Pudendal Neuralgia and Pudendal Nerve Block

The pudendal nerve carries signals to and from the genitals, anal area, and urethra. Although there are slight differences in each patient’s nerve branches, there are typically three branches of the nerve on each side of the body; a rectal branch, perineal branch, and clitoral / penile branch (female / male, respectively). While ongoing research is underway to determine the exact areas innervated by the pudenal nerve, peripheral neuralgia occurs when the pudendal nerve, or one of its branches, becomes damaged, inflamed, or entrapped.

Pudendal neuralgia is a pain condition involving the lower central pelvic areas. This is usually precipitated by prolonged sitting or trauma to the genital area, combined with genetic and developmental susceptibility.

When pudendal neuralgia is suspected following the patient’s history and physical examination, an image-guided pudendal nerve block is an important diagnostic tool.

Pudendal Nerve Block Procedure

The patient is administered a mild sedative. Our physicians use a fluoroscopic unit (real time x-ray) and nerve stimulator to localize the pudendal nerve. Using a stimulating needle, a small amount of electrical current is passed along the distribution of the pudendal nerve. The patient will feel a tingling sensation in the area innervated by the pudendal nerve.

Next, a small amount of local anesthetic and possibly cortisone (steroid) is injected. The steroid works as an anti-inflammatory, reduces compression and pain. The procedure offers diagnostic and therapeutic value.

Numbness and pain relief identifies the pudendal nerve as the likely cause. However, the cause of pain may involve other nerves, as there are many nerves in the pelvic region. Other causes of pudenal neuralgia include:

• Coccydynia
• Piriformis syndrome
• Interstitial cystitis
• Myofascial pain / trigger points
• Connective tissue restrictions and adverse neural tension
• Sacroiliac joint dysfunction
• Other spine-related pathology

Other treatable causes of pelvic pain must be ruled out by your gynecologist or urologist.

To Learn More

If you have been diagnosed with pudenal neuralgia, or are interested in learning about treatment options to manage your pain, please contact our pain management experts at Spine and Pain Consultants of New York in Manhattan, New York and Staten Island, New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.