The pudendal nerve carries signals to and from the genitals, anal area and urethra. Although there are slight differences in each patient’s nerve branches, there are typically three branches of the nerve on each side of the body; a rectal branch, perineal branch, and clitoral/penile branch (female/male, respectively). While ongoing research is underway to determine the exact areas innervated by the pudendal nerve, peripheral neuralgia occurs when the pudendal nerve, or one of its branches, becomes damaged, inflamed, or entrapped.
Pudendal neuralgia is a condition that results in pain in the lower pelvic areas. Causes include prolonged sitting or trauma to the genital area, combined with genetic and developmental susceptibility. A pudendal nerve block is an important diagnostic tool when pudendal neuralgia is suspected after studying a patient’s history and physical examination.
How is the procedure performed?
The patient is administered a mild sedative, then a real-time x-ray known as a fluoroscope is used to navigate a nerve stimulator to localize the pudendal nerve. Using a stimulating needle, a small electrical current is passed along the pudendal nerve and a tingling sensation in the area innervated by the pudendal nerve. Next, a small amount of local anesthetic and possibly cortisone (steroid) is injected. The steroid works as an anti-inflammatory, reduces compression and pain. The procedure offers diagnostic and therapeutic pain management.
What should be expected?
Numbness and pain relief identifies the pudendal nerve as the likely cause. However, the cause of pain may involve one or more of the many nerves in the pelvic region. Other causes of pudendal neuralgia include: coccydynia, piriformis syndrome, interstitial cystitis, myofascial pain, trigger points, connective tissue restrictions and adverse neural tension, sacroiliac joint dysfunction and other spine-related pathology. For further diagnoses, patients are recommended to see their gynecologist or urologist.