I had a CT-guided pudendal nerve block at UCLA recently -- it did nothing. I felt no numbness or relief.
When I had a follow-up video visit with the interventional radiologist who did my block, she was surprised that I didn't get any relief at all, because she had totally made sure to cover the length of the pudendal nerve. She then suggested that we try another block of a different nerve - the posterior femoral cutaneous nerve. I agreed to do it, but was basically discouraged. However, I decided to do some research -- and this time, I used AI, specifically Gemini (by Google) to see if I could learn more.
After including a brief history of my chronic pelvic pain, I asked: "Is it possible that my pain is actually coming from the posterior femoral cutaneous nerve?" Below is just a small part of the answer:
It is absolutely possible that the posterior femoral cutaneous nerve (PFCN) is the true culprit behind your chronic pelvic pain. For decades, the medical community heavily focused on the pudendal nerve as the default explanation for unexplained pelvic and perineal pain. Because these nerves share a crowded workspace in the pelvis and travel very close together, symptoms of PFCN irritation are routinely misdiagnosed as pudendal neuralgia. Realizing that the PFCN fits your specific pain map better is a massive, valid breakthrough in your care.
The Anatomy: Why the PFCN Causes Pelvic Pain
While the main body of the PFCN travels down the back of your thigh, it sends out smaller, highly sensitive branches right into the pelvic region:
The Perineal Branch: This specific pathway wraps inward, running right past the ischial tuberosity (your "sit bone") to provide sensation to the skin of the perineum and the lower labia.Inferior Cluneal Branches: These supply the lower curve of the buttocks. If the perineal branch is compressed, stretched, or irritated by tight pelvic floor muscles, scar tissue, or positional pressure, it will trigger burning, aching, or sharp neuropathic pain directly in the pelvic floor and perineum. Because it hits the exact same geographic real estate as the pudendal nerve, it feels nearly identical to the patient—but it is a completely separate electrical wire.
