Pudendal neuralgia is a condition that affects both men and women and concerns chronic pain in the pudendal nerve. The pudendal nerve runs from the lower back, along the pelvic floor out to the perineum. It leads to pain in the genital area like the clitoris and vulva in women and penis and scrotum in men. It is a condition that occurs when the pudendal nerve is exposed to trauma or is compressed by big pelvic floor muscles and tight ligaments.
The nerves in the human body are stretchy and supple. The pudendal nerve can become irritated if a patient experiences major trauma like an accident, or fall or more minor traumas like years of straining, constipation, or heavy exercise. When the nerves are irritated the pain response is greater.
Different causes of pudendal neuralgia include:
- Direct injury to the nerve
- Compression of the pudendal nerve by pelvic floor muscle spasms
- Injuries to the pudendal nerve due to infections and various diseases
- Compressions of the spinal cord or nerve roots
The most common causes are:
- Prolonged sitting
- Pelvic trauma or surgery
- Bicycle riding
- Anal intercourse or excessive masturbation
The pain from pudendal neuralgia is described as itching, burning and tingling sensation in the genital area affecting both men and women. The symptoms get worse while sitting and they tend to get better when a person is lying down or standing.
In women the pain is localized in the clitoris, labia major, labia minor, vagina and vulva. In men the pain is localized in the penis and scrotum, not usually affecting the testes.
Its is very rare for the pain to spread to other parts like the lower back or abdomen.
The pain is described as itching, burning or tingling sensation and rarely spreads to parts outside of the zone of the pudendal nerve. Sometimes it may spread to the lower back, posterior thigh or even the lower abdomen. The pain while having sexual activity is so intense, that patients suffering from pudendal neuralgia are not able to engage in sexual activity at all.
Treatment for pudendal neuralgia is conservative and most often improved via changes to one’s lifestyle. For those with limited ability to change their lifestyle, medication such as muscle relaxants, analgesics and anticonvulsants are recommended..
If the cause of the pudendal neuralgia are muscle spasms, then physical therapy is recommended as treatment to relax the pelvic floor. If there are no improvements with physical therapy, injections with Botulinum toxin are another treatment option.
Steroid injections or local anesthetics are another treatment option. Surgical decompression of the pudendal nerve is a treatment choice for patients with pudendal nerve entrapment.