Guidelines 2016 – Pudendal Neuralgia
Guidelines for Nurse Practitioners in Gynecologic Settings 2016
I. DEFINITION
Neuropathic pain along the tract of the pudendal nerve; burning, tingling, or itching sensation usually unilateral; noted when sitting; relieved by stand- ing or lying down. Often, sensation of a foreign body in the vagina; painful defecation and urination; symptoms often concurrent with sexual arousal, penetration, and orgasm.
II. ETIOLOGY
A. Direct injury to the nerve
B. Pelvic floor muscle spasm
C. Relationship to intense exercise programs; using hip adductor fly machine
D. Pelvic surgery, especially with use of mesh
E. Childbirth trauma
F. Bicycle riding
G. Prolonged sitting
H. Constipation
I. Anal intercourse/use of anal devices
J. Excessive masturbation
III. HISTORY
A. Onset
B. Concurrent events
C. Frequency of symptoms
D. Specific triggers
E. What if anything relieves symptoms; treatments explored
IV. PHYSICAL EXAMINATION
A. Location of pain in dermatome of pudendal nerve
B. Sensation in the area
C. Skin perspiration or dryness on affected side
D. Detailed examination of back, abdomen, pelvic floor muscles
E. Assess rectus, abdominis, psoas major, levator ani, obturator internus, and coccygeus muscles for tenderness, strength, and spasm
F. Check for tenderness over ischial spines and Alcock’s canal for tingling sensation (Tinel’s sign); also can present with percussion of the dorsal branch as it emerges from under the inferior ramus of pubic bone
V. TREATMENT
A. Lifestyle changes: avoidance of injury and of trauma; avoid activities that cause symptoms
B. Medical therapy: muscle relaxants, anticonvulsants, analgesics
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