Health Organization for Pudendal Education

Having your pudendal nerve 'pressed' - did this procedure make your symptoms worse?
I was recently examined for suspected pudendal neuralgia and had my pudendal nerve pressed during a 'pelvic floor' examination, apparently as a test for sensitivity to see if I had pudendal neuralgia. As you can imagine, digitally pressing (with a finger)an already damaged nerve attached to so many pain receptors, with the potential when damaged to cause such pain, made my symptoms worse requiring eg stronger painkilling medication etc.
I would like to know if anyone else has had a bad reaction to having their pudendal nerve pressed, to find out more about this procedure, specifically:
1) If you have been examined for pudendal neuralgia by a pelvic floor specialist, was this procedure ever done to you or did you just have a nerve block injection or some other procedure instead as your diagnostic method?
2) Was informed consent taken from the doctor before pressing your pudendal nerve? Did the doctor warn you painkillers would be required?
3) Did you feel the pain immediately your pudendal nerve was pressed or some time after the procedure was performed?
4) How long did the stirred-up pain last for until it died down to its previous levels? Did it ever return to previous levels?
5) Was the pain of sufficient intensity that painkillers were required and did you require stronger painkillers than you normally take to deal with it?
Am just trying to find out more about this procedure to see how commonly it's actually performed (is it even a standard medical protocol?) and also how safe it is.
Thanks in advance for any information and people's experiences.

First - welcome to the forum! That always sounds a bit wrong, when the reason that people come here is because they are in pain. But anyway, you are welcome here, and we'll help you and support you in whatever way we can.

I take it you've had an examination where the doctor presses on the nerve, and you went through the roof. I think we've all been there! It is not nice.

But pressing the pudendal nerve is routine when investigating PN. And yes, it hurts if there is a problem with the nerve - normally it wouldn't hurt. I swear my vision went black and I lost the power of speech when it was done to me. And yes, a flare afterwards - delayed pain is very common with PN. I don't know why this is.

They do try to avoid doing this because if we have PN then it will be very painful - once it has been done, they won't be repeating it. (Except - I couldn't speak - so he did it again! - does that hurt? - strangled 'yes' from me....!!!) But it has to be done at some point, it is the most basic of checks before moving on to more complex investigations, if they are justified that is.

Going through your questions-
1) If you have been examined for pudendal neuralgia by a pelvic floor specialist, was this procedure ever done to you or did you just have a nerve block injection or some other procedure instead as your diagnostic method? Yes,I've had this - it is routine. I've not had any nerve blocks or any other diagnostic procedures because in my case diagnosis was very clear.

2) Was informed consent taken from the doctor before pressing your pudendal nerve? Did the doctor warn you painkillers would be required? Yes, he did tell me it might hurt. Whether painkillers will be required - well, pain is subjective. This won't be the same for everyone. I had taken more painkillers beforehand because I knew it was likely that I'd be examined.

3) Did you feel the pain immediately your pudendal nerve was pressed or some time after the procedure was performed? Both. Immediate very severe pain, and a flare over subsequent days. Delayed pain is very common with PN.

4) How long did the stirred-up pain last for until it died down to its previous levels? Did it ever return to previous levels? Trying to remember - more than a week, I think. I did not have effective pain management running at that point.

5) Was the pain of sufficient intensity that painkillers were required and did you require stronger painkillers than you normally take to deal with it? Well, considering that the pain is at a level where I need strong painkillers every day - yes, painkillers were required. Stronger - no, I did not have stronger meds available then. But I managed. In perspective, I've dealt with worse. And the thing with flares is that they do go away, although it may not feel like it at the time.

Doctors do need to examine the patient, in order to be sure what they are dealing with. And yes, it is safe.

I do hope that you feel better soon.

KKL, welcome to the forum. I ditto Calluna's response. I just want to add one more thing. The diagnostic term for this test is called a "Tinel's sign." This is routinely done to any peripheral nerve to see if you have pain or radiating pain when the nerve is pressed . It you do have pain it is considered a "positive sign" that something is wrong with the nerve. And yes, it is painful and I flared for weeks.

I agree with Calluna and nyt.

Violet

That's what happened to me. Never got better. Made me worse. pt therapist caused it to get worse.

Thanks so much for all your knowledgeable and in-depth replies. With me, unfortunately the procedure made my symptoms permanently worse.
Am I right in thinking the Tinel procedure can be used as a diagnostic test for a damaged pudendal nerve? A normal nerve won't give a pain response from the patient and damaged one will?
My experience of a pelvic floor examination and having my pudendal nerve pressed was different to calluna's and others I've heard about, in that initially I felt little or no pain, but it gradually built up in the days afterwards and never died down.
Also, without me really reporting any pain during the examination, the physician then told me what they'd done and warned me that I was going to need painkillers.
Why would the physician tell me I was going to need painkillers if I had reported no pain? Presumably the physician's diagnosis should have been that I didn't have pudendal neuralgia? If the procedure requires painkillers in both patients with and without pudendal neuralgia, then I can't see how it can be used as a diagnostic technique...?
Subsequently, when I asked the hospital more about the procedure done to me, it was simply referred to as 'stirring up my pain', no mention of Tinel's sign was made.
I'm just trying to work out if what was done to me was this Tinel procedure, or some unusual variation on it.
More experiences of people having their pudendal nerve pressed and the protocol used for them also welcome.
Thanks in advance for any info.

Not sure there was any special named procedure but his pressing cause only some initial pain, the nerve blocks after were even more painful but all suside fairly qucikly so I am fortunate.
Janet

It seems to me the name of the procedure would simply be a pelvic examination. As I understand it a simple pelvic exam where pelvic structures (including the nerve) were palpated or pressed on should not cause permanent pain unless there was already some underlying pathology and the pelvic exam just triggered an increase in pain. A pelvic exam would not require pain killers in a patient who doesn't have pelvic pain or neuralgia. Typically a pelvic exam for a pudendal neuralgia patient is painful at the time of examination although I have heard of people whose pudendal neuralgia was triggered by a pelvic exam. But if you already had suspected pudendal neuralgia you must have had some symptoms before the exam, right?

I wouldn't refer to tinel's sign as a procedure. Tinel's sign can be elicited in the pudendal nerve by pressing on the nerve during a pelvic exam but it would only be present if there is some injury or pathology in the nerve.

According to an online dictionary http://medical-dictionary.thefreedictio ... l%27s+sign here is the definition of tinel's sign:

Ti·nel's sign (t-nlz, t-)
n.
A sensation of tingling felt in the distal extremity of a limb when percussion is made over the site of an injured nerve, indicating a partial lesion or early regeneration in the nerve.
Tinel's sign
[tinelz′]
Etymology: Jules Tinel, French neurosurgeon, 1879-1952
an indication of irritability of a nerve; a distal tingling sensation on percussion of a damaged nerve. The sign is often present in carpal tunnel syndrome and is produced by tapping over the median nerve on the volar aspect of the wrist.
Tinel's sign [tin-elz´]
a tingling sensation in the distal end of a limb when percussion is made over the site of a divided nerve; it indicates a partial lesion or the beginning regeneration of the nerve.

It may well be that the Tinel sign, 'pressing' did cause a short term flare of symptoms, as almost everyone has reported, this is not unusual kkl. (Welcome from me too btw) Usually any heightened pain subsides with time.
However, the current chronic pain focus is on chronic pain 'syndromes' where pain becomes the 'disease' due to changes in the central nervous system and the way the brain 'reads and interprets' the pain signals.
It could be that (for what ever initial reason or cause) your existing PN was then made worse for a while by the examination, which often happens, but now the 'gate' allowing your pain signals to be read and interpreted by the brain, has been 'raised' because of changes to your central nervous system (CNS)
There is an absolute ton of current study about this CNS change, termed plasticity. The good news is that with the correct treatment the 'gate' can be lowered again too, although it can take some time and effort. It's not an easy fix, but it is fixable (pain management techniques can help)
Take care,
Helen