Pudendal Neuralgia

Pudendal neuralgia is a condition that affects the pudendal nerve, which is responsible for transmitting sensory information from the perineal region to the brain. People who experience pudendal neuralgia often describe it as a burning, shooting, or stabbing pain in the pelvic region.

To diagnose pudendal neuralgia, healthcare professionals may utilize nerve conduction studies. These studies evaluate the electrical signals transmitted along the pudendal nerve, helping to identify any abnormalities or impairments. This diagnostic tool can provide valuable insights into the functioning of the pudendal nerve and assist in formulating a treatment plan.

One of the primary causes of pudendal neuralgia is pudendal nerve entrapment syndrome. This occurs when the pudendal nerve becomes compressed or trapped, leading to pain and discomfort in the pelvic area. Advanced practitioners, such as physical therapists specializing in pelvic health, can work alongside healthcare professionals to address this condition comprehensively.

When it comes to managing pudendal nerve pain, various treatment options are available. Pudendal neuromodulation, for instance, has shown promise in providing relief to individuals experiencing pudendal neuralgia. This technique involves the use of implanted devices to deliver electrical impulses to the pudendal nerve, helping to modify and alleviate pain signals.

Pudendal neuropathy, another term often used to describe pudendal neuralgia, can have a significant impact on sexual health and function. Many individuals with this condition may experience sexual dysfunction, such as pain during intercourse or diminished sensation in the genital area. Addressing sexual health concerns should be approached holistically, with input from healthcare professionals specializing in both pain management and sexual health.

Perineal pain is a common symptom associated with pudendal neuralgia, and it can be highly debilitating. This type of pain is often described as occurring in the area between the anus and genitals. Understanding the neuropathic nature of this pain is crucial, as it helps guide treatment strategies and ensures that appropriate interventions are employed to alleviate discomfort effectively.

Addressing pudendal neuralgia requires a comprehensive understanding of entrapment syndrome, as it plays a significant role in the development and progression of the condition. For example, the sacrospinous ligament has been named as a possible place where nerves can get pinched, which can lead to damage to the pudendal nerves and pain. This knowledge allows for more targeted approaches to treatment and potential surgical decompression options for those who do not respond adequately to conservative management.

By educating individuals about pudendal neuralgia and its symptoms, we contribute to a greater understanding of this condition. Health encyclopedias and informational resources are invaluable tools in disseminating accurate and helpful information to those seeking knowledge about their condition. Empowering individuals with knowledge enables them to make informed decisions regarding their healthcare and seek appropriate treatment and support.

Pudendal neuralgia is a complex condition that can significantly impact pelvic health and sexual function. With the guidance of healthcare professionals and advanced practitioners and the use of diagnostic tools like nerve conduction studies, we can better understand and effectively manage pudendal nerve pain. By exploring treatment options such as pudendal neuromodulation and addressing related symptoms like sexual dysfunction, we can strive towards improving the quality of life for individuals with pudendal neuralgia.

Pudendal Neuralgia Is a Relatively Unknown Cause of Severe Pelvic Pain

In my practice, I define it as a pain located in the area of innervation of the pudendal nerve. Pudendal nerve entrapment is an impingement of the pudendal nerve due to scar tissue, surgical supplies, or mesh. Pudendal nerve entrapment is, therefore, one of the causes of pudendal neuralgia; however, other causes such as inflammation, spasms of the surrounding muscles, or other nerve diseases may also be a reason for pain.

Innervation of the Perineum

Almost always, a traumatic event in the pelvis is what causes pudendal nerve entrapment. This may be pelvic surgery (with or without mesh), difficult childbirth, athletic injuries, falls, and other accidents. A repetitive injury, such as bicycle seat pressure on the pelvic floor, may also lead to pudendal nerve entrapment (cyclist syndrome).

Diagnosis of pudendal nerve entrapment is not easy and relies heavily on taking a detailed history. Pain is located in the vagina, vulva, clitoris, perineum, and rectum, and it may involve one or all of those areas. Pain is more severe with sitting than with standing or lying down, and sitting on the toilet is generally better than sitting on a chair. Most of the patients with real nerve pain injuries have pain on one side only, or one side is significantly more painful than the other. Chronic Pelvic Pain is generally more severe with urination, bowel movements, and intercourse. Some patients may also have difficulty emptying their bladder (hesitancy) and bowel (constipation). One of the most debilitating symptoms of pudendal nerve entrapment is a sensation of continuous sexual arousal (persistent genital arousal disorder, or PGAD). Patients often reduce this sensation through masturbation, which only provides temporary relief.

Nantes Criteria

A pioneer in the treatment of pudendal nerve entrapment, and my mentor, Professor Roger Robert, has developed Nantes criteria that greatly assist in diagnosing this condition. Studies have shown that patients who more closely meet the criteria have better outcomes from the surgical decompression of the nerve.

Inclusion Criteria

Pain in the area is innervated by the pudendal nerve Pain is more severe when sitting Pain does not awaken patients from sleep Pain with no objective sensory impairment Pain relieved by diagnostic pudendal block

Exclusion Criteria

Pain located solely in the coccygeal, gluteal, pubic, or hypogastric area (without pain in the area of distribution of the pudendal nerve) Pruritus (itching) Pain is exclusively paroxysmal (acute attacks of pain without any triggers) Abnormality on imaging (MRI, CT), which can account for pain

Complementary Criteria

Pain characteristics: burning, shooting, numbing Allodynia or hyperesthesia (pain in response to light touch; may be from underwear) Allotriesthesia (sensation of a foreign body in the rectum or vagina) Pain progressively worsens throughout the day Pain is predominantly unilateral (one-sided) Pain triggered by a bowel movement Significant tenderness around the ischial spine Abnormal neurophysiology testing (PNMTL)

Associated Signs

Buttock pain (around ischial tuberosity) Referred sciatic pain (pain down the back of the leg) Pain referred to the medial side of the thigh Suprapubic pain Urinary frequency with a full bladder Pain after orgasm or ejaculation Pain with or after intercourse Erectile dysfunction Normal PNMTL (pudendal nerve motor terminal latency testing)

Inferior Rectal Nerve

Cutaneous Branch of the Obturator Nerve

Lateral Cutaneous Branch of Iliohypogastric Nerve

Femoral Branch of Genitofemoral Nerve

Posterior Femoral Cutaneous Nerve

Lateral Femoral Cutaneous Nerve

Iliohypogastric Nerve

Clitoral/Perineal Nerves

Femoral Nerve

Genital Branch of Genitofemoral Nerve

Other Nerves Innervating the Pelvis

Pain in pudendal nerve entrapment is of a neuropathic nature, which means that patients feel burning, tingling, and numbing sensations (paresthesia). Some patients have the sensation of a foreign body located in the rectum or vagina (allotriesthesia) and may describe it as a “red hot poker” in the rectum. Some patients do not experience any chronic pain but have complete or partial numbness in the area of innervation of the pudendal nerve.

Extra tests, such as magnetic resonance neurography (MRN), pudendal nerve motor terminal latency (PNMTL), another electrophysiologic test, or sensory threshold testing, usually can not tell if someone has pudendal nerve entrapment. An important part of the Nantes criteria is a CT-guided pudendal nerve block, which is used to find and treat pudendal nerve entrapment. If pain doesn’t go away right away after a CT-guided pudendal nerve block, it’s likely that the pudendal nerve is not the source of the pain.

Conservative Treatments of Pudendal Neuralgia

1. Avoidance of Additional Injury: Patients need to immediately stop the activities that lead to injury of the nerve in the first place. For example, if nerve pudendal neuralgia was caused by riding a bicycle, the patient has to immediately stop cycling. Of course, this cannot be done in cases where the patient develops pudendal neuralgia as a result of surgery or childbirth.
2. Nerve Protection: Protect the nerve by using sitting cushions, zero-gravity chairs, or kneeling chairs.
3. Medications: Oral medications and vaginal/rectal suppositories.
4. Pelvic Floor Therapy: Appropriate pelvic floor physical therapy can minimize pelvic floor muscle spasms.
5. Botulinum Toxin A Injections: These injections to the pelvic floor muscles can minimize pelvic floor muscle spasms.
6. Pudendal Nerve Blocks: Using CT, ultrasound, or unguided transvaginal blocks, restrict the nerve as it enters the lesser sciatic foramen, 1 cm inferior and medial to the sacrospinous ligament-ischial spine attachment.
7. Pudendal Nerve Injections: These injections are done with amniotic fluid and a liquified amniotic membrane.
8. Ablation Procedures: Pulsed radiofrequency ablation (pRFA) and cryoablation
9. Nerve Stimulators and Spinal Cord Stimulators: These are implantable devices used to manage chronic pain in pudendal neuralgia by delivering electrical impulses to disrupt pain signals.
10. Surgical Decompression of the Nerve: Pudendal nerve decompression can be done using several different approaches: transgluteal, transischorectal, transperineal, and laparoscopic/robotic.

Professor Roger Robert first described the transgluteal approach in Nantes, France, after which I significantly modified it. This approach offers by far the best access to the pudendal nerve, therefore allowing for the most complete decompression. One of the earlier drawbacks of the technique was the cutting of the sacrotuberous ligament, which in some cases could lead to pelvic instability. The risk of that instability was eliminated when I began repairing the sacrotuberous ligament. Cutting that ligament frees the nerve from scar tissue or surgical materials and lets you get to the nerve. However the sacrotuberous ligament should be fixed after nerve decompression is done.

Other Modifications I Have Introduced to the Pudendal Neurolysis Surgery

1. Use of surgical microscope for better visualization of the nerve and surrounding structures
2. Use of the Nerve Integrity Monitoring System (NIMS monitor) to aid with the identification of the pudendal nerve It is especially helpful in cases where the nerve is significantly scarred and in cases of repeat surgery.
3. Use of a pain pump that delivers a local anesthetic to the nerve for about seven days after surgery. This decreases pain levels and is thought to reverse central sensitization (the memory of pain in the brain). This step may lead to a faster recovery and resolution of pain after surgery.
4. Nerve wrapping with an adhesion prevention barrier decreases the risk of scarring or re-scarring of the nerve after surgery. Several years ago, I switched from regular nerve wraps to wrapping the nerve with an amniotic membrane product. In addition to anti-adhesion (anti-scarring) properties, the amniotic membrane contains nerve growth factors that promote nerve healing. It also may have the ability to attract your own body’s stem cells close to the nerve, which further helps with nerve regeneration.
5. Use of suction dressings after the closing of the skin to minimize the risk of wound infection.

A microscope is used for transgluteal pudendal surgery, with a NIMS monitor for monitoring the nerve during surgery.

Laparoscopic/robotic procedures are less invasive, but they do not offer as good access to Alcock’s canal as transgluteal procedures do. It may be effective in cases where the nerve compression is limited to a small area, but the location of the compression may be difficult to determine prior to surgery.

In my practice, I perform both transgluteal and robotic nerve decompression procedures, but I believe that since the transgluteal technique offers better access and allows for decompression of the larger part of the pudendal nerve, it should be a preferred approach. Even though the recovery time is longer compared to the laparoscopic procedure, the benefits of more complete nerve decompression are very important when considering the choice of surgery.

Overall, the results of surgery show that the majority of patients have significantly decreased pain and benefit from pudendal nerve decompression procedures.

If you or someone you know experiences pain from sitting in the clitoris, vulva, penis, scrotum, perineum, or rectum, call 480 599-9682 or email [email protected] to learn more about available treatments.

View of the pudendal nerve through the microscope (nerve in the blue rubber band—vessel loop)

What to Expect Before and After Transgluteal Nerve Decompression Surgery

1. Prior to surgery, Dr. Hibner and his team will use some or all available non-invasive methods to help you with your pain. They may include physical therapy, suppositories, oral medications, nerve ablations, and injections of amniotic fluid or membrane products.
2. The patient and Dr. Hibner decide together whether to have the surgery. It is based on all the information from the patient’s history, exam, radiology results, and any additional testing. Also, the fact that all offered conservative treatments have failed is taken into account when deciding on surgery.
3. Transgluteal pudendal nerve decompression is Dr. Hibner’s favorite way to free the nerve from scar tissue. However, a robotic approach or a carefully chosen approach to the pudendal nerve may also be chosen in some cases.
4. Prior to the surgery, please follow all the pre-operative instructions that will be given to you during the visit
5. For the transgluteal decompression surgery, you will be positioned on your abdomen (prone), and the incision will go on the buttock on the operated side. It will measure anywhere from 2 to 4 inches.
6. When you wake up from surgery in the recovery area, you will have a catheter in your bladder, a pain pump dripping local anesthetic on your nerve, and a negative pressure dressing on the skin over the incision. You will receive a bag to wear over your shoulder for the pain pump and a device providing suction to the dressing. It is very important to be gentle with the pump to avoid dislodging the catheter. If the pain pump catheter is dislodged, it cannot be replaced.
7. You should feel numbness in the area of the pudendal nerve (where the pain was before surgery), but the incision over the buttock will be quite tender. Pain pump medication does not reach the muscles or skin of the buttock, and it is only meant to provide pain relief in the nerve.
8. Most patients spend one night in the hospital. A very rare two-night stay is required
9. You should be active and try to walk with support the next day after surgery. This prevents a loss of muscle and could also decrease the risk of nerve scarring. Please be very careful when moving and walking not to pull the pain pump.
10. You will be discharged home with pain medications, instructions on how to use the pain pump, and a negative pressure dressing. You may need to return to the clinic for the dressing and pain pump removal, or we will instruct you on how to do it yourself. When the pain pump comes out, your pain may increase until the nerve begins healing.
11. You can shower two days after surgery. Try to avoid making the area of the incision wet. You can wrap that area with a large garbage bag for the time of surgery. Water is not going to contaminate the incision but may make the adhesive covering the pain pump catheter wet, leading to the earlier removal of the pump.
12. Most patients can travel within 5-7 days after surgery, but a longer stay is encouraged before returning home.
13. You can resume the activity after surgery, but avoid doing things that significantly increase your pain. Sitting should be avoided. If surgery was done on one side, only try to sit on the opposite buttock.
14. Do not flex your hip(s) over 90 degrees. This may lead to the pulling apart of the sacrotuberous ligament, which was repaired during surgery. This ligament takes approximately 6 months to heal. You should therefore avoid squatting, taking two steps at a time when walking upstairs, etc.
15. You should resume pelvic floor physical therapy approximately 6 weeks after surgery. You will be given instructions for you and your physical therapist regarding recommended therapy.
16. It may take 3–4 months to start feeling the improvement in pain. It is normal to have better and worse days. When you have a better day, please be careful not to overexert yourself. Follow the instructions of your pelvic floor physical therapist on physical activity.
17. Please continue to take all your medications until you are instructed to stop. You can continue vaginal/rectal suppositories, but you should be decreasing the number of narcotic pain medications you take. Generally, we do not schedule patients for in-person postoperative visits. Care can be done over the phone or by telemedicine.
18. Maximum healing may take 18 to 24 months after surgery. After 2 years of surgery, the majority of patients have less or no pain. If you continue to be in pain, we will look for other solutions to help you with your condition.

Outcomes

The outcomes of this procedure depend on the causes of nerve compression, the degree to which the nerve was compressed, and how much time elapsed between the injury and surgery. Unfortunately, the degree of nerve damage is difficult to assess before surgery. From my extensive experience of doing hundreds of pudendal decompression surgeries, approximately two-thirds (66%) of patients benefit from this procedure. This number includes all the patients, even those with severe nerve injuries. That means that patients with less severe nerve injuries may benefit from the procedure even more.

The patient is positioned for pudendal decompression surgery. The incision on the buttock is marked with a pen. Electrodes are placed to monitor the pudendal nerve (NIMS monitor).

A Little History

The book “The Change of Life in Health and Disease,” published in Philadelphia in 1871, established pudendal neuralgia as a medical condition. Knowledge of pudendal neuralgia was almost lost until the late 1980s. French neurologist Dr. Gerard Amarenco reported on a series of patients with “syndrome du cyclist”, the cyclist syndrome, which occurs when a pudendal nerve is compressed between a narrow bicycle seat and the medial surface of ischial tuberosity (sitz bone).

Dr. Ahmed Shafik, an Egyptian surgeon, first described how to surgically decompress the pudendal nerve using the transperineal technique (an incision around the anus) in 1992. Soon after, my mentor, Professor Roger Robert from Nantes, France, described transgluteal pudendal neurolysis—decompression of the pudendal nerve with an approach through the buttock. Professor Robert is not only an outstanding neurosurgeon but also an anatomist, and this unique combination allowed him to develop a whole new procedure for pudendal nerve decompression.

I graduated from my fellowship in gynecologic surgery at the Mayo Clinic in 2003 and opened a pelvic pain practice in Phoenix in 2004. I started seeing patients with pelvic pain whose condition I was unable to explain using any known diseases.

So, in early 2005, I googled the symptoms: perineal/vaginal bringing pain with sitting. Several medical articles showed up, but most of them had one common name as one of the authors: Roger Robert. I then wrote to Professor Robert in Nantes, France, asking if I could come and learn from him. In the summer of 2005, I traveled to Nantes and worked with Professor Robert for almost 3 weeks, assisting him with numerous surgeries and seeing many patients in the office with him.

I also worked with the wonderful Dr. Jean Jacques Labat, a neurologist who assisted Professor Robert with diagnosing and treating patients before surgery, and with the amazing radiologist Dr. Thibault Riant, who taught me how to perform CT-guided pudendal nerve blocks. When I returned to Phoenix, I started seeing more and more patients with pudendal neuralgia and pudendal nerve compression, and I performed my first transgluteal pudendal nerve decompression in the fall of 2005.

It was the patient who developed pudendal neuralgia after the removal of Bartholin’s gland. She did well after surgery, and soon many more patients followed. I started modifying the original method that my great mentor, Professor Robert, had created from the very first surgery. The first modification was the repair of the transected sacrotuberous ligament.

There was a concern that leaving this ligament unrepaired may cause instability in the sacroiliac joint. So, from the very first patient, I would repair the sacrotuberous ligament the same way that an orthopedic surgeon repairs a ligament in the knee. Next, I incorporated the use of a neurosurgical microscope into the procedure. This allowed for significantly improved precision.

The next modification was the use of an On-Q pain pump placed next to the nerve towards the end of surgery to provide postoperative analgesia and decrease central sensitization (memory of pain in the brain). In the third change, NIMS (nerve integrity monitoring system) was added so that the nerve could be found even when there was a lot of scarring.

The next modification was the use of nerve wrap to prevent the reoccurrence of adhesions. Initially, I was using a collagen nerve conduit, but a few years ago I switched to an amniotic membrane, which, in addition to preventing adhesions, also contains factors/chemicals promoting nerve healing. The last major modification was the method by which I cut the sacrotuberous ligament. Cutting it in a Z fashion allows me better access to the nerve and facilitates the repair at the end of surgery.

Up to today, I have done several hundred of those procedures, most likely more than any other provider, with the exception of my amazing mentor, Professor Roger Robert.

From the left: Dr. Jean-Jacques Labat, me, Professor Roger Robert and Dr. Thibault Riant

For More Information, Visit:

https://www.glowm.com/section_view/heading/pudendal-neuralgia/item/691

Drawing of the steps of transgluteal pudendal neurolysis by Professor Roger Robert

View of the opened space between the sacrotuberous and sacrospinous ligaments by Roger Robert

One of my numerous publications on pudendal neuralgia

Special Thanks

The hard work and knowledge of many people led to the development of transgluteal pudendal decompression surgery, the way I perform this procedure today. I would like to take this opportunity to thank Professor Roger Robert, Professor Oskar Aszman, Dr. Jamie Balducci, Dr. Jacek Bendek, Dr. Mario Castellanos, Dr. May Nour, Cindy Love, and many others.

A big thank you from me and on behalf of my patients, whom I was able to help with the pain.

Pudendal Neuralgia and Associated Conditions

Here are some of the associated conditions with pudendal neuralgia you should be aware of:

1. Piriformis Syndrome

Piriformis syndrome is a neuromuscular disorder in which the piriformis muscle, located in the buttock region, compresses or irritates the sciatic nerve. This condition may coexist or be confused with pudendal neuralgia, as the pudendal nerve and sciatic nerve are in close proximity anatomically. Patients with piriformis syndrome often present with pain, tingling, or numbness along the distribution of the sciatic nerve, typically affecting the buttocks and extending down the leg. Treatment usually focuses on addressing the underlying muscle tightness or dysfunction through physical therapy, stretching exercises, anti-inflammatory medications, and, in refractory cases, injections or surgery.

2. Interstitial Cystitis

Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic, painful bladder condition characterized by pain and pressure in the bladder area along with a frequent urge to urinate. The pain associated with IC can be debilitating and can significantly impact the quality of life. Pudendal neuralgia might be connected to interstitial cystitis due to the proximity of the pudendal nerve to the bladder and pelvic floor muscles, influencing the sensation and function of the bladder. Management of interstitial cystitis often involves multimodal strategies, including dietary modifications, physical therapy, medications to reduce bladder pain and inflammation, and sometimes surgical interventions.

3. Vulvodynia

Vulvodynia is a chronic pain condition affecting the vulvar area in women and is often described as burning, stinging, itching, or rawness. The symptoms of pudendal neuralgia and vulvodynia can sometimes be the same. This is because the pudendal nerve supplies feeling to the vulvar area. There are many things that can cause vulvodynia, including hormonal, genetic, and inflammatory factors. It can be hard to treat. Treatment strategies are typically multimodal, including topical medications, oral pain relievers, pelvic floor physical therapy, cognitive-behavioral therapy, and, in some cases, surgery to decompress the pudendal nerve.

4. Prostatitis

Prostatitis refers to the inflammation or infection of the prostate gland, predominantly seen in men, and is characterized by discomfort, pain, urinary tract symptoms, and sexual dysfunction. Pudendal neuralgia might be interrelated with prostatitis due to the anatomical pathways of the pudendal nerve in proximity to the prostate gland, impacting sensation and pain in the region. Prostatitis can be caused by bacteria or something else. Depending on what is causing it, antibiotics, anti-inflammatory drugs, alpha-blockers, and physical therapy for the pelvic floor may help ease the symptoms.

Even though these conditions are different, they may share some symptoms, pathophysiology, and anatomical links with pudendal neuralgia, which makes diagnosis and treatment more difficult. A comprehensive and multidisciplinary approach to evaluating and treating these conditions is crucial for addressing the intricate and multifaceted nature of pelvic pain syndromes.

 

Pelvic Pain Frequently Asked Questions:

Here are some frequently asked questions that may help you greatly:

• What is Pelvic Pain?

Pelvic pain in women is a common symptom that accounts for up to 30% of visits to a gynecologist, yet it is thought that close to 70% of cases of pelvic pain are not of a gynecological origin. Chronic pelvic pain is defined as pain that has been present for six months or longer, is localized to the pelvis, and is severe enough to cause functional disability requiring treatment. It is estimated that chronic pelvic pain affects 15% of women in the United States sometime during their lifetime.

Yet, almost 60% of those patients do not have a proper diagnosis (and therefore no treatment). This is because this pain usually spans more than one specialty, and treatment requires physicians specifically trained in chronic pelvic pain. Those statistics are even more staggering because over 20% of women with pelvic pain miss work, close to 50% feel depressed, and in 90% of women, it affects their sexual life.

Pain during or a complete inability to have intercourse significantly affects personal relations between the patient and her partner and further adds to suffering. Despite the fact that chronic pelvic pain in women is more common than coronary artery disease, asthma, or migraine headaches, very few physicians specialize in its treatment. Pain is often blamed on psychological issues, and patients are often referred to a mental health provider instead of getting treatment for their true, existing disease.

• What Conditions Cause Pelvic Pain?

Multiple conditions may cause pelvic pain, often coexisting in one patient. Some of the more common conditions are:

• Endometriosis
• Interstitial cystitis/bladder pain syndrome
• Irritable bowel syndrome
• Spastic pelvic floor syndrome
• Adhesions in the pelvis and abdomen
• Pelvic congestion syndrome
• Pelvic nerve neuralgias
• Pain caused by pelvic mesh

The Arizona Center for Chronic Pelvic Pain offers comprehensive treatment for those and many other conditions causing pelvic pain.

• What is Pudendal Neuralgia?

Pudendal neuralgia is a relatively unknown cause of severe pelvic pain.

In my practice, I define it as a pain located in the area of innervation of the pudendal nerve. Pudendal nerve entrapment is an impingement of the pudendal nerve due to scar tissue, surgical supplies, or mesh. Pudendal nerve entrapment is, therefore, one of the causes of pudendal neuralgia. However, other causes, such as inflammation, spasms of the surrounding muscles, or other nerve diseases, may also be reasons for pain.

• What is Pudendal Neuralgia for Men?

Pudendal neuralgia is defined as pain in the area of innervation of the pudendal nerve. In men, the areas affected can be the penis, scrotum, perineum, and rectum. Pudendal nerve entrapment is described as compression of the pudendal nerve from ligaments, scar tissue, or surgical materials, which leads to pudendal neuralgia.

Some patients with pudendal nerve entrapment experience burning pain, but others may have a sensation of numbness. It may be present on one or both sides, and some patients experience problems with erection and pain with ejaculation. Penile numbness is one of the more frequent signs of pudendal neuralgia in men.

 

What are the Symptoms of Pudendal Nerve Entrapment?

How Do You Know If You Have Pelvic Floor Dysfunction?