Pudendal nerve entrapment

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Pudendal nerve entrapment or PNE is a cause of chronic pain in which the pudendal nerve, located in the pelvis, is entrapped or compressed. This can be caused by pregnancy, scarring due to surgery, accidents, heavy and prolonged bicycling that can eventually thicken the sacrotuberous and/or sacrospinous ligaments and trap the nerve between them, or anatomic abnormalities that have the pudendal nerve fused to different parts of the anatomy, or trapped between the aforementioned ligaments. Pain is worsened by sitting, and can include prickling, stabbing, burning, numbness, and the sense of a foreign object in the urethra, vagina, or rectum. Pain is not the only symptom of PNE. PNE can also cause loss of orgasm, erection, and ejaculation. Decompression surgery is done primarily in Nantes, France; Houston, Texas; and in Egypt.

However, the validity of decompression surgery as a treatment and the existence of entrapment as a cause of pelvic pain are highly controversial. While certain doctors will prescribe decompression surgery, others will not. Notably, in February 2003 the European Association of Urology in its Guidelines on Pelvic Pain said:

the reality is that pudendal nerve neuropathy is probably only a likely diagnosis if the pain is unilateral, has a burning quality and is exacerbated by unilateral rectal palpation of the ischial spine, and the pudendal motor latency is delayed on that side only. However, such cases account for only a small proportion of all those presenting with perineal pain and the proof of the diagnosis resting on relief of pain following decompression of the nerve in Alcock's canal is rarely achieved. The value of the clinical neurophysiological investigations is debatable; some centres in Europe claim that the investigations have great sensitivity (1,2), while other centres, which also have a specialized interest in pelvic floor neurophysiology, have not positively identified any cases."[1] (emphasis added)