What is pudendal neuralgia?

The pudendal nerve is one of the primary nerves in the pelvis, running from the back to the base of the penis or vagina. When this nerve is not functioning correctly, it is a painful and disabling neuropathic condition. Pudendal neuralgia is a nerve condition that is characterized by several symptoms:

  • Pain in the clitoris, vulva, perineum, and rectum, especially when sitting
  • The sensation of a foreign body in the vagina, perineum, or rectum, often only on one side
  • Sudden or frequent need to use the bathroom
  • Pain during sex
  • For men, difficulty getting an erection

Causes of pudendal neuralgia

No causative factors have yet been identified, but the following can result in injury to the pudendal nerve or its branches:

  • Bicycle riding (spinning)
  • Vaginal childbirth
  • Episiotomy
  • Trauma to the coccyx (tailbone)
  • Trauma to the pelvis
  • Pelvic surgery
  • Vaginal surgery

How is pudendal neuralgia diagnosed?

The first step in diagnosing pudendal neuralgia will be a physical examination, such as a rectal or vaginal exam. Pressure will be gently applied to the nerve to see if it is causing the pain. An MRI may be needed to determine whether the nerve is trapped or other conditions, and nerve block injections may be performed to see if the pain subsides.

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What are the treatments for pudendal neuralgia?

Treatment for pudendal neuralgia typically involves a combination of the following:

  • Physical therapy
  • Physiotherapy, with a series of exercises that help relax the pelvic floor or other muscles that
  • may be irritating the pudendal nerve 
  • Lifestyle changes
  • Medicines
  • Pudendal nerve blocks
  • Ablations
  • Lifestyle changes, such as avoiding cycling and sitting down for long periods
  • Painkilling injections, such as anesthetic or steroid
  • Treatments to avoid constipation
  • Special medications for nerve pain

Every treatment plan at Pelvic Pain Doc in New York City is customized for the patient. If it is determined that the nerve is being restricted by pressure from another area of the body, surgery may be performed to relieve the pressure. At Pelvic Pain Doc, we take a multidisciplinary approach to pelvic pain and work with other specialists when needed.

BOTOX injections for pudendal neuralgia

BOTOX injections are an advanced treatment to relax the pelvic floor. This treatment should be performed by a surgeon that can do these procedures in their sleep – Dr. Bahlani. She brings the clinical acumen to properly diagnose patients with pudendal neuropathy and the skills to achieve arguably the best results. She is fellowship trained in sexual and pelvic health and has focused her practice on these issues – which many doctors are not. BOTOX injections are performed in-office, with minimal anesthesia, and are 90-95% effective. A follow-up with a second round of BOTOX injections occurs after four weeks.

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Why choose us?

If you are experiencing the painful symptoms of pudendal neuralgia, you want to ensure you are under the care of an expert in pelvic pain. At Pelvic Pain Doc, you will discover a boutique, concierge urology and gynecology practice where your condition, symptoms, and challenges matter. For 5-star care from a thought leader and expert in resolving pelvic pain, you deserve the level of care you can expect from Dr. Bahlani and her staff. Contact us today.

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