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[Pudendal neuralgias].
1Chirurgien gynécologue et de la douleur, centre L'Avancée, clinique Axium, Aix-en-Provence, et centre de la douleur, hôpital Saint-Joseph, Paris, France.
La Revue Du Praticien
|June 23, 2025
Summary
Pudendal neuralgia diagnosis is clinical, focusing on neuropathic pain patterns. Surgical decompression offers significant pain relief and healing for carefully selected pudendal nerve entrapment patients.
Area of Science:
- Neurology
- Pain Medicine
- Surgical Anatomy
Background:
- Pudendal neuralgia (NP) presents as neuropathic pain in the pudendal nerve distribution.
- Diagnosis is primarily clinical, relying on pain characteristics and location.
- Pudendal nerve entrapment (PNE) is a common cause, requiring adherence to specific diagnostic criteria.
Purpose of the Study:
- To outline the diagnostic approach for pudendal neuralgia.
- To review the various causes of pudendal neuropathies.
- To present current treatment recommendations for pudendal nerve entrapment.
Main Methods:
- Clinical diagnosis based on neuropathic pain and topography.
- Exclusion of tumoral or anatomical abnormalities via pelvic MRI.
- Diagnostic anesthetic block test for pudendal nerve entrapment.
Main Results:
- Pudendal nerve entrapment requires meeting the five Nantes criteria and responding to anesthetic injection.
- Other causes include stretching, trauma, metabolic, infectious, toxic, and myofascial factors.
- Surgery for PNE shows 70-80% pain improvement and 50-60% healing rates in selected patients.
Conclusions:
- Clinical evaluation is key for diagnosing pudendal neuralgia, with MRI used to exclude other pathologies.
- Multimodal treatment is the first-line approach for PNE.
- Surgical decompression-neurolysis is effective for refractory PNE after a positive block test.
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