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Acetabular Labral Tears

 “Unique in women is the possible concomitant pelvic-floor pain that may occur in association with labral tears, hip impingement, dysplasia, and early and late arthritis. Because these hip disorders are more common in women, a thorough history should include the discussion of pelvic-floor symptoms. The obturator internus is considered one of the primary musculature sources of pelvic-floor pain that often presents with the complaint of deep vaginal pain. Because the obturator internus is a primary hip rotator, a hip-related cause of pelvic pain should be considered in the differential diagnosis when the pain is determined to be originating from this muscle and when other causes have been excluded.”

Hunt D, Clohisy J, Prather H. Acetabular labral tears of the hip in women. Phys Med Rehabil Clin N Am.  2007 Aug:18(3):497-520, ix-x.

Pelvic floor dysfunction
 
This term refers to a condition in which the pelvic floor muscles that are not functioning properly.  Typically the muscles are in a state of constant contraction and while the patient may not feel contractions there is generally a sense of pain or achiness in the pelvic region including voiding problems and sexual dysfunction.  The tight contracted muscles can impinge on the pudendal nerve and cause many of the symptoms of pudendal neuralgia.  Often it is difficult to determine if the nerve irritation came first, causing the muscles to spasm, or if the tight muscles irritated the nerve.  An experienced pelvic floor physical therapist is the best qualified specialist to treat this problem.  Therapy should include myofascial release of the pelvic floor muscles to help them to return to a relaxed state.  Strengthening exercises such as Kegals should be avoided as they only further contribute to an overly contracted pelvic floor.   
 
Vulvodynia
  
This is a term that literally means pain in the vulva.  When a person is diagnosed with vulvodynia that in itself does not explain exactly what the cause of vulvodynia is.  One possible cause of vulvodynia is pudendal neuropathy, especially if there does not appear to be an explainable cause such as a vaginal infection or injury to the area.  The vulvar area is innervated by the pudendal nerve so if that nerve is damaged, entrapped, or somehow irritated the result can be pain in the vulva and surrounding areas.   
 
Vestibulitis
    
One type of vulvodynia is vestibulitis, a term that refers to pain or inflammation in the area surrounding the opening to the vagina.   The pudendal nerve also innervates this area.   
 
Prostatitis or Non-bacterial protatitis 
  
Prostatitis refers to pain or inflammation of the prostate gland.  The primary symptoms that are similar to pudendal neuralgia are pain, sexual dysfunction, and urinary problems, symptoms similar to pudendal neuralgia.   If all of the usual tests for prostate disease come back negative and the normal prostatitis treatments do not help then pudendal neuralgia must be considered. 
 
Interstitial cystitis (IC)
  
Many of the symptoms of IC are similar to those of pudendal neuralgia including bladder pain and frequent urination.  The nerves that innervate the bladder are in close communication and intertwined with the nerves branching off of the main pudendal nerve. 
 
Coccydynia
  
Pain in the area of the tailbone is called coccydynia.  Often this occurs as the result of an injury or fall but can sometimes be related to prolonged sitting.  Frequently people with pudendal neuropathy also complain of tailbone pain but often it is very difficult to determine whether the pudendal nerve might be the cause or if there is another source.  A ganglion impar block has been helpful to some people with coccydynia.  Removal of the coccyx has not been successful in eliminating pain for people who have pudendal neuropathy and may in fact exacerbate the problem.  www.coccyx.org/
 
Sacro-iliac joint dysfunction  (SI joint dysfunction) 
  The SI joint is located where the pelvis and sacrum meet.  Sometimes this joint becomes inflamed and causes low back pain that radiates to other areas including the pudendal nerve distribution area.  Other times the joint becomes unstable allowing the pelvis to become misaligned.  This can cause undue pressure on one or both of the pudendal nerves causing pudendal neuralgia.  A trained pelvic physical therapist should be able to diagnose this problem.  The difficulty arises when pelvic floor and core strengthening exercises are prescribed to stabilize the pelvis.  These exercises can cause a tightening of the pelvic floor and increase the pain of pudendal neuralgia. It is important to be treated by a therapist who understands the special problems associated with pudendal neuralgia.
 
Persistent Genital Arousal Disorder (PGAD), sometimes referes to as  Persistent Sexual Arousal Syndrome (PSAS) or Hyperarousal
  
The primary nerve involved in sexual arousal and orgasm is the pudendal nerve. When that nerve becomes entrapped, inflamed, or irritated it can misfire, sending incorrect signals to the brain.  This can be perceived as a feeling of constant unwanted sexual arousal with no sexual desire.  It may be accompanied by actual engorgement of the genital area or simply an extremely uncomfortable feeling of constantly being on the verge of an orgasm from which there is no release.  Sometimes it is accompanied by painful spontaneous orgasms.  Antidepressants may be helpful in alleviating some of these symptoms. 
 
Click here for more information on PGAD.   
 
Erectile dysfunction (ED)
 
The dorsal nerve of the penis is one branch of the pudendal nerve and plays a major role in orgasm for men.  Consequently pudendal neuropathy can be one of the causes of ED.
 
Arachnoiditis
  
This is a condition in which the arachnoid lining of the spinal cord becomes inflamed causing irritation, scarring, and binding of the nearby nerves.  If this occurs in the sacral area where the S2, S3, and S4 nerve roots exit the sacrum the resulting symptoms can be similar to symptoms of pudendal neuralgia although the area affected is often more widespread than that of pudendal neuralgia.  Unfortunately, the conventional treatments for pudendal neuralgia do not address the area that is affected by arachnoiditis.  
 
Cauda Equina Syndrome
 
This is a similar condition to arachnoiditis that involves damage to the nerves coming off of the spinal cord, sometimes called the horse’s tail or cauda equina.  Some of the symptoms can be similar to pudendal neuralgia although typically there is involvement to a wider area than that innervated by the pudendal nerve.

 

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