Treatment of Chronic Pelvic Pain Syndrome with Neuropathic Perineal Pain in the Pudendal Nerve Distribution (Pudendal Neuralgia)
This page covers the structured, evidence-based approach to chronic pelvic pain syndrome presenting as neuropathic perineal pain confined to the distribution area of the pudendal nerve, where there is objective evidence of nerve injury or damage.
Clinical scenario
The patient presents with perineal pain in the pudendal nerve territory, arising from demonstrable nerve damage. This condition — pudendal neuralgia — is a specific disorder distinct from primary perineal pain syndrome and represents the most frequently described form of nerve-damage-related perineal pain.
Treatment approach (partial overview)
Management in this setting centres on a surgical intervention directed at the pudendal nerve itself. The approach and technique selection depend on the underlying pathology.
The complete structured regimen — including approach selection, patient criteria, and sequencing — is available in the full protocol.
References
- Primary perineal pain syndrome should be distinguished from pudendal neuralgia, which is a specific disease associated with perineal pain that is caused by nerve damage.
- In the literature, pudendal neuralgia is the most often mentioned form of nerve damage.
- Decompression of an entrapped or injured nerve is a routine approach and probably should apply to the pudendal nerve as it applies to all other nerves.
- One prospective RCT (transgluteal approach) suggests that, if the patient has had the pain for less than six years, 66% of patients will see some improvement with surgery (vs. 40% if the pain has been present for more than six years).
- There are several approaches, and selection is largely dependent on the underlying pathology.
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