Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment

Aims: This study was conducted to evaluate pudendal entrapment as an etiology of chronic pain, a diagnostic protocol for pudendal entrapment, and clinical response to surgical decompression. Methods: A case series of 58 consecutive patients with a diagnosis of pudendal entrapment, based on clinical factors, neurophysiologic studies, and response to pudendal nerve infiltrations, is described. All patients were refractory to other treatment modalities. Patients were assessed before and after surgical decompression: degree of pain was assessed by visual analog scale (VAS) score, percent global overall improvement, and improved function and quality of life before surgery and 12 months or longer after surgery. Results: The primary presenting feature was progressive, chronic, intractable neuropathic pain in the perineum (ano-rectal and/or urogenital) that worsened with sitting. Other symptoms included urinary hesitancy, frequency, urgency, constipation/painful bowel movements, and sexual dysfunction. After surgical decompression, 35 (60%) patients were classified as responders, based on one of the following three criteria: a greater than 50% reduction in VAS score, a greater than 50% improvement in global assessment of pain, or a greater than 50% improvement in function and quality of life. Conclusions: Pudendal entrapment can be a cause of chronic, disabling perineal pain in both men and women. Since symptomatic patients seek medical care from many different medical specialists, a reliable diagnostic protocol should be established. For patients refractory to conventional interventions, surgical decompression of the pudendal nerve can improve pain-related symptoms and disability. With ongoing work on this subject, which is a difficult disorder to accurately diagnose and treat, a better awareness of pudendal entrapment across specialties will emerge.