Health Organization for Pudendal Education

I have some potentially hopeful news.
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.

My next block - of the poster femoral cutaneous nerve - is June 30.
I will post the results -- here's hoping we are on the right track!
Sharon

Hi Lotta,

Interesting. I didn't realize how close that nerve was the pudendal nerve. It's great that the doctor will be able target it in another diagnostic block. I'm glad you may be able to more fully understand what's going on. Keep us posted.

April

Hi. I have always wondered if this is my problem too due to the absence of internal vaginal or anus pain. I did have an ic block and pfcn block but no joy. However. Speaking to a lady who has been confirmed with pfcn she said these injections are hard to hit right spot and have to be done by expert. I did go and have surgery for pn a few months ago and he found a hard compression in the Alcocks canal. I was a prolific cyclists. However the following describes me perfectly.

Sitting pain has been ascribed to pudendal nerve
compression at the sacrotuberous ligament. However, when sitting produces pain in the buttock and posterior thigh as well as the ischial tuberosity, the posterior femoral cutaneous nerve (PFCN) must be the peripheral nerve to evaluate and treat, as pudendal nerve compression causes pain in the rectum,
vagina/perineum/scrotum, and the clitoris/penis. The anatomy of the PFCN has not been well described, and just one small cohort of 17 patients has been reported to have surgery for the PFCN.

Good luck with your block, Lottanerve.

So, Monty999 are you having any improvement in pain since your PN surgery? It can take quite a few months so it may be too soon to tell for sure.

Thank you all for your responses and Monte, thanks for the article. I will be posting results of my block after June 30!!!
Sharon