Pudendal neuralgia overview

Chronic pain affecting the pudendal nerve

The pudendal nerve connects the spinal cord to the genitalia and the skin of the perineum (the section of skin between the genitals and the anus) and the anus. It provides sensation from these areas, as well as control of a number of muscles in the pelvic area, including the anal and urethral sphincters, which control urination and defecation.

Neuralgia is the medical term used to describe chronic pain relating to a specific nerve, and pudendal neuralgia is therefore chronic pain related to the pudendal nerve.

The condition can affect both sexes, but is relatively rare.

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Common causes of pudendal neuralgia

What can damage the pudendal nerve?

As with all types of neuralgia, pudendal neuralgia is caused by some form of damage to the nerve. This can be physical damage, or damage caused by some other medical condition.

Causes of pudendal neuralgia include:

  • Childbirth trauma
  • Infection
  • Pelvic injury
  • Certain sports and exercises
  • Intense physical exercise
  • Colorectal or gynaecological surgery
  • Tumour compression on the pudendal nerve

Myelopathy can also be caused by radiation treatment.

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Pudendal neuralgia symptoms

How pudendal nerve pain can present

The main symptom of pudendal neuralgia is pain, which can be anything from itchiness to shooting pains or a dull ache, affecting the genital area from the penis or vagina to the rectum.

This sometimes makes sitting down quite painful. Many people with the condition do not have pain in the morning, but it starts in the middle of the day and gets worse until night time, when it reduces or goes away.

Symptoms relating to childbirth are sometimes temporary and resolve themselves within a few weeks, although this is not always the case. Other symptoms may include:

One-sided pain

Pain may be limited to one side or to the front or back of the body.

Loss of genital sensation

Reduced sensation, sometimes accompanied by pain during sexual intercourse or erectile difficulties.

Numbness or pins and needles

Altered sensation affecting the genital area.

Bladder or bowel problems

Difficulty urinating or defecating, sometimes with a feeling of fullness or urgency.

Pain beyond the pelvic area

Pain may also affect the buttocks, legs and feet.

Pudendal neuralgia tests and diagnosis

How pudendal nerve pain is assessed

The first step in the diagnosis of pudendal neuralgia is a review of medical history and symptoms by your doctor. An examination will involve an assessment of the function of muscles, joints and reflexes, which may involve palpation (i.e. checking with the fingers) via the rectum or vagina of the pudendal nerve itself.

A pudendal nerve block may be recommended. This is a form of local anaesthetic to the nerve itself which numbs the skin of the perineum. If the pain resolves, then this indicates it is the pudendal nerve that is affected.

Other tests that may be recommended include ultrasound to check the pelvic floor muscles and bone structure at the base of the spine (sacro-iliac area), and / or an MRI scan to check that the symptoms do not have another cause.

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