Pudendal Nerve Injury

Other Names

• Pudendal Neuralgia

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Pathophysiology

Pathoanatomy

• Nerve Roots -S2-S4
• Consists of sensory, motor and autonomic nerve fibers
  • Sensory - innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineum
  • Motor - innervates various pelvic muscles, the external urethral sphincter and the external anal sphincter.
• Forms at the sacral plexus, descends and passes between the piriformis and ischiococcygeus muscles. Nerve exits the pelvis through the greater sciatic foramen, crosses the sacrospinous ligament and re-enters at the lesser sciatic foramen

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Clinical Features

• History
  • Burning pain in the distribution of the pudendal nerve
    • Females - Vulva, vagina, clitoris, perineum, rectum
    • Males - Glans penis, scrotum, perineum, rectum
  • Commonly report hyperalgesia, allodynia or paresthesias
  • May have associated symptoms of urinary frequency, urgency, symptoms of painful bladder and dyspareunia
  • Classic presentation is unilateral, however bilateral has been reported
  • Pain is worse while sitting, relieved with standing or lying down
  • Commonly worse when sitting on chair than on toilet
    • This allows descent of levator ani with less compression of nerve
  • Patients may report sensation of sitting on an object or foreign body in vagina
  • Patients commonly favor sitting on a certain side
• Physical Exam
• Special Tests

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See Also

• Neuropathies (Main)

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