by Glenn Cameron RMT, CCIP 
Registered massage Therapist, Board Certified Chronic Intractable Pain & Neuropathy 

Pudendal Neuralgia (PN) seems to be difficult to resolve today, leaving many to believe they must live with the condition on a permanent basis. This is due, in part, to a potentially incomplete diagnostic process and incomplete treatment strategy, focusing on symptomatic regions instead of its causes.

There is no reason why anyone should continue to suffer from this condition, given the knowledge those of us who treat chronic pain conditions possess and with the tools and technologies available today that solve both complex musculoskeletal and resistant peripheral nervous system dysfunctions. At our Clinic, we have witnessed many conditions exist whose symptoms imitate those of an actual pudendal nerve dysfunction, yet are not PN. Diagnosing PN by symptoms alone may result in misdiagnosis, leading patients in a direction that will only lead to prolonged pain and suffering, costly and unsuccessful interventions and ultimately, anxiety and depression.

It is an absolute necessity that the health care professional providing the assessment be well versed with treating complex chronic pain conditions, as they are accustomed to providing high-level diagnostics and treatments on a regular basis. The diagnostic process must involve a thorough and comprehensive array of both neurological and musculoskeletal analysis to accurately identify all dysfunctions to arrive at a competent conclusion based upon facts and not on best-guess thoughts, or symptoms alone.

Briefly, real pudendal neuralgia develops whenever the nerve’s axons and/or cell body’s suffer physical or metabolic damage. Physical damage results due to trauma such as infection, or compression/stretch forces resulting from dysfunctional connective tissue along the nerve’s pathway, adversely affecting the entire nerve from spine to genitals.

Metabolic damage occur due to problems such as Candida, high sodium or glucose levels, chronic stress, medications, infection, heavy metal toxicity, and autonomic nervous system issues to name a few. Again with metabolic dysfunction, the entire nerve is affected, not one specific location. The most common treatment for PN seems to be with pelvic floor work, which can be incorrect. A tight pelvic floor is usually a symptom only, and not just of pudendal neuralgia, but indicative of other nerve and musculoskeletal dysfunctions that may not have anything to do with the pudendal nerve itself.

We cannot stress enough how important the assessment and diagnostic process is, to verify that symptoms are indeed those of true pudendal neuralgia and not from other conditions that mimic it. Symptoms of any neuralgia are experienced at the end of the nerve’s pathway, typically in the organs or structures being innervated. The most important aspect to neuralgias like that of pudendal is that the faults are rarely found at the end of the nerve’s pathway, being the genitals and pelvic floor. Only symptoms are experienced there which indicate that a problem of some nature does indeed exist. PN is no different from that of sciatica, which is also a neuralgia of the sciatic nerve. The most common symptoms for sciatica are numbness in the foot resulting from dysfunctions higher up in the lumbar spine or buttocks, or due to a metabolic dysfunction of the nerve itself. Consider what would happen if therapy was administered to the affected foot of someone with sciatica.

Health care professionals who offer to treat true pudendal neuralgia must have the knowledge to correctly diagnose and distinguish it from other conditions that mimic it. They must also own and be proficient in the use of the various tools and technologies required to resolve both the physical and metabolic forms of the condition.

No one should live with PN today, as modern innovations in knowledge and technology afford us the ability to solve it, as we do with all other neuralgia’s, including those of sciatica, thoracic outlet syndrome and femoral neuropathy.

Glenn Cameron, RMT, CCIP 
Registered Massage Therapist, Board Certified Chronic Intractable Pain & Neuropathy
Founder and President,
Innovative Therapy Canada
www.innovativetherapycanada.com

---

Violet: I was wondering if you could please elaborate on several statements in your article.

1.      Glenn’s article: At our Clinic, we have witnessed many conditions exist whose symptoms imitate those of an actual pudendal nerve dysfunction, yet are not PN. Diagnosing PN by symptoms alone may result in misdiagnosis….

Violet’s Question: What are some of the other possible diagnosis that would have the same symptoms as pudendal neuralgia but not be actual PN?

Glenn’s Answer:

Other conditions whose symptoms imitate those of Pudendal Neuralgia include :

Twisted spine with meningeal adhesions

Chronic Paraspinal ligament sprain

Chronic Iliacus adhesions/strain

Acetabular labral tear with ligamentous sprain complication

Chronic mechanical Obturator internus adhesions

Unresolved piriformis dysfunction/damage

Chronic Connective tissue strain of the Lumbosacral plexus

Chronic Femoral triangle ligamentous tissue sprain

Unresolved psoas muscle dysfunction/damage

Unresolved Damaged hamstring tendon

Chronic Yeast Overgrowth syndrome induced neuropathy

Keep in mind that any of these conditions could be present alone, in combination, and even exist with true pudendal neuropathy, thus confusing practitioners at the diagnostic stage. 

2.      Glenn’s article: The diagnostic process must involve a thorough and comprehensive array of both neurological and musculoskeletal analysis to accurately identify all dysfunctions to arrive at a competent conclusion based upon facts and not on best-guess thoughts, or symptoms alone.

Violet’s question: When a patient presents with chronic pelvic pain in the areas innervated by the pudendal nerve, what diagnostic tests would you recommend?

Glenn’s Answer:

There are no orthopedic or neurological tests that can directly confirm pudendal neuropathy, as there are too many complicating factors that can cloud the diagnostic process.    

I have found that switching some of my technologies to a diagnostic role helps identify pudendal neuropathy, along with careful palpation for signs of dysfunction along the course of the nerve. 

The technologies I use include deep penetrating radial shockwave therapy, high energy pulsed electromagnetic field therapy, vibration plate, and neurostimulator technology.

3.      Glenn’s article: No one should live with PN today, as modern innovations in knowledge and technology afford us the ability to solve it, as we do with all other neuralgia’s, including those of sciatica, thoracic outlet syndrome and femoral neuropathy.

Violet’s question: What therapies have you used to successfully treat pudendal neuralgia patients and is the nerve ever so damaged that a person cannot see improvements?

Glenn’s Answer:

Since all cases of PN are somewhat dynamic in nature, physical/metabolic/both, I use any combination of the technologies in the clinic summarized as follows:

EMS Swiss Dolorclast Pro Radial Shockwave Therapy (w/power applicator)

Pulse Centers XL-Pro, high energy Pulsed electromagnetic field therapy (PEMF)

Rebuilder Medical 2407 Neurostimulator nerve regenerator

Live O2 Cardiovascular Altitude simulator Oxygenation system

Trigenics Myoneural System

Vibration Plate 2.5 technology 3G Cardio

Health Light vascular infrared system

Pudendal Neuropathy, both physical/metabolic, should be resolvable in most cases as long as the mechanism of injury is correctly identified and curable. Surgical errors would be an example of a mechanism of injury that is not curable, thus no pudendal cure possible.  

Secondly, as long as symptoms of the neuropathy are still present in their original form, it is an indication that the nerve pathways have not died, giving hope of regeneration.   

Damaged or dysfunctional nerves that no longer illicit pain or sensation in their original form is a good indicator that some or all of the nine nerve pathways within the pudendal nerve have died and thus are no longer treatable.

Violet’s Question: What are the nine nerve pathways and what would be an example of them dying?

Glenn’s Answer:

Generally, peripheral nerves are comprised of 9 distinct pathways, in which 2 are dedicated to pain, 3 for motor muscle contraction, and 4 for proprioception, and sensation. 

In this example of a numb penis, all sensory pathways suffered damage and no longer generate and/or propagate sensory impulses.  Testing could verify if proprioception and/or pain pathways have also been damaged.  This should be done to help determine a mechanism of injury, thus a treatment plan. 

Damage to motor pathways would result in erectile dysfunction as the smooth muscles of the penis could not dilate allowing blood to rush in for the erection. 

Violet’s Question: We frequently have men come on the forum who say they have a numb penis. Would that fit into the category of a nerve that is no longer treatable due to loss of sensation or would there still be hope of regeneration?

Glenn’s Answer: 

Unfortunately, hope fades over time.  The length of time for a nerve to suffer permanent death varies, determined by the mechanism of injury, and one’s overall health and physiology.