Hip / Groin / Leg

Pudendal Neuralgia

Definition

Pudendal neuralgia is a neurological disorder due to lesions or dysfunction of this nerve, and is accompanied by pain and neurological deficits in region of the pudendal nerve.

Aetiology

Pudendal neuralgia is caused by entrapment near the sacrotuberal or sacrospinal ligaments, or in the channel of Alcock. Pudendal neuralgia is also seen in herpes zoster. Other aetiological factors are surgery and cycling.

Signs and symptoms

The symptoms of pudendal neuralgia neuropathy usually consist of an unpleasant painful feeling in the penis, scrotum, greater labia, vulva and perineum. The pain is provoked by sitting, and disappears during standing and with the patient in the supine position. Patients complain of a characteristic burning, stabbing neuropathic pain.

Diagnostics

Physical Examination

Neurological examinations, particularly in the region of the pudendal nerve, can confirm the diagnosis.

Additional Somatic Diagnostics

  • Prostate disease must be excluded
  • EMG pelvic floor
  • RAND-36 (quality of life)
  • VAS Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.

Interventional Pain Treatment