pudendalneuralgi

Pudendal neuralgia is a chronic pain condition that originates from irritation, inflammation, or compression of the pudendal nerve, which supplies the external genitalia, perineum, and pelvic floor. The pain is often described as burning, aching, or electric‑shock‑like and is frequently aggravated by sitting, walking, or prolonged periods of standing. In some patients the discomfort may extend to the inner thighs, buttocks, or lower back.

The etiology of pudendal neuralgia is multifactorial. Common precipitating factors include childbirth, pelvic surgery, perineal trauma, prolonged lateral position during surgery, or repetitive activities that exert pressure on the coccyx or ischial spine. Less frequently, the nerve may become inflamed due to infections, systemic inflammatory diseases, or tumors. In many cases, no clear cause is identified, leading to a diagnosis of idiopathic pudendal neuralgia.

Diagnosis requires a thorough history and physical examination focused on pain distribution and provocative maneuvers such as Carnett’s sign and the Digital rectal test. Imaging, particularly MRI of the pelvis, is used to rule out alternative pathologies such as herniated discs or tumors. Ultrasound may aid in guiding diagnostic blocks. A definitive diagnosis is often confirmed by response to a diagnostic pudendal nerve block with local anesthetic.

Treatment is usually multimodal. First‑line non‑invasive measures include physical therapy targeting pelvic floor relaxation, pessary use, and lifestyle modifications to reduce aggravating positions. Pharmacologic options involve neuropathic pain agents such as gabapentin or pregabalin, tricyclic antidepressants, and topical lidocaine. When conservative measures fail, interventional options such as pudendal nerve blocks, pulsed radiofrequency ablation, or neurolytic procedures are considered. In refractory cases, surgical decompression of the nerve or neuromodulation techniques may provide relief. Early referral to a multidisciplinary team that includes pain specialists, pelvic floor experts, and surgeons increases the likelihood of successful management.