A rare and often overlooked genital condition, pudendal neuralgia involves injury or inflammation of the pudendal nerve in the pelvis. The pudendal nerve runs from the back of your pelvis to the vagina or penis, where it then splits into many other nerves. This nerve provides sensation to your inner buttocks, anus, perineum (the area between your anus and genitalia), and genitals.
In women, pudendal neuralgia is often experienced as severe burning or almost electrical pain and pain around the genitals, especially the vulva and the clitoris. In men, it is experienced with a burning sensation around the penis and the scrotum. Pain from pudendal neuralgia is often intermittent and exacerbated by certain movements and positions.
In Dr. B’s experience, pudendal neuralgia is most often misdiagnosed myofascial pain. Injury to fascia causes numbness, tingling, burning, aching, cramping, and more. Pudendal nerve pain is not any different. Doctors are taught that pain comes from nerves, and and many of us now know that pain is not what we were taught. Pain rarely comes from a nerve as we were taught.
Here’s how the Health Organization for Pudendal Education describes the condition:
“Pudendal neuralgia is a commonly overlooked condition when evaluating chronic pelvic and genital pain disorders. The pain associated with many of the following disorders may be caused by (or in part by) pudendal neuralgia or pudendal nerve entrapment: vulvodynia, vulvar vestibulitis, interstitial cystitis, irritable bowel syndrome, chronic or non-bacterial prostatitis, prostadynia, burning scrotal syndrome, chronic pelvic pain syndrome, proctalgia fugax, hemorrhoids, coccydynia, piriformis syndrome, anorectal neuralgia, pelvic congestion, pelvic floor dysfunction, ischial bursitis, levator ani syndrome, and others. All of these disorders can have the same symptoms as pudendal neuralgia or actually be caused by PN. Sadly, it is common for patients with any of these conditions to be told their problem is psychosomatic and to seek psychiatric help.” And, most of the time all of these diagnoses are actually misdiagnosed myofascial pain and they can be successfully treated.
Causes & Symptoms of Pudendal Nerve Pain
As you can see, there are many causes of pudendal neuralgia. Even so, in roughly 50% of all cases, there is thought to be no known cause. Yet the condition generally occurs from a blow or an injury — sometimes as simple as falling onto the buttocks and injuring the nerve. Pudendal nerve pain can also result from sitting too long, bike riding too much, running or horseback riding a lot. And in these cases, the pain is not usually coming from the pudendal nerve. Most likely you have injuries to your thigh, hip and pelvic fascia from childhood through adulthood. Dr. Blatman can most likely help you feel and understand these injuries and then help your body repair.
Dr. B has found that pelvic pain should not be attributed to the pudendal nerve until there is no tenderness or spasm in the muscles and fascia of the thighs, abdomen, pelvis, and buttocks. Ruling out myofascial pain helps isolate the pudendal nerve as the cause of your pain.
Symptoms of pudendal neuralgia can affect your life in the most intimate of ways, which can be taxing emotionally as well as physically. Besides the symptoms of burning, numbness and pain from the pudendal nerve, other problems patients tend to have with pudendal neuralgia include:
- Trouble becoming aroused
- Frequent and sudden urges to use the restroom
- Pain during sex
How is Pudendal Neuralgia Diagnosed?
This condition, which most doctors consider rare, is diagnosed by ruling out other possible causes. This includes a comprehensive physical exam to rule out myofascial pain and other injuries and illness. Doctors may inject a nerve block into the pudendal nerve to see if your symptoms abate. They may also do an MRI to see if there is anything compressing or irritating the nerve.
Fortunately, if your condition is, in fact, pudendal neuralgia, there are numerous natural and holistic remedies that can provide relief without surgery.
Physical Therapy for Pudendal Nerve Pain
Physical therapy, particularly exercises that benefit the pelvic floor, can do wonders for what is called pudendal neuralgia, mostly because injured fascia gets a chance to unkink and heal. Pelvic floor physical therapy — in which a physical therapist places their fingers through the vagina and or rectum to stretch contracted pelvic floor muscles — may also be beneficial. If any of this work helps even temporarily, your suspected neuralgia is really myofascial pain.
At our health and wellness clinics in Cincinnati and Manhattan, we can help set you up on an exercise and therapy program that can help strengthen and heal your pelvic fascia, and ease the pain attributed to pudendal neuralgia. We also have 30 years of experience making pelvic pain go away.
At-Home Remedies for Pudendal Nerve Pain
There is that classic joke where the patient walks into a doctor’s office and says, “Doctor, it hurts when I do this…” The doctor responds, “Then don’t do that.” We offer the same advice. Change your lifestyle to accommodate the condition. Avoid exercises that are painful such as bicycling, bending, and squatting. Avoid prolonged sitting or use a donut cushion when necessary. Some therapeutic gels may provide relief.
Not that we want to discourage exercise — only exercises that can cause pain to the genital or buttock area. Swimming provides great fitness for those who suffer from pudendal neuralgia because it involves no pressure or contact to the afflicted areas.
Treating Pelvic Pain with Oral Medications
There are a variety of muscle relaxants that may be beneficial for pudendal nerve pain, as they help release tension in the area where the damaged fascia is causing the nerve to be irritated. Anti-seizure medications, antidepressants, benzodiazepines, and low-dose opioids can also be prescribed for pudendal neuralgia.
People who suffer from this condition may also benefit from a medical marijuana recommendation from a certified MMJ doctor so they can treat the pudendal nerve pain with medical marijuana or CBD pills.
Radiofrequency Treatment for Pelvic Pain & Pudendal Neuralgia
People who suffer from pudendal neuralgia may also benefit from radiofrequency treatments. At our Cincinnati health and wellness clinic, we use TempSure Vitalia to gently heat the skin and vagina to increase collagen production in the area. The process is not uncomfortable. The procedure takes about 45 minutes and can be done perhaps within the space of your lunch hour. There is no recovery time needed.
The Blatman Health & Wellness Center: Regenerative Therapies for Holistic Healing
There is an alternative to pharmaceuticals and surgeries for a host of painful conditions like pudendal neuralgia. Our clinic focuses on regenerative therapies and whole-body wellness; treatments that will truly heal the problem at-hand, not just cover the symptoms.
If you’re suffering from chronic pain, whether pelvic, knee, back, shoulder, etc., you can benefit from stem cell injections, PRP treatments, or prolotherapy. Combined with pain remedies like massage therapy, RF technology, biofeedback or medical marijuana, we can help you relieve your pain without the risks that come with invasive procedures.