Pudendal Neuralgia Fact or Fiction?

Purpose. To review the condition of pudendal neuralgia (PN) and its role in chronic pelvic pain in women. Methods. A Medline search for articles published before April, 2008 was done using a list of terms related to PN including: pudendal nerve, neuralgia, chronic pelvic pain syndromes, and entrapment neuropathies. Results. The prevalence of PN is unknown and it seems to be a rare event. The main feature is neuralgic pain in the distribution of the pudendal nerve. The most common patient's profile is a patient who had seen multiple physicians, with no evidence of organ disease, normal urogynecological and colorectal evaluations, and failed multiple pharmacologic treatments. The cause of the PN is not always clear, but it is believed that neuronal insult caused by stretching or compression is the primary etiology. FIN is said to be a diagnosis of exclusion and requires a high index of suspicion. Although there are no pathognomonic signs and symptoms, clinical diagnostic criteria were recently discussed and published by a multidisciplinary working party in Nantes (France 2006). Clinical neurophysiology tests have quite low diagnostic efficacy and must therefore be considered to be complementary investigations. Optional treatments include behavioral modifications, physical therapy, analgesics, pudendal nerve block, and surgical nerve decompression. Conclusions. PN does seem to exist as a clinical syndrome rather than a specific diagnosis. It is important to note that it does not have definite etiological implications, and there is no evidence to support equating the presence of this syndrome with a diagnosis of pudendal nerve entrapment although that may be 1 etiological condition.