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

11. Groin Pain Etiology: Pudendal Neuralgia
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Genital branch of the
genitofemoral nerve
Obturator nerve
Inferior cluneal
nerve
Pudendal
nerve
Fig. 11.2. Dermatomal distribution of the perineum. ( a ) Pudendal nerve, ( b )
inferior cluneal nerve (or gluteal branch of posterior femoral cutaneous nerve),
( c ) obturator nerve, and ( d ) genital branch of the genitofemoral nerve and ilioinguinal
nerve.
Pudendal nerve entrapment (PNE) is the direct result of pelvic trauma
[ 3 ]. Causes of trauma can include surgery, childbirth, bicycle seats, sex,
or athletic activities. Pelvic surgery is among the more common causes
of PNE today.
Symptoms : What the Patient Experiences
Patients with pudendal neuralgia commonly describe their pain as
a burning sensation in the region innervated by the pudendal nerve.
Patients often state that the pain is exacerbated by sitting and
improved with lying down [ 4 ]. The pain can be bilateral or unilateral.
However, those with direct pudendal nerve injury tend to have unilateral
pain.
It is important to appreciate that this pain is neuropathic in nature and
often accompanied by significant allodynia and hyperesthesia. Common
complaints or descriptions that arise during consultations include feelings
of a foreign body sensation in the rectum or vagina, without an