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Pudendal neuralgia
Other Resources UpToDate PubMed

Pudendal neuralgia

Contributors: Andrea Wasilewski MD, Michael W. Winter MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Pudendal neuralgia (pudendal nerve entrapment, Alcock syndrome) is a condition of chronic neuropathic pain consistent with the pudendal nerve dermatome. Pain is typically intense and sharp and occasionally described as numb. Pain may appear in the perineum, rectum, vulva, vagina, clitoris, scrotum, and/or the glans penis. Pain can affect the entire area or it may be localized to a branch of the pudendal nerve.

Findings include dysuria, dyschezia, dyspareunia, and erectile dysfunction. Pain typically increases while sitting and does not classically wake patients from sleep. Etiology includes nerve compression or entrapment (caused by surgery, childbirth, or trauma), herpes simplex, pressure from tumors, endometriosis, chemoradiotherapy, and exercises such as biking or squatting. Pudendal neuralgia occurs much more frequently in women than in men.

Initial treatment includes physical therapy, muscle relaxants, and neuromodulators. Pudendal nerve block is used for both diagnostic and therapeutic purposes.


G57.90 – Unspecified mononeuropathy of unspecified lower limb

427972000 – Pudendal neuralgia

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Differential Diagnosis & Pitfalls

  • Sacral radiculopathy
  • Cauda equina syndrome
  • Genitourinary syndrome of Menopause
  • Vulvodynia (localized provoked and generalized)
  • Pudendal Neurilemmoma
  • Sexually transmitted infections
  • Lichen sclerosus
  • Postherpetic neuralgia

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Last Reviewed:06/16/2019
Last Updated:06/18/2019
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Pudendal neuralgia
A medical illustration showing key findings of Pudendal neuralgia : Numbness, Perianal pain, Unilateral distribution, Vulvar pain, Dysuria, Hyperesthesia, Painful ejaculation, Pain worsened while sitting, Bicycling, Scrotal pain
Copyright © 2024 VisualDx®. All rights reserved.