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Pudendal neuralgia

Orpha number ORPHA60039
Synonym(s) Alcock syndrome
Pudendal algia
Pudendal nerve entrapment syndrome
Pudendal neuralgia by pudendal nerve entrapment
Prevalence 1-5 / 10 000
  • Sporadic
Age of onset Adulthood
ICD-10 -
  • C1997249
MeSH -
MedDRA -
  • 427972000


Pudendal neuralgia is characterised by chronic and neurogenic perineal pain as a result of compression of the pudendal nerve in the pudendal (or Alcock) canal. Although no epidemiological studies have been performed, pudendal neuralgia does not appear to be a rare disease. It affects 4% of patients undergoing consultation for pain and affects seven women for every three men. The clinical picture is characterised by uni- or bilateral perineal pain that may variably spread to the anterior or posterior perineum. The pain worsens upon sitting and is relieved by standing. Symptoms disappear upon lying down and there is no nocturnal pain. The disease course is chronic and the pain is unresponsive to regular analgesics. In many cases, the causes of pudendal neuralgia remain unknown but the disease is often associated with trauma, surgery or sporting activities (in particular cycling). Imaging studies yield normal results but electrophysiological tests reveal prolongation of the distal latency of the pudendal nerve. A positive response to blockage of the pudendal nerve by injection at the level of the pudendal canal is strongly indicative for diagnosis. The nerve block is effective in between 1/3 and 2/3 of cases but the results are short-term. Drug treatments are the same as those used to treat other causes of neurogenic pain and antidepressants and antiepileptic agents may be benecial. A recent randomised study reported that surgical decompression of the pudendal nerve is the most efficient conservative treatment, with 71% of patients reporting pain relief 12 months after the intervention.

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