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.
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…
- Trauma during childbirth - this is the most common cause of pudendal neuralgia in women.
- Surgery in the pudendal area - generally colorectal or gynaecological surgery.
- Other injury to the pelvic / pudendal area – caused for example by a heavy fall on to the bottom.
- Some sports/exercises – particularly cycling (especially long distance), weightlifting and some specific exercises for the pelvic area, such as 'Kegel' exercises.
- Intense physical exercise.
- Compression on the nerve from a tumour.
The main symptom of pudendal neuralgia is pain (this 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.
Other symptoms may include…
- Pain limited to one side only, or to the front or the back of the body.
- Loss of sensation in the genitals (in some cases accompanied by pain during sexual intercourse or in men an inability to get an erection) .
- Numbness / pins and needles in the genital area.
- Problems defecating and / or urinating (sometimes accompanied by a feeling of fullness in the bladder or rectum, or by an urgent need to defecate).
- Pain in the buttocks, legs and feet.
Symptoms relating to childbirth are sometimes temporary and resolve themselves within a few weeks, although this is not always the case.
Tests / Diagnosis
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.