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Genital Diseases: Pudendal Neuralgia

 
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Pudendal neuralgia occurs when the pudendal nerve or one of its branches becomes trapped or damaged. The pudendal nerve is in the pelvic region of both men and women and is responsible for sensation in the external genitals, the bladder and the rectum.

Damage to the nerve can occur from riding a bike (this can result in compression), falling on your buttocks or another trauma such as a car accident or pelvic surgery.

People who sit still for long periods of time or go on long-haul drives regularly can get pudendal neuralgia. Likewise, athletes can sometimes get it due to repeatedly flexing their hips or lifting weights.

Women with endometriosis can get it if the endometrial tissue grows on the pudendal nerve. It can also occur after childbirth. For many women this is just a temporary effect, but for some, they find the pain does not go away.

If the person is disabled, any tight muscles or misalignment of the pelvis can pinch on the nerve. Autoimmune or inflammatory illnesses can result inflammation on the nerve.

There is some evidence that it runs in families so there may be genetic predisposition at play as well.

Symptoms

Symptoms of pudendal neuralgia include:

• Burning pain during urination
• Urinary retention
• Not feeling the sensation of urination when you go
• Cystitis-like symptoms, wanting to go even when your bladder is empty
• Pain when pressing on the vagina or rectum
• Pain in the perineum
• Scrotal pain
• Pain before, during or after a bowel movement
• Constipation
• Pain or numbness in the buttocks
• Low back pain (referred)
• A feeling of inflammation when walking or sitting.

If your pudendal nerve is trapped, it can also cause difficulties with your sex life. Women frequently report pain during and after intercourse and pain during orgasm. Men report a reduction in sensation during intercourse and inability to orgasm or pain after because of this.

Many people completely recover from their nerve entrapment but for some, it is persistent and they develop a pain syndrome, depression or post-traumatic stress disorder.

Treatments

Antidepressants or anticonvulsant medication may be given as these subdue the nerve’s ability to transmit pain.

Physical therapy to improve posture and muscle function may take the pressure off the nerve.

Self-help measures may be advised such as avoiding triggers (giving up cycling, weight lifting, sitting for long periods of time) and sitting on a U-shaped cushion to protect the nerve.

Pudendal nerve blocks use a mixture of local anaesthetic and steroid that are injected into or very near the affected nerve with the aid of X-ray or CT scan so the doctor can see where they are injecting and make sure it’s in the correct place. Steroids don’t have a great record for permanently curing people.

Dr. Renney from Houston Orthopaedics Sports Medicine Associates says he has only had one patient who was permanently cured by this technique. It can however, provide much needed pain relief . Sixty-eight percent of Dr. Renney’s patients in France were able to obtain relief after a pudendal nerve block.

Sacral nerve stimulation from electrical nerve stimulation may relieve pudendal neuralgia.

Surgery can be done to decompress the pudendal nerve. In a study on perineal pain after surgery found that the cure rate after 22.2 months was 61.1 percent.

A diet high in antioxidants (in fresh fruit and vegetables) and omega-3 essential fatty acids may help. Supplementing with vitamin D might help too as vitamin D deficiency can contribute to pudendal neuralgia. (pudendalhope)

Support

For help and support in dealing with pudendal nerve entrapment, see:
The International Pudendal Neuropathy Association - http://www.tipna.org/

Sources:

Pudendal Neuralgia Symptoms, Health Organization for Pudendal Education. Web. 28 February 2012.
http://www.pudendalhope.org/node/9

The Pudendal Nerve, Perineology. Web. 28 February 2012. http://www.perineology.com/files/pudendal_nerve.htm

Pudendal Nerve Blocks, Pudendal Help. Web. 28 February 2012. http://www.pudendalhelp.com/Pudendal_Nerve_Blocks.html

An Introduction to PNE - Does PNE Mimic IC and Other Urological Conditions? The International Pudendal Neuropathy Association. Web. 28 February 2012. http://www.tipna.org/news/ICN_DrRenneyLecture.htm

Pudendal nerve decompression in perineology : a case series, BMC Surg. 2004; 4: 15.
Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC529451/

Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.

Reviewed February 28, 2012
by Michele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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