Genitofemoral neuralgia: A review

Abstract

Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin pain that is localized along the distribution of the genitofemoral nerve. The symptoms include groin pain, paresthesias, and burning sensation spreading from the lower abdomen to the medial aspect of the thigh. It may present with scrotal pain in male, while females experience symptoms radiating to the labia majora and mons pubis. Genitofemoral neuropathy has been attributed to iatrogenic nerve injury occurring during inguinal and femoral herniorrhaphy, with cases developing after both open and laparoscopic techniques. Diagnosis of genitofemoral neuralgia can be challenging, due to the overlap in sensory distribution the nerve shares with the ilioinguinal and iliohypogastric nerve. Differential nerve blocks are recommended in effort to differentiate the nerves when patients present with lower abdominal and groin pain. Once a diagnosis has been made, there exist several treatment options for genitofemoral neuralgia ranging from medical management, non-invasive injections, and surgery. Literature has also brought light to radiofrequency ablation and cryoablation performed under ultrasound guidance as emerging treatments. The aim of the current article is to review the anatomy, diagnostic techniques, and treatment options for patients with genitofemoral neuralgia.

Revisiting the genital and femoral branches of the genitofemoral nerve: Suggestion for a more accurate terminology

“…Since the genitofemoral nerve overlaps the cutaneous distribution with the other inguinal nerves, a definitive diagnosis necessitates selective nerve blockade (Tubbs et al, ). However, it may be difficult to identify a single nerve as the cause of the neuralgia and paravertebral blockade of the L1 and L2 nerve roots or triple neurectomy may be necessary (Cesmebasi et al, ). Fritz et al () used magnetic resonance neurography‐guided blockade via a retroperitoneal approach for genitofemoral nerve blockade with good results.…”

Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia

“…For interventional pain management, peripheral nerve blocks are necessary to show the affected nerves and demonstrate the location of nerve damage (8). To show the location of the nerve injury, local anesthetic must be administered to proximal to the site of injury.…”

“…Differential diagnostic nerve blocks are simple techniques that can produce dramatic relief. Nerve blocks are essential to reveal which nerve or nerve combinations are affected, or to show if the nerve damage is peripheral or centrally originated (8). If IH, II, and GF nerve blocks are ineffectual, a diagnosis of lesions more proximal in the lumbar plexus or an L1 radiculopathy should be considered (30).…”

Ultrasound of the Hip Joint, Soft Tissues, and Nerves

“…US can help in both diagnosis and pain relief with some interventional approaches. 46,47 Fig. 9 Oblique high-resolution US image of the iliohypogastric nerve between the transversus abdominis and obliquus internus abdominis muscle.…”