Diagnosing Pudendal Neuralgia

What is pudendal neuralgia?

Pudendal neuralgia is a condition that occurs when the pudendal nerve, which runs from the back of the pelvis near the base of the penis or vagina, is damaged or irritated. This nerve sends signals to the brain from the genitals, anus and other nearby body parts. It controls the sphincter muscles that open and close when passing urine or emptying the bowels. Once this nerve is damaged, it can cause issues with bladder and anal incontinence or hesitancy, having sex or simply sitting down.

How is pudendal neuralgia diagnosed?

Pudendal neuralgia is a rare condition. The International Pudendal Neuropathy Foundation estimates that only 1 in every 100,000 people may be affected by this condition. Because it is so rare, the diagnostic process is limited. Pudendal neuralgia is a diagnosis of exclusion; doctors elimiate the possibility of other medical conditions before diagnosing an individual with pudendal neuralgia.

Gathering a history

An individual will be asked if any of the following symptoms are currently experienced or have been experienced in the past. Symptoms include, but are not limited to, the following:

• Pain or numbness in the genital area, rectum or urinary tract
• Sexual dysfunction, including persistent arousal or male impotence
• Sphincter dysfunction causing fecal and urinary incontinence or hesitancy
• A sensation of heaviness in the anus, rectum, urethra or vagina

Physical examination

A physical examination will be performed to confirm that the pain is located in the area of the pudendal nerve. Sensation in this area will be tested. Skin perspiration or dryness is often seen in individuals affected by this condition. A detailed examination of the back, abdomen and pelvic floor will also be performed.

Medical Tests

Although there is not one specific diagnostic test for pudendal neuralgia, several diagnostic tests can help health care providers reach a proper diagnosis.

• Nerve block of the pudendal nerve
  A physician injects a local anesthetic into the area of the pudendal nerve. After performing the injection, the physician waits to see if the individual experiences pain relief. If they do, this indicates that the pudendal nerve is causing the pain, and the condition is likely pudendal neuralgia.
• Pudendal nerve motor latency test
  This test is used to determine if there is nerve damage to the pudendal nerve. It measures the motor function of the nerve and helps determine if pudendal neuralgia is present.
• High-frequency ultrasonography
  This test helps determine if the pudendal nerve is flat from compression or inflamed.
• Doppler ultrasound
  Doppler ultrasound is used to diagnose compression of the pundendal nerve. This test is not ideal for this condition since the pudendal nerve is positioned deep in the pelvis, but it does have the ability to detect blood flow in the veins around the area of compression.
• Quantitative sensory threshold testing
  Quantitative sensory threshold testing is designed on the basis that when nerves are compressed, they are unable to recognize and communicate vibration and temperature fluctuations. Therefore, during the test, individuals with pudendal neuralgia will not feel gradual temperature changes in the affected area.