What is pudendal neuralgia?
Pudendal neuralgia is a painful irritation of the pudendal nerve, which presents itself as pain in the area between the genitals and the anus (perineal region). Pain can radiate forwards and backwards and be accompanied by other symptoms such as urinary or fecal continence or disorders of sexual function. It is also typical that the pain increases when sitting and decreases significantly when lying down. The disease is relatively rare and affects women twice as often as men.
Causes
The causes of pudendal neuralgia are manifold. In most cases, it is a mechanical compression of the nerve that causes irritation and thus pain. This is for example the case with cyclists, where a permanent constriction of the pudendal nerve occurs during longer distances.
But also in the case of a change in the surrounding tissue, such as vascular disease and damage to the connective tissue, constriction can occur. Not infrequently, pudendal neuralgia occurs as a result of operations in the pelvic region. In this case, there is a risk of direct injury to the nerve by the surgeon, on the one hand, and the risk of mechanical irritation due to excessive traction on the leg, as is often the case in fracture surgery, on the other.
In addition to these mechanical causes, there are a number of other diseases that can lead to the clinical picture of neuralgia of the pudendal nerve. These include diabetes mellitus and so-called shingles. and shingles
Diagnosis
The diagnosis of pudendal neuralgia is ensured not only by a detailed medical history, but above all by the use of several imaging and electrophysiological methods. In electrophysiology, where, among other things, the nerve conduction velocity can be measured, this is usually shown to be prolonged. Imaging procedures such as X-rays or an MRI are mainly used to search for possible causes and exclude other differential diagnoses, since pudendal neuralgia itself is rarely accompanied by structural changes that can be detected in imaging. Thus, the diagnosis of pudendal neuralgia is mainly guided by the clinical picture of the symptoms, which is usually specific for this disease.
