It sits in a region called “Alock’s Canal”, located on the ischiorectal wall, it passes through a channel created by the obturator fascia, an extension of the obturator internus muscle. This channel carries the nerve and the blood vessels. Trapping of the nerve causes pain in the penis and in the perineum, with the classic “golf ball” sensation when sitting down and the relief upon standing. The entrapment can be temporary and associated with muscle tension, or it can be structural, requiring an injection or surgery to release.
The pudendal nerve can also be associated with pelvic pain and may give rise to other conditions. The research literature places pudendal neuralgia as a stand-alone condition, void or any other pelvic complaints. However, evidence is very limited and our experience is that it may present with other chronic pelvic pain conditions with a mix of symptoms. It is important to identify co-existing conditions.
Diagnosis is through the tunnels test where an internal examination presses against the nerve to elicit symptoms. There will often be a positive response to pudendal nerve palpation, and we have found manual therapy, exercise rehabilitation and Focus Shockwave Therapy to be helpful for this condition. Typically, it is expected to take between 3 and 6 months to treat.