Anatomic basis of chronic perineal pain: role of the pudendal nerve

Abstract

Our anatomic findings have led us to define conflictual relations that may be encountered in their course by the pudendal n. and its branches. Starting from the clinical study of a group of patients suffering from chronic perineal pain in the seated position, we have defined, beginning with the cadaver, three possible conflictual settings: in the constriction between the sacrotuberal and sacrospinal ligaments; in the pudendal canal of Alcock; and during the straddling of the falciform process of the sacro-tuberal ligament by the pudendal n. and its branches. Consequently, considering so-called idiopathic perineal pain as an entrapment syndrome, the clinical and neurophysiologic arguments and infiltration tests have led us to define a surgical strategy which has currently given 70% of good results in 170 operated patients. Earlier diagnosis should improve on this.

Adding corticosteroids to the pudendal nerve block for pudendal neuralgia: a randomised, double‐blind, controlled trial

“…PN due to pudendal nerve entrapment (PNE) is related to loss of mobility of the pudendal nerve over its gluteal or pelvic course. This loss of mobility is due to anatomical impingement2 in various sites: in the reflection of the obturator fascia (Alcock's, or pudendal, canal), in the space between the sacrospinous ligament (SSL) and the sacrotuberous ligament (STL) or in the infrapiriformis canal. The loss of mobility induces compression of the pudendal nerve against the falciform process of the STL while sitting.…”

Surgical Options for the Treatment of Chronic Pelvic Pain

“…Primary control of this pain, which is usually unilateral, is achieved with local injections and pelvic floor therapy. However, depending on the location of the nerve entrapment, such as in interligamentous space (Alcock canal), the edge of the sacrospinous ligament, or the falciform process of the sacrotuberous ligament, some cases may be refractory [18]. Surgical decompression of the impinged or compressed pudendal nerve has been shown to be effective in 80% of the cases [19].…”

Le syndrome du canal d’Alcock ou névralgies pudendales : un diagnostic à ne pas méconnaitre

“…• le nerf anal qui contribue à la sensibilité de la marge anale et à la motricité du sphincter externe strié de l'anus; • le nerf périnéal, sensitif, qui assure l'innervation des téguments du périnée, des bourses ou des grandes lèvres; • le nerf périnéal, moteur, qui innerve les muscles ischio-et bulbo-caverneux et le sphincter strié de l'urètre; • et le nerf dorsal de la verge ou du clitoris 11 . Puis, il entre dans le dos du pénis dans un canal distinct constitué par l'os de la symphyse pubienne dorso-crânia-lement.…”