6 months 1 week post op in Pudendal Decompression Surgery

What is pudendal Neuralgia?

PN is pain, discomfort or numbness in the distribution of the pudendal nerve. The pudendal nerve is a peripheral nerve that is the main nerve of the pelvis/ pelvic floor. The pudendal nerve emerges from the S2, S3, and S4 roots’ ventral rami of the sacral plexus. It carries sensory, motor, and autonomic fibers, however an injury to the pudendal nerve causes sensory deficits more than motor. These areas include the rectum, anus, urethra, perineum, and genital area. In women this includes the clitoris, mons pubis, vulva, lower 1/3 of the vagina, and labia. In men this includes the penis and scrotum. But often pain is referred to nearby areas in the pelvis. The symptoms can start suddenly or develop slowly over time. Typically pain gets worse as the day progresses and is worse with sitting. The pain can be on one or both sides depending on which nerve fibers and which nerve branches are affected. The skin in these areas may be hypersensitive to touch or pressure (hyperesthesia or allodynia). This is a chronic/ lifelong issue that can severely affect a persons quality of life and there are no simple treatment options.

What is pudendal nerve entrapment syndrome?

Pudendal nerve entrapment or PNE… is pain caused by a mechanical compression/ entanglement of the pudendal nerve between ligaments or scar tissue. Usually the sacrotuberous ligament and or the sacrospinous ligament. The only way to really definitively tell if you have a nerve entrapment is via surgery although some other specified imaging techniques which are able to image/ doppler where there is a hold up/ issue with nerve within scar tissue. This phenomenon is still debated and under studied. Pudendal decompression surgery is how this issue is diagnosed/seen. There are a few doctors who perform the surgery in the USA, but in Europe there are more options in terms of surgical techniques and experience. Please visit www.pudendalhope.com for more information.

The pudendal nerve entrapment syndromes subdivide into four types based on the level of compression.
Type I - Entrapment below the piriformis muscle as the pudendal nerve exits greater sciatic notch.
Type II - Entrapment between sacrospinous and sacrotuberous ligaments - this is the most common cause of nerve entrapment.
Type III - Entrapment in the Alcock canal.
Type IV - Entrapment of terminal branches.