Pudendal Neuralgia Treatment
A rarer cause of chronic pelvic and genital pain is a disease called Pudendal Neuralgia. I have treated many patients over the past few years with this diagnosis, and it has been professionally rewarding for me – and a long-overdue relief for them.
My offices are in Bellevue and Seattle, WA, but I have helped pudendal neuralgia sufferers from all over the world and the US, including patients from British Columbia, London, Ecuador, Idaho, New York, Texas, Georgia, South Carolina, Montana, Oregon, Arizona, Nevada, California, Utah, Kansas, Alaska, Hawaii, and Michigan. I may be able to help you, too.
What Is Pudendal Neuralgia?
“Pudendal neuralgia is a commonly overlooked condition when evaluating chronic pelvic and genital pain disorders. The pain associated with many of the following disorders may be caused by (or in part by) pudendal neuralgia or pudendal nerve entrapment: vulvodynia, vulvar vestibulitis, interstitial cystitis, irritable bowel syndrome, chronic or non-bacterial prostatitis, prostadynia, burning scrotal syndrome, chronic pelvic pain syndrome, proctalgia fugax, hemorrhoids, coccydynia, piriformis syndrome, anorectal neuralgia, pelvic congestion, pelvic floor dysfunction, ischial bursitis, levator ani syndrome, and others. All of these disorders can have the same symptoms as pudendal neuralgia or actually be caused by PN. Sadly, it is common for patients with any of these conditions to be told their problem is psychosomatic and to seek psychiatric help.” — Health Organization for Pudendal Education
What Causes Pudendal Neuralgia?
The pudendal nerve is a very little-known but very important nerve in the pelvis. It is a nerve that provides sensation to your inner buttocks, anus, perineum (the area between your anus and genitalia), and genitals.
This nerve can be injured or irritated for many reasons. In roughly 50% of patients, we have no idea what triggered the issue. Some patients have Pudendal neuralgia from falling on their buttocks while snowboarding. It can be as simple as that. Some patients have endured serious surgeries such as pelvic sling mesh placement and have woken up with this pain. Regardless of the cause, the symptoms can be severely debilitating.
Typically my female patients with pudendal neuralgia experience severe perineal burning electrical pain and pain around the genitals, especially the vulva and the clitoris. They often complain of a sensation of “sitting on a rock” near their sitting bones (ischial tuberosities).
Men with pudendal neuralgia typically have pain more focused around the scrotum or end of the penis. The most common cause in men by far is extreme bicycling.
The images you see demonstrate the course of the pudendal nerve, and you can imagine that burning, electrical, stinging pain anywhere along this nerve would be extremely distressing.
How to Combat Pudendal Neuralgia
The first step in beating pudendal neuralgia is education. This means finding physicians that are versed in this nerve. Unfortunately, there are very few of us. This seems to be due to the fact that we are not taught about the pudendal nerve in medical school, residency, or even fellowship training. Indeed, I’ve spoken to urologists and gynecologists who either had forgotten about this nerve or had no idea it can play a role in chronic pain. Even though I completed a very intensive Pain Medicine fellowship, I never learned of it either. It was not until I started seeing patients in my clinic for whom nobody had found a diagnosis that I did further research and came to appreciate the importance of this nerve.
I’d strongly recommend you visit pudendalhope.info to get educated on this condition. It is a wonderful resource for education and resources.
The next step is getting diagnosed and treated. Typically, this means seeing a urologist, uro-gynecologist, or OB/GYN specialist who likes to treat pelvic pain. One such person I can highly recommend in my state of Washington is Dr. Cindy Mosbrucker and her colleague Dr. Irene Grias. If it is found that your pain is not due to issues with your internal organs, then the pain may be due to pudendal neuralgia. This is when I can help.
Typically I will review your records from the other specialists you have seen to be sure no diagnosis has been overlooked. I review any tests such as MRIs you may have had. I then perform a very careful history and gentle physical exam. We then discuss treatment options.
The treatment options are generally “multi-modal,” which means it would involve referral to various specialists with unique skills in treating this issue, such as physical therapists who work on the pelvic floor. Medications such as custom made suppositories to relax your pelvic nerves and muscles may be prescribed. Special Imaging studies such as MRI neurogram of the pudendal nerves may be ordered. Typically, I will want to confirm your Pudendal nerves are causing your pain by using an ultrasound machine to see the nerves and guide a thin needle to them through your buttocks and turn them off temporarily via a local anesthetic injection. This is called an ultrasound-guided pudendal nerve block. Oftentimes the treatment just detailed is sufficient to cure the issue. If insufficient, you may be a candidate for other procedures I perform such as low volume caudal epidural injections, pulsed radiofrequency ablation of the pudendal nerves, botox injections into the pelvic floor muscles, or spinal cord stimulation trial over a special area of the spinal cord called the conus meddularis.
Need to discuss options? Contact me
Pudendal Neuralgia is a challenging condition to treat and to diagnose, but there is hope. Feel free to contact me, Dr. Jason Attaman, to discuss treatment options. You can call my office at 206-395-4422 (Seattle) or 425-247-3359 (Bellevue), or to schedule an appointment online.