Neurophysiology of the female pelvic floor

The neurogenic theory of female pelvic floor dysfunction suggests a common thread for malfunction of pelvic visceral and support activities. Support for the neurogenic hypothesis has been promoted by recent literature showing that more central neuropathic processes, such as in the cauda equina or pelvic plexus, can be associated with the previously described peripheral neuropathies and are linked to pelvic floor disorders. Damage by vaginal dissection has been suggested as another etiologic factor. This concept has further been supported by studying the effects of pudendal nerve blockade. Methods for investigating pelvic floor neurophysiology are becoming more refined and widespread, and therapeutic horizons are described including nerve stimulation and surgical therapy of nerve compression.