Pudendal neuralgia is inflammation or entrapment of the pudendal nerve resulting in pain, burning, or pressure in the path of the nerve. A very difficult condition to diagnose, there are no specific tests for diagnosis. Diagnosis is primarily one of exclusion of all the other possible conditions. It appears in most patients that sit for long periods of time or experience trauma in a fall or an accident to the pelvis.
The characteristic pain of pudendal neuralgia is positional, increases by sitting and improves on standing, and disappears when lying down. It improves when pressure is relieved from the perineal area. Fecal and urinary disorders may also be related to the dysfunction of the pudendal nerve. Chronic burning in the vagina, pain with intercourse, constant arousal sensation, and urinary tract infection sensation may also be present.
A pudendal nerve block, injection of an anesthetic in the region of the pudendal nerve, can be both diagnostic and therapeutic. If numbing the pudendal nerve resolves the pain then the diagnosis may likely be established. Nerve studies are also helpful in establishing the proper functioning of the nerve and MRI may be able to identify the entrapment of the nerve.
Treatment is usually a combination of pudendal block, pelvic floor therapy, medication, and ultimately surgical nerve release.
Dr Tahery as a urogynecologist has a good grasp of the anatomy and function of the nervous system in the pelvic region and can help you identify the source of your pain and recommend the appropriate treatment.