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Surgical procedures in the pelvic region may cause damage to the pudendal nerve. [34] Pudendal nerve injury has been reported in obstetric, perineal, and colorectal procedures. [34] Individuals with atypical pelvic anatomy are at higher risk of development of pudendal neuralgia after pelvic surgery.
The pudendal nerve is the main nerve of the perineum. [1]: 274 It is a mixed (motor and sensory) nerve and also conveys sympathetic autonomic fibers.It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well as the motor supply to various pelvic muscles, including the male or female external urethral sphincter and the external anal sphincter.
The timing/duration of symptoms may be continuous, intermittent, and/or positional. This is dependent on the underlying cause of entrapment and the specific nerves involved. For example, pain while sitting is associated with inferior cluneal nerve entrapment, pudendal nerve entrapment, and anococcyeal nerve entrapment. [11] [12] [13]
Pudendal nerve entrapment. (PNE), also known as Alcock canal syndrome, is an uncommon source of chronic pain in which the pudendal nerve (located in the pelvis) is entrapped or compressed in Alcock's canal. Abdominal. Loin pain hematuria syndrome. Proctitis—infection or inflammation of the anus or rectum. Colitis—infection or inflammation ...
The risk of damage to the pudendal nerve is also higher if obstetrical forceps are used. [20] 60% of females who sustained obstetric tears were demonstrated to also have pudendal nerve damage. [21] Any damage to the pudendal nerve occurring during childbirth may not become fully apparent until years later, for example at the onset of menopause ...
In one study of 68 people with proctalgia fugax, 55 had tenderness along the course of the pudendal nerve. Pudendal nerve block relieved symptoms completely in 65% of the participants and reduced symptoms in 25%. This suggests that a major cause of proctalgia fugax may be pudendal neuralgia. [8]
Damage to the defecation centre within the medulla oblongata of the brain can lead to bowel dysfunction. A stroke or acquired brain injury may lead to damage to this centre in the brain. Damage to the defecation centre can lead to a loss of coordination between rectal and anal contractions and also a loss of awareness of the need to defecate. [12]
Pain extending outside of the vulvar vestibule may have other sources. Damage to the pudendal nerve ("pudendal neuralgia" or pudendal nerve entrapment) can cause unilateral or bilateral pain. Persistent genital arousal disorder can also cause pain in the vulvar vestibule. Spinal pathology can also cause vulvar pain. [10]