Pudendal Neuralgia: Underdiagnosed, Undertreated, and Patients Underserviced

Pudendal Neuralgia (PN) is a neuropathic condition that causes patients to suffer chronic pain or numbness.  Furthermore, PN is often accompanied by fecal incontinence, urinary incontinence, and numbness of the genitalia.  Patients experiencing PN struggle with one of the most difficult nerve conditions and one that affects men and women alike.

Physical therapy has shown itself to be one of the few methods to successfully treat PN.  However, few physical therapists have the knowledge, experience, and skills required.  Recently, Greg Vigna, M.D., J.D. wrote an article for New York Injury News about pudendal neuralgia.  In it, he describes the obstacles facing patients with PN:

"Historically the management of pudendal neuralgia was only available at a select few centers throughout the country. The reasons for this is that pudendal neuralgia was quite rare, often overlooked, and under diagnosed by the medical community. There are only a few doctors in this country who have received the advanced training in the management of this disorder. Even fewer have the advanced surgical training. A great number of physicians do not have a base understanding of the pudendal nerve and are unaware of pudendal neuralgia."

One of the reasons PN is so hard to diagnose, is that the most obvious symptom is intense pain while sitting.  Patients associate the feeling with having a foreign body in your rectum or vagina.  Men often feel pain while ejaculating or develop erectile dysfunction because of PN.

While women are twice as likely to suffer from PN as men, the condition affects people from all walks of life.  PN was termed “cyclists syndrome” by French cyclists.  Prolonged driving and sitting are also common causes.  Young people who participate in sports, such as cyclists, runners, gymnasts, and horseback riders, also can be affected.

For women, PN frequently occurs immediately after childbirth.  Sometimes, the symptoms are temporary.  For others, the condition is not.  Patients with PN notice symptoms of the condition throughout the day.  As a patient’s day progresses, pain generally smarts as a patients activity level rises.  These symptoms are often debilitating.

In August, Herman & Wallace will be offering a course on treating and assessing PN.  Focusing on the pudendal nerve and pelvis, the course is designed to give medical practitioners the skills they need to rehabilitate those suffering from PN.

The course will be taught by Tracy Sher, MPT, CSCS and Loretta J. Robinson, PT, MS.  Tracy is an accomplished pelvic and orthopedic physical therapist, who has presented for the International Pelvic Pain Society and the APTA’s Annual Conference.  Loretta co-authored a paper on PN with Dr. Michael Hibner and has long been regarded as a leader in the field.  Her practice exclusively serves men and women suffering pelvic dysfunction.