Minimally Invasive Interventional Management of Pudendal Neuralgia: A Narrative Review

Chronic pelvic pain (CPP), affecting approximately 26% of women globally, is a multifactorial condition with causes including, but not limited to, gynecologic disorders, musculoskeletal disorders, and neuropathic disorders including pudendal neuralgia. A comprehensive evaluation and a multimodal treatment strategy - encompassing medical, minimally invasive non surgical, and surgical therapies - are essential for effective management. This narrative review explores current minimally invasive interventional management options for pudendal neuralgia causing CPP.

Pudendal nerve blocks demonstrated pain relief, but the duration of relief varied. Pulsed radiofrequency ablation revealed longer-lasting pain relief compared to pudendal nerve blocks, with several clinical trials and case reports supporting its efficacy. Additionally, neuromodulation techniques, including neuraxial and peripheral nerve neuromodulation, showed promising results in alleviating pain for patients who did not respond to conservative measures. While studies describe interventional therapy for pudendal neuralgia, there is a dearth of randomized controlled trials, which limits the ability to generalize treatment options for pudendial neuralgia. Despite this, current data suggest the possible benefit of interventional management of for pudendal neuralgia.