Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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M. Hibner and C. Coyne
Piriformis muscle
Sacrospinous
ligament
Pudendal nerve
artery & vein
Obturator muscle
Sacrotuberous
ligament
Ischial tuberosity
MH
Alcock’s canal
Transversus
perineal muscle
Levator ani muscle
Anus
Reflected gluteus
muscle, fat and skin
Fig. 11.1. Course of the pudendal nerve. Posterior, close-up view of the sacral
region. Important anatomical landmarks such as ligaments and muscles are represented,
illustrating the course of the pudendal nerve.
10,000 patients have pudendal neuralgia, and of their population suffering
from chronic pain, around 4 % have this condition.
Etiology: Types of Pudendal Neuralgia
Pudendal neuralgia is broadly defined. We define this as pain in the
distribution of the pudendal nerve that can arise from a series of separate
mechanisms (Fig. 11.2 ).
Pain that mimics pudendal nerve compression may be caused by
pelvic floor muscle spasm. Since the pudendal nerves course through the
pelvic floor muscles toward the surface of the skin, any muscle spasm
that occurs in the pelvic floor can result in further compression of the
nerve and severe pain. Causes of pelvic floor spasm include direct pelvic
floor injury, other pain conditions in the pelvis, psychological influences,
or idiopathic causes (Fig. 11.3 ) [ 2 ].