Pudendal neuralgia

The term pudendal neuralgia (PN) is used interchangeably with 'pudendal nerve entrapment', but a 2009 review study found both that 'prevalence of PN is unknown and it seems to be a rare event' and that 'there is no evidence to support equating the presence of this syndrome with a diagnosis of pudendal nerve entrapment,' meaning that it is possible to have all the symptoms of pudendal nerve entrapment (otherwise known as pudendal neuralgia) based on the criteria specified at Nantes in 2006, without having an entrapped pudendal nerve. A 2015 study of 13 normal female cadavers found that the pudendal nerve was attached or fixed to the sacrospinous ligament in all cadavers studied, suggesting that the diagnosis of pudendal nerve entrapment may be overestimated. There are no specific clinical signs or complementary test results for this condition. The typical symptoms of PNE or PN are seen, for example, in male competitive cyclists (it is often called 'cyclist syndrome'), who can rarely develop recurrent numbness of the penis and scrotum after prolonged cycling, or an altered sensation of ejaculation, with disturbance of micturition (urination) and reduced awareness of defecation. Nerve entrapment syndromes, presenting as genitalia numbness, are amongst the most common bicycling associated urogenital problems. The pain is typically caused by sitting, relieved by standing, and is absent when recumbent (lying down) or sitting on a toilet seat. If the perineal pain is positional (changes with the patient's position, for example sitting or standing), this suggests a tunnel syndrome. Anesthesiologist John S. McDonald of UCLA reports that sitting pain relieved by standing or sitting on a toilet seat is the most reliable diagnostic parameter. Other than positional pain and numbness, the main symptoms are fecal incontinence and urinary incontinence. Differential diagnosis should consider the far commoner conditions chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis. Similar to a tinel sign digital palpitation of the ischial spine may produce pain. In contrast, patients may report temporary relief with a diagnostic pudendal nerve block (see Injections), typically infiltrated near the ischial spine. Electromyography can be used to measure motor latency along the pudendal nerve. A greater than normal conduction delay can indicate entrapment of the nerve.