Resources & Info – Pudendal Neuralgia
What is Pudendal Neuralgia?
Pudendal neuralgia is chronic pain related to the pudendal nerve. Your pudendal nerve runs from your lower back, along your pelvic floor muscles, out to your perineum (the skin between your pubic bone and your tailbone).
It supplies the skin between the anus and the clitoris (or a man’s penis) as well as the muscles of the urethra and the anus (see light green area below).
The nerves throughout our bodies are usually supple and stretchy. They slide smoothly when we go about our everyday lives. Think about how far the nerves in your arms stretch when you reach above your head. We can also gently squash them for a while before they let us know, like the ‘dead arm’ feeling of pins and needles. They usually recover fairly quickly, too.
When nerves go through a large trauma (like a big fall onto a hard surface or a difficult labour) or lots of repetitive small trauma (like years of straining with constipation or repetitive heavy physical exercise) they can become irritated. Your nervous system can then become sensitised so that pain is triggered at a lower level, and the response is greater. It’s as though the volume is turned up for pain.
Pudendal neuralgia can come about when your pudendal nerve is exposed to traumas, the nerve is irritated, or compressed by bulky pelvic floor muscles or tight ligaments.
Symptoms of pudendal neuralgia
The main symptom of this problem is pain. This can be highly variable. You might feel burning, electric shock, shooting, aching, itch or a raw feeling in your clitoris, labia, vagina (penis in men), urethra, perineum, anus or rectum. You might find it difficult to sit because of your pain.
You may also experience bladder and bowel irritation. Sometimes you can feel this irritation without feeling much pain. Occasionally there is a full sensation in vagina or rectum.
Sometimes pain can be felt into the buttocks, legs and feet. This is because the skin there is supplied by the same level of your spinal cord and your brain ‘perceives’ the pain in the skin of your buttocks, legs and feet.
You may also have associated bladder, bowel or sexual problems.
SYMPTOMS (snippet taken from the link to the left from GLOWM)
Pudendal neuralgia is described as a neuropathic pain in the distribution of the pudendal nerve.3 Pain may be present along the entire dermatome, or may be restricted to sites innervated by the nerve’s branches (Fig. 1). Pain may be localized to the clitoris, labia, vagina, and vulva in women, and to the penis and scrotum in men, excluding testes. In both sexes, pain may be localized to the perineum, rectum, and area immediately medial and anterior to ischial tuberosities. Symptoms are frequently unilateral, however, in patients presenting with bilateral pain, there is often a more affected side. Neuropathic pain is described as a burning, tingling, or itching sensation.5 Patients have significant hyperalgesia (increased sensitivity to mild painful stimuli), allodynia (pain in response to nonpainful stimuli), and parathesia (sensation of tingling or numbness). A small percentage of patients may have pain outside the area of innervation for the pudendal nerve, commonly presenting in the lower abdomen, posterior thigh, and lower back. This pain is usually attributed to muscle spasm or somatic referred pain.
Typically, symptoms are present with sitting and absent during standing or lying down. However, with disease progression, the pain may become constant and severely aggravated by sitting. Most patients tolerate sitting for only several minutes before their pain becomes unbearable, and some are unable to sit at all. Interestingly, most patients report absence or improvement of pain when sitting on a toilet seat,6 as the body weight in this position is supported by the ischial tuberosities, thereby relieving pressure from the pelvic floor. Similarly, sitting on hard surfaces is more comfortable as well.
Another common symptom is the sensation of a foreign body in the vagina, perineum or rectum, frequently described as a “golf ball” or “tennis ball”. To help describe this sensation, we have coined the term “allotriesthesia” from the Greek allotri- (foreign) and esthesia (sensation). Defecation and urination can also be painful, leading to dyschezia and urinary hesitancy. Urinary or fecal incontinence may develop from decreased sphincter tone if motor function is affected.7 Patients with pudendal neuralgia are often diagnosed with interstitial cystitis,8 vulvodynia, dyspareunia, and persistent sexual arousal.9 Dyspareunia, pain with intercourse, can be so severe that patients are often unable to engage in sexual activity. Pain may be specific to arousal/erection, ejaculation, vaginal penetration, as well as orgasm. In contrast, pudendal neuralgia may also present as persistent sexual arousal, also called restless genital syndrome.9 It is a very unpleasant and sometimes painful sensation of intense arousal without the ability to climax. Unfortunately, this sensation remains constant, climax itself providing only momentary relief.