Pudendal neuralgia
Pudendal neuralgia (PN) results from damage, irritation, or compression of the pudendal nerves.
Symptoms of PN:
1- Burning pain, often one-sided, in the perineal region
- Tingling or numbness in the buttock, vulva, perineum
Symptoms usually get worse while sitting and may subside while standing or lying down
2 - Sexual dysfunction (pain during intercourse), genital pain in women and erectile dysfunction in men
3 - Sphincter dysfunction - constipation, fecal incontinence, urination disorders
4 - Sensation of a foreign body in the anus, vagina
Causes
PN can develop as a result of mechanical as well as non-mechanical damage to the pudendal nerves. The most common cause of mechanical damage is the compression of the pudendal nerves. Non-mechanical damage to the pudendal nerves can develop as a result of a viral infection (HIV, herpes zoster), multiple sclerosis, diabetes mellitus, etc.
The reasons for the development of PN can be
- previous surgery in the pelvic area
- direct injury of the buttocks
- natural delivery
- chronic constipation
- long cycling
- motorcycling
Treatment options
1) Drug treatment - analgesics, muscle relaxants, anticonvulsants (gabapentin, pregabalin).
2) Pudendal nerve blockade using local anesthetics and/or corticosteroids. Blockade must be performed under X-ray or ultrasound navigation control in order to minimize the risk of complications.
3) Pulse radiofrequency treatment of pudendal nerves.
4) Cryoanalgesia is a relatively new method, it means exposing the pudendal nerves to low (up to -80° C) temperature.
Prognosis
Pudendal neuralgia is a chronic disease, relapses may alternate with periods of remission. The condition considerably reduces the quality of life of patients and often leads to the development of depressive disorders.
Symptoms of PN:
1- Burning pain, often one-sided, in the perineal region
- Tingling or numbness in the buttock, vulva, perineum
Symptoms usually get worse while sitting and may subside while standing or lying down
2 - Sexual dysfunction (pain during intercourse), genital pain in women and erectile dysfunction in men
3 - Sphincter dysfunction - constipation, fecal incontinence, urination disorders
4 - Sensation of a foreign body in the anus, vagina
Causes
PN can develop as a result of mechanical as well as non-mechanical damage to the pudendal nerves. The most common cause of mechanical damage is the compression of the pudendal nerves. Non-mechanical damage to the pudendal nerves can develop as a result of a viral infection (HIV, herpes zoster), multiple sclerosis, diabetes mellitus, etc.
The reasons for the development of PN can be
- previous surgery in the pelvic area
- direct injury of the buttocks
- natural delivery
- chronic constipation
- long cycling
- motorcycling
Treatment options
1) Drug treatment - analgesics, muscle relaxants, anticonvulsants (gabapentin, pregabalin).
2) Pudendal nerve blockade using local anesthetics and/or corticosteroids. Blockade must be performed under X-ray or ultrasound navigation control in order to minimize the risk of complications.
3) Pulse radiofrequency treatment of pudendal nerves.
4) Cryoanalgesia is a relatively new method, it means exposing the pudendal nerves to low (up to -80° C) temperature.
Prognosis
Pudendal neuralgia is a chronic disease, relapses may alternate with periods of remission. The condition considerably reduces the quality of life of patients and often leads to the development of depressive disorders.