A rare and often overlooked genital condition, pudendal neuralgia involves injury or inflammation of the pudendal nerve in the pelvis. This nerve provides sensation to your inner buttocks, anus, perineum (the area between your anus and genitalia), and genitals. It 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.
In Dr. B’s experience, pudendal neuralgia is most often misdiagnosed myofascial pain. Injury to fascia causes numbness, tingling, burning, aching, cramping, and more.
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.”
There are many causes of pudendal neuralgia. In roughly 50% of all cases, there is 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. Fortunately, there are numerous natural and holistic remedies that can provide relief without surgery.
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.
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.
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.
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.
There are a variety of muscle relaxants that may be beneficial. Anti-seizure medications,
antidepressants, benzodiazepines, and opioids can also be prescribed for pudendal neuralgia. People who suffer from this condition may also benefit from medical marijuana or CBD pills.
People who suffer from pudendal neuralgia may also benefit from radiofrequency treatments. At our Cincinnati health and wellness clinic, we use TempSure Envi 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.