerve entrapment.

The most advanced pain management center, Brooklyn pain management doctors and specialists at Pain Physicians NY offers a unique, individualized approach. We are using the most effective pelvic pain management options utilizing the latest technologies available in the USA.