Pudendal neuralgia
Pudendal neuralgia
Pudendal neuralgia means pain, discomfort, or sensory deficit disorders (numbness) in the area of the sexual organs and the pelvic floor. This occurs when the pudendal nerve is damaged or irritated. This results in sexual intercourse, washing, and sitting being difficult for the woman. Pain suddenly occurs and then, after some time, again “disappears“.
Symptoms include:
Sharp or burning pain
Increased sensitivity
Sensory dosorder – numbing or, in contrast, tingling
A feeling of swelling
Sudden need to go to the toilet
Pain during sexual intercourse (dispareunia)
These feelings may be worse when seated. These pains may also be felt in the abdomen, buttocks or legs.
causes
The cause may be injury, pelvic surgery, or giving birth. A tumor or inflammation can put pressure on the nerve and cause it to be irritated. In some cases the cause may be pressure placed upon it during some form of activity such as a long bicycle ride.
How the problem is diagnosed
It is necessary to see a doctor for a thorough interview and subsequent examination. Part of this procedure will include a vaginal examination, whereby the doctor will apply a finger to the passage of the pudendal nerve.
A further diagnostic tool is a pudendal block, with which the doctor applies an analgesic (antiinflamatory) compound to the area of the pudendal nerve to temporarily anaesthetize it. As a result you may notice, after a certain length of time (a few days), some relief from your problems.
In some cases a gynecological ultrasound or magnetic resonance is performed to ascertain whether some abnormal growth is not placing pressure on the pudendal nerve.
How the problem is treated
In the majority of cases pudendal neuralgia is overcome with a combination of physical treatment, lifestyle changes, and medication.
Sitting up straight with frequent standing to alleviate pressure on the pudendal nerve Picture of sitting up straight
Abstaining from cycling and squats (if these activities make the problem worse)
Physical therapy loosens and stretches the muscles of the pelvic floor. This can reduce the pressure on the pudendal nerve causing its irritation. At the same time, this approach can help in cases when the pudendal neuralgia reduces control over the bladder and digestive tract.
Muscle relaxants can relieve the tension of the pelvic floor muscles.
Antidepressants (and even some antiepileptics) can also help in the management of secondary problems.
In cases when intial treatment is insufficient, your doctor will apply an injection to the area of the pudendal nerve containing a combination of medicines which numbs the nerve or lowers the inflammatory response of the organism which is causing the irritation of the nerve.
In some cases an operation can help, during which the pudendal nerve is loosened from the surrounding tissues, which may be, for example, scarred.