Pudendal neuralgia, a severe pain syndrome

Objective To describe the clinical and electrodiagnostic findings, therapies, and outcomes of patients with pudendal neuralgia. Study design A retrospective, descriptive study of 64 patients from March 19 to December 22, 2003. Results Clinical findings included pain along nerve distribution (64, 100%), pain aggravated by sitting (62, 97%), pain relieved by standing or lying (57, 89%), and misdiagnosis (53, 83%). Neurophysiologic findings were normal (23, 35%), demyelination (17, 26%), axonal loss (5, 7.5%), and demyelination with axonal loss (21, 32%). Therapies were conservative (64, 100%), nerve injection (38, 59%), neuromodulation (2, 3%), and decompression surgery (10, 15%). Slight or moderate pain improvement with therapies included conservative (64, 100%), nerve injection (12, 31%), neuromodulation (2, 100%), and decompression (6, 60%). Conclusion Pudendal neuralgia is poorly recognized and poorly treated. Improvement is gained with conservative therapy. Injections and decompression benefit one half and one third of patients, respectively. Neuromodulation needs further evaluation.