Pudendal Neuralgia Treatment Without Surgery

Pudendal neuralgia is a chronic, often debilitating pain condition caused by irritation or compression of the pudendal nerve, which runs through the pelvis and supplies sensation to the perineum, genitals, and lower pelvic floor. It is often misdiagnosed or underdiagnosed, and patients frequently endure years of symptoms before receiving an accurate diagnosis.

Dr. Ghattas’s specialized training in interventional pain management and nerve procedures positions Palm Beach Regenerative to offer a precise, image-guided approach to pudendal neuralgia that many standard pain practices do not provide. Schedule your appointment with Dr. Ghattas today.

The pudendal nerve can become compressed or irritated at several points along its course through the pelvis, most commonly at the Alcock’s canal. Irritation or inflammation of this nerve produces pain in the perineum, genitals, anus, and inner thighs that is characteristically worsened by sitting and relieved by standing or lying down.

• Burning, stabbing, or aching pain in the perineum, genitals, or rectum
• Pain that is worsened by sitting and relieved by standing
• Sensitivity to clothing or touch in the pelvic region
• Urinary urgency or frequency
• Pain with sexual activity
• Constipation or pain with bowel movements in some cases

• Compression from prolonged cycling or narrow bicycle seat use
• Pelvic floor muscle tightness compressing the nerve
• Prior pelvic surgery or childbirth injury
• Sacral or coccyx trauma
• Inflammatory conditions in the pelvic region

Pudendal neuralgia is a clinical diagnosis supported by the characteristic symptom pattern, physical examination findings, and response to a diagnostic pudendal nerve block performed under CT or fluoroscopic guidance.

Dr. Ghattas performs the diagnostic block with real-time imaging guidance to accurately place anesthetic adjacent to the pudendal nerve at the ischial spine.

• Pelvic floor physical therapy
• Oral medications including tricyclic antidepressants and nerve pain agents
• Image-guided pudendal nerve blocks with local anesthetic and steroid
• Nerve hydrodissection to release perineural adhesions
• Surgical decompression in confirmed entrapment cases

Dr. Ghattas performs image-guided pudendal nerve hydrodissection using fluoroscopic guidance, delivering precise platelet and anesthetic preparations around the pudendal nerve at the site of compression to reduce perineural inflammation and free the nerve from adhesions.

This is delivered as part of a compassionate, comprehensive care plan that coordinates with pelvic floor physical therapy and appropriate oral medications. Patients with pudendal neuralgia deserve the same precision and thoroughness as any other complex pain condition.