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
present among patients with other painful conditions, including pudendal
nerve entrapment, endometriosis, and even inguinal hernia .
Painful Bladder Syndrome/Interstitial Cystitis Symptoms of interstitial
cystitis are primarily suprapubic discomfort associated with filling
of the bladder, including frequency, urgency, and/or nocturia. These
symptoms overlap with that of pudendal neuralgia [ 12 ]. There is pain
relief with bladder emptying. Patients can also experience pain in the
labia/scrotum, vagina, and clitoris/penis. Inflammation of the bladder
may be incited by exogenous factors, including certain foods. On examination,
the patient may demonstrate bladder tenderness. Cystoscopy
with hydrodistention should be included as part of the workup. The
potassium chloride sensitivity test involves instillation of KCl into the
bladder during cystoscopy. Eliciting pain is diagnostic of, though not
specific to, interstitial cystitis and predictive of positive response to
medical therapy for this disease. After this test, local anesthetic can be
instilled in the bladder. Relief of pain with this anesthetic challenge test
is also diagnostic.
Vulvodynia The diagnosis of vulvodynia can be enigmatic. It is often
chronic, and diagnosis and treatment are difficult, as no single variant
exists. As the term denotes, patients suffer from pain of the vulva.
This may involve the labia, vagina, and clitoris. It is often due to a dermatologic
condition, but similar symptoms can be mimicked by pudendal
neuralgia [ 13 ].
Provoked Vestibulodynia This disease results in pain at the vulvar
vestibule , also referred to as vulvar vestibulitis syndrome . Patients have
a burning pain only upon entry to the vagina, such as with sexual intercourse.
On examination, palpation with a Q-tip results in tenderness of
vestibule .
Vaginismus This is a spasm of the muscles surrounding the vagina.
It is typically elicited upon any insertion or penetration, similar to pelvic
floor tension myalgia or levator syndrome. On pelvic examination, pelvic
floor muscle spasms are obvious in response to digital examination.
As explained prior, treatment of pelvic floor muscle spasms must be
completed prior to initiating treatment for pudendal neuralgia.
Endometriosis Endometriosis should be included in all diagnoses of
the pelvis among women. The pelvic pain is cyclical and typically in the
lower abdomen. More severe cases may result in continuous pain.
Hormonal therapy may help address the symptoms. Laparoscopy will
confirm the diagnosis.