gms | German Medical Science

Objective: Perineal neuralgia is stil controversely discussed and often misunderstood, so that a huge number of patients is misdiagnosed. We report on our experience with this illness, highlighting the anatomy, symptoms, diagnostic tools and surgical technique. We also refer briefly to some current European studies.

Methods: We retrospectively assessed four cases treated in our hospital from 2003 until 2011.

Results: Our four patients were females suffering from unilateral perineal pain. All of them had had other pathologies in their histories (violation, hysterectomy, hemicolectomy and thrombosis of an anal vein). One year later, they developed neuropathic pain, but it took them up to six years until the right diagnosis of pudendal nerve entrapment was made. Three of four underwent a preoperative CT-guided infiltration and all of them improved, some even throughout five days. After the surgical decompression of the pudendal nerve, only two of four patients experienced pain relief. No complications occurred and the postoperative course was uneventful.

Conclusions: There is very little literature concerning pudendal nerve entrapment. Although surgical decompression is of low risk, it still remains a challenge to find the right diagnosis and to decide which patient will improve after surgery and which will not. At the moment only clinical examination and proper infiltration under CT scan can help in finding the right decision.