What Is Pudendal Neuralgia?
Pudendal neuralgia is a neuropathy affecting the perineum, genital, and anal areas, with pain that worsens when sitting.
Anatomy in Simple Terms
- Origin: S2–S4 roots
- Pathway: Alcock canal, then three branches:
- Inferior Rectal: anal area and sphincter
- Perineal: skin and muscles of the perineum
- Dorsal of Penis/Clitoris: external genitals
Where You Feel the Pain (5 Key Areas)
- External Genitals: stinging, burning
- Perineum: burning, hypersensitivity
- Anal Area: worse when sitting or during bowel movements
- Pelvic Depth: feeling of weight or foreign body
- Sitting Pain: intense pain when seated
Typical Symptoms
- Persistent burning
- Sudden electric shocks
- Sharp stabbing pains
- Allodynia: pain to light touch
- Hyperalgesia: exaggerated pain response
Diagnosis: Nantes Criteria
- Pain in the pudendal territory
- Worsens when sitting
- Does not wake at night
- No objective sensory loss
- Relief with targeted anesthetic block
Most Common Causes
- Prolonged Compression: cycling, poor posture
- Muscle Hypertonicity: overly contracted pelvic floor
- Pelvic Trauma or Surgery
Treatment: Integrated Approach
- Medications: tricyclics, SNRIs, gabapentinoids
- Ergonomic Education: seating, relief cushions, breaks
- Injections: anesthetics ± corticosteroids
- Pelvic Floor Rehabilitation
- Surgery: in rare refractory cases
Role of Osteopathy
- Manual manipulations to release myofascial tensions
- Posture and diaphragm corrections
- Integrated support with a multidisciplinary team
Warning: How to Choose the Practitioner
- Verify specific experience in neuropathic pelvic pain
- Consider pelvic floor physiotherapist if no expert osteopath available
Practical Solutions I Recommend
- Alternate sitting/standing; use a relief cushion
- Diaphragmatic breathing to relax the pelvic floor
- Ergonomic bike setup: centrally unloaded saddle
Explanatory Video
Conclusion
Pudendal neuralgia is complex but with correct diagnosis and targeted approach, improvement is achievable.