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_______________________ Etiology Pudendal neuralgia can be caused by various mechanisms. These can be separated into three basic categories starting centrally and moving peripherally: 1. Sacral or radicular type factors causing nerve compression or inflammation at the sacral or nerve root level. Possible examples being benign or malignant tumors and trauma to the area. 2. The pudendal nerve is anatomically vulnerable to compression and entrapment along its course. The two main areas being the interligamentous clamp between the sacrospinous and sacrotuberous ligaments and Alcock’s canal. Most commonly at the level of the falciform process. Patients with anatomical predispositions (i.e. smaller canals, narrow window between ligaments, etc.) or biomechanical abnormalities are more susceptible to compression injuries. Patients may have a silent or asymptomatic compression for an extended period of time. Then, an exacerbating and inflaming factor such as surgery, hematoma, cycling, prolonged sitting, stress and tension-holding patterns, horseback riding, etc. causes entrapment, nerve dysfunction and symptoms. 3. The pudendal nerve is also vulnerable to tension injuries. A variety of factors can put undo tension on the nerve causing it to lengthen beyond its normal limits and result in neural inflammation. Such inciting factors include vaginal childbirth, constipation with repetitive straining to defecate and squatting with heavy weights. Pelvic floor dysfunction, genital prolapse and so-called descending perineum syndrome can also contribute to nerve tension injury. Fixation along the nerve pathway will result in the nerve becoming more likely to be injured with any of the above factors. _______________________ |
