pudendal nerve sleeping position

Pudendal Nerve Neuralgia/Entrapment | SpringerLink meds over the years including morphine patches and all very limited usefullnss and at best just taking the edge off the pain. What you describe is just what I feel when I have a flare up. max, thats it). Emotional reaction to the chronic pain is one of the most important things I learned from physical therapy. An injury or transection of the sacrotuberous ligament can occur during surgery. It becomes very uncomfortable and is not eased with an orgasm, which actually makes it worse. [35][36] It is generally recommended as an adjunctive treatment when there is evidence of psychological issues such as anxiety, depression, hopelessness, emotional instability, etc. I have had injections to coccyx pelvic floor therapy and many meds but no doctor can seem to chase this down, Any thoughts? Its exacerbated by standing and sitting and its getting worse daily. We live in the Boston area. He tends to think worse case scenario based on other health issues- celiac and joint problems- and is very depressed about his future in terms of pain management, difficulty sitting for work and relationships due to pain. There are numerous studies in the literature that describe correlations between sleep positioning and carpal tunnel but actually, any of the peripheral nerves are subject to it. It is worth it. Pudendal Nerve: Function, Anatomy and Branches - Cleveland Clinic It controls motor functions for your urination and defecation. I have already been to my OBGYN who did not seem concerned and told me to use a personal lubricant for comfort and I am trying to get in with my Gastro they are putting me off for a while.. This painful condition often develops with childbirth or prolonged cycling. [54] Since this was a single study with a very small sample size without a control group, further research into this therapy is needed before it can be recommended outside a clinical trial. Nothing has shown anything wrong or of concern. We know it is not always easy and your words are great to see! I live near Tulsa Oklahoma and am wondering if you know of a doctor near me. The pudendal nerve is a mixed nerve having sensory, motor, and autonomic functions. [49]When compared to pudendal nerve blocks, pulsed radiofrequency ablation showed equivalent pain relief, but the benefit extended substantially longer, out to three months. Thanks so much! Pudendal Neuralgia | Anesthesia Key This means that every time you visit this website you will need to enable or disable cookies again. [51][52]While promising, these studies are not yet sufficient to justify the widespread use of this treatment modality. [Neuralgia of the pudendal nerve following violent trauma: analgesia by pudendal neuromodulation]. What are your thoughts on pudendal nerve denervation. Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP. You will be glad to know, before I went into surgery, I started to train my women with mild pelvic floor dysfunction the importance of proper pelvic floor exercise. It is 16 days out and I sit on my left buttocks, am numb with now transient knifing pain. Peripheral Nerve Stimulation for Pudendal Neuralgia: A Technical Note Pharmacologic therapy: The drugs used are analgesics, muscle relaxants, and anticonvulsants. As estimated by the International Pudendal Neuropathy Foundation, the incidence of this condition is 1 per 100,000, but the actual prevalence is believed to be substantially higher than reported. Successful Pudendal Nerve Block : r/PelvicFloor - reddit Our body has this wonderfully efficient system to alert us to make a change-before permanent nerve damage occurs. 5 years of rectal pain and counting. My 28 year old son is experiencing a great deal of pelvic pain, which he is convinced is Pudendal neuralgia. It presents in the sensory distribution region of the pudendal nerve and affects both males and females. These relationships mean that in some instances, recommended courses, instructors, networks, and other resources you see listed on this site may pay Pelvic Guru referral fees for sending them new business. Pudendal neuralgia caused by pudendal nerve entrapment (PNE) is a chronic and often severely disabling neuropathic pain syndrome. The pudendal nerve is a branch of the sacral plexus, originating from the ventral rami of S2, S3, and S4 nerve roots. Additionally, it transmits motor signals, which cause movement, to . Sacral neuromodulation is safe, effective, minimally invasive, widely available, and generally underutilized for pudendal neuralgia. ? Patients with chronic pelvic pain and diagnosed with pelvic pathology who do not respond to standard therapy should be re-evaluated for possible pudendal nerve entrapment. [6]These include: The physical examination in patients with pudendal nerve entrapment is relatively normal, except for pain reproduction. Choose a pillow with a loft, or thickness, that matches the distance between your neck and your shoulder. [50] Several recent studies showed persistent pain relief in 89% of the 90 pudendal neuralgia patients followed for six months after pulsed radiofrequency ablation therapy. My legs are always stronger afterwards as well. Individualized treatment is necessary. Can a pudendal nerve be injured by a poorly placed buttock injection? For repeated injections, ultrasound is preferred over ionizing radiation for imaging guidance. Same here I have 2 TVT removals now I am in a lot of nerve pain. [1]It presents in the sensory distribution region of the pudendal nerve and affects both males and females. These are the inferior rectal branch, perineal branch, and dorsal sensory nerve of the penis or clitoris. Martin R, Martin HD, Kivlan BR. Wadhwa V, Hamid AS, Kumar Y, Scott KM, Chhabra A. Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation. Did you ever get an answer? Heres the tricky part the pudendal nerve is simply one nerve out of many in that area. It is frequently misdiagnosed or underdiagnosed and inappropriately treated, initially causing a significant delay in proper management and severely negatively impacting the quality of life. I had a MRN done that confirms the serious nerve damage. I am seeing a neurologist next week. Squats with weights, could cause pudendal neurlagia. Finally I came across a forum where this women had similar issues. Ploteau S, Labat JJ, Riant T, Levesque A, Robert R, Nizard J. I spent 4 days at Barrow ER with no resolution. My buttocks itches like crazy and I get stabbing/tingling sensations in my vulva, clitoris, anus. Is pudendal nerve entrapment a potential cause for weak - Nature Patients with neuropathic pain may improve their overall quality of sleep by simply changing their sleeping position. Do you have such a thing? . Better prospective studies are urgently needed to determine better treatment paradigms. Excessive cycling -The condition is presumably because of chronic perineal microtrauma, which causes fibrosis in the pudendal canal as well as the sacrospinous and sacrotuberous ligaments. [Sacral staged reflexes to localize the pudendal compression: an anatomical validation of the concept]. Dr. Hibner is no longer with St. Joes here in Phoenix. I am coping with the pelvic symptoms but am concerned that Im experiencing some weakness in my legs and strange sensations in my feet. It literally felt like I had been kicked by a donkey in my coccyx with no specific point yenderness. did you find any good solutions? Never have had any issues like this before. Only recently did I read that both the urethra and clitoris are connected to the pudendal nerve. Image guidance (using fluoroscopy, ultrasound, or CT scan imaging) significantly increases the reliability of the nerve blocks. Lifestyle modifications, such as avoiding aggravating activities and using a proper seating pad, are essential elements of the overall treatment plan. Pudendal Nerve Injection - The American Society of Regional Anesthesia I experienced prolonged inflammation from a major bout with lichen sclerosus and for months have been experiencing so that align with a diagnosis of prudential neuralgia. I have an appointment with a urogynecologist soon, and am wondering what could be going on and what next steps I should take. Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, van Ophoven A, Williams AC., European Association of Urology. The pudendal nerve fixed to the sacrospinous ligament by connective tissue. [26] While this can be effective, there is evidence that ongoing therapeutic pudendal blocks may lose efficacy after two years. A firm mattress will support your body better, which may prevent your body from folding in on the nerve and making it hurt more. Dr Castellanos is fantastic. Direct trauma to the buttocks or back can result in pudendal neuralgia. The outcome measurement was defined in terms of pain scores and quality of life. Besides being in the best position to uncover the cause behind a patient's pain/dysfunction, an important role of a PT treating PN is to help the patient sort through all past tests, interpret the responses to various treatments, and make informed choices about diagnostic tests and interventions going forward. Patients were put in lithotomy position. Ive been doing pelvic floor PT for 2 years which hasnt been effective. This website uses cookies so that we can provide you with the best user experience possible. If you are experiencing pelvic pain, you may benefit from manual therapy and exercises provided by a pelvic floor physical . Hello, (Using a midline vertical incision would help avoid this rare complication.). It's sometimes called pudendal neuralgia. I have also light urine leakage and burning after I urinate. Damage to the pudendal nerve can lead to pain and affect your ability to have or enjoy sex. Sitting and Bending | Health Organization for Pudendal Education At Sleep Foundation, we personally test every product featured in our reviews and guides. I see this post was nearly a year ago. What Your Sleeping Position Says About You | Sleep Foundation Pudendal nerve and/or artery entrapment, or pudendal neuralgia, is a reversible cause of multiple sexual dysfunctions. Ive been seeing a doctor at the Cleveland Clinic/Fairview Hospital (Ohio) for pelvic floor pain after trying pelvic floor PT with no success. Pudendal nerve entrapment and neuropathy are relatively unknown and unstudied conditions. Compressed nerves and associated veins appear flat, whereas inflamed nerves appear edematous. I have a very uncomfortable feeling in my clitoris (kind of like being arroused) but without any sexual thoughts or situation. Your pudendal nerve runs from the back of your pelvis to all the muscles and skin in your genital area, including your anus, vagina and penis. Thank you very much for sharing this comment! have you found any answers. Clinical therapy that focuses on TRE and biofeedback can help with relaxation of pelvis, or some PT that uses more visceral techniques like Barral can help settle the vagus nerve which calms the chain down to pelvis. Stockbridge EL, Suzuki S, Pagn JA. The incidence increases if a mesh is used. High-frequency ultrasonography is helpful in the detection of the site of compression. Your pelvic pain is worse when you're in a sitting position. I also have scleroderma. In: StatPearls [Internet]. The pain can feel such as an ache, or it may burn or tingle. This hands-on approach allows us to provide accurate, data-driven recommendations for mattresses, pillows, sheets, and other sleep essentials. [3] Course Pudendal nerve block injections with a local anesthetic have been recommended to help confirm the diagnosis of pudendal nerve entrapment, especially if the injection is done directly into Alcock's canal using image guidance. Choi SS, Lee PB, Kim YC, Kim HJ, Lee SC. The pudendal nerve starts at your sacrum (S2-4), travels towards the sacral spine, through the Alcock's canal and then runs along the pubic bone. Side sleeping can also relieve symptoms for those with neck or back pain. The Effectiveness of Pudendal Nerve Block Versus Caudal Block - LWW Have you noticed that when you wake up in the middle of the night, your fingers are numb and tingling? Im struggling to determine whats going on following a failed pessary fitting (pessary was in for about 25 min. Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome: a placebo-control randomized trial. I feel so frustrated. Identify the etiology of pudendal nerve entrapment syndrome. Of the many doctors and physical therapists Ive seen, none ever seemed to understand the clitoral/urethral connection I spoke of and it seemed like they ignored it to focus on various treatments for vulvodynia and ic. Appointments 216.444.6601 Mollo M, Bautrant E, Rossi-Seignert AK, Collet S, Boyer R, Thiers-Bautrant D. Evaluation of diagnostic accuracy of Colour Duplex Scanning, compared to electroneuromyography, diagnostic score and surgical outcomes, in Pudendal Neuralgia by entrapment: a prospective study on 96 patients. Ofcouse I was told that I might have flare ups if the nerve gets inflamed due to too much stretching, prolonged sitting,(in this case I use this specific cushion for it) etc. It doesnt matter how many times a web search indicates pudendal neuralgia involves pain with sitting (or the Nantes Criteria indicates this), it does not mean you have PN if you have pain with sitting. I have IBS, avoid gluten and limit dairy, ovary pain possible endometriosis ? It also controls the sphincter muscles that open . Consider sleeping on your back with your arms at your sides or on pillows to keep your elbows and wrists in an ideal position. At that time, another injection can be given if needed. Doppler ultrasound has a role in thediagnosis of pudendal nerve entrapment. Since the emergency surgery i have these convulsions or spasms. A pudendal nerve block is a form of analgesia occasionally given before vaginal childbirth, episiotomy and other minor vaginal procedures. Three branches of the pudendal nerve supply the rectum, perineum and clitoral/penis regions. Im thinking the worse case scenario based on other health issues such as neck problems that render me dizzy/pain/faintish. It often is not correctly diagnosed initially, so most patients get treated for other conditions, which are usually unsuccessful. Lyndsey, Thank you for your reply. The best sleeping position for is on your side with a pillow or blanket between the knees. Type III - Entrapment in the Alcock canal. The Ultimate Pelvic Anatomy Resource: Articles, Links, and Videos, Oh My! laflor / iStockphoto. Transcutaneous electrical nerve stimulation as an additional treatment for women suffering from therapy-resistant provoked vestibulodynia: a feasibility study. Pudendal Nerve Entrapment: Symptoms, Treatment, and More Best and Worst Sleep Positions for Health Conditions Over a period of two days I engaged in both activities and now I am suffering from altered sensation in my vulva and pubis mondis just above clitoris. Alter sleeping position. My urethra is very tender and I can feel it spasming. [20]This criterion has been validated by many European physicians who have substantial experience treating similar conditions. Please help me. Pudendal nerve | Radiology Reference Article | Radiopaedia.org Explain some interprofessional team strategies for improving care coordination and communication to advance care for patients affected by pudendal nerve entrapment syndrome and improve outcomes. What large city are you near? Im sorry you are dealing with all of this! Vallinga MS, Spoelstra SK, Hemel IL, van de Wiel HB, Weijmar Schultz WC. Spinosa JP, de Bisschop E, Laurenon J, Kuhn G, Dubuisson JB, Riederer BM. He tends to think worse case scenario based on other health issues- celiac and joint problems- and is very depressed about his future in terms of pain management, difficulty sitting for work and relationships due to pain. It should be suspected in patients complaining of burning pain in the clitoris/penis, vulva/scrotum, perineum, and rectum. A 2005 study found that patients could treat their nocturnal pain by sleeping in a position that extends the spine, potentially decompressing the nerves that control sensations in the lower limbs and feet. Need help. I was prescribed all sorts of antibiotics. [1] It presents in the sensory distribution region of the pudendal nerve and affects both males and females. This is not a complication of the surgery but rather just the expected healing process. Maybe we can help you connect with someone. Use of this nerve block for vaginal delivery was reported as early as 1916. He was able to eliminate pudendal neuralgia and recently prescribed diazepam/baclefem suppositories (made at the pharmacy in the same building) for rectal spasms and pain. Pudendal nerve stretch during vaginal birth: a 3D computer simulation. The best long-term cures are from decompressive surgery, where the response rates are 60% to 80%. [8], Pudendal nerve entrapment is a rare syndrome, and its true prevalence is unknown. Any suggestions on providers here that may be helpful? Hi I am here in NYC and Im trying to find the best doctor to help me with my pudendal neuralgia. Maldonado PA, Chin K, Garcia AA, Corton MM. Neuralgia meaning "nerve inflammation and pain.". Pudendal Neuralgia: Causes, Symptoms, Diagnosis, and Treatment - WebMD Non-mechanical causes of pudendal neuralgia include viral infections (herpes zoster, HIV), multiple sclerosis, radiation therapy, and diabetes mellitus, among others. Erdogru described a new modification (the Istanbul technique) of laparoscopy using an omental flap in 27 patients. Access free multiple choice questions on this topic. Lipofilling: This is a relatively new experimental treatment of pudendal neuralgia. There are few good prospective studies and virtually none that are large, comparative, include a proper control group, have standardized inclusion criteria, a uniform definition of "success), and long-term follow-up. Commonly used medications include:[38], Pudendal Nerve Block:Infiltration with a local anesthetic or steroid in an area encircling the pudendal nerve is a mainstay of pudendal nerve pain. I even have 3 lumbar protrusions L3-S1. This sounds a lot like how my pain started and it hasnt let up. Entrapment at the piriformis leads to spasms and tenderness of the piriformis muscle. Pudendal nerve pain is caused by injury to the pudendal nerve, which is located in the pelvic area. It can affect the penile/clitoris region, along with the . Pudendal neuralgia (PN) is a condition in which there is pain in the lower central pelvic regions due to the pudendal nerve. I was also diagnosed with PNE by the late C.Paul Perry in Birmingham AL. I am just hoping to get some pain relief to enable me to continue working. Other activities to avoid might be hip flexion exercises, jogging, rowing, gymnastics, skiing, and snowboarding. Two cadavers (one male, one female) were dissected to provide evidence for localization of the pudendal nerve. She saw a pelvis specialist and got better. Pudendal nerve entrapment - Wikipedia Robert et al [2] suggested that the pu- Eid MM, Rawash MF, Sharaf MA, Eladl HM. Thanks! (The pudendal nerve supplies the external genitalia and perineum. For example, a cyclist should stop biking. Prologo JD, Lin RC, Williams R, Corn D. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia. Lien KC, Morgan DM, Delancey JO, Ashton-Miller JA. The pudendal nerve is unique in that it supplies both sensory (pain/pleasure) feeling and motor function to the muscles it travels through. Neuroplasty of the pudendal nerve from this point and continuing inferiorly across the ischial spine and into the lesser sciatic notch is then carried out. I get some temporary relief but the pain returns and is relentless. Ive had MRIs with and without contrast of my lumbar, cervical, thoracic regions and my brain. Are you familiar with Doctor Parekatil in Clermont Florida? If the patient fulfills all the "Nantes" criteria,no further investigation is generally needed to make the diagnosis. This condition has varied symptoms and has several causes, and can happen in both women and men. Endless treatment pelvic floor PT. Beco J, Seidel L, Albert A. Normative values of skin temperature and thermal sensory thresholds in the pudendal nerve territory. I have now gone to private clinic in London and being assessed for medical Cannabis. Our body has this wonderfully efficient system to alert us to make a changebefore permanent nerve damage occurs. This study is aimed at evaluating the clinical efficacy of ultrasound-guided high-voltage long-duration pulsed radiofrequency (PRF) for PN. The Pudendal Nerve: Anatomy, Function, and Treatment - Verywell Health Type II - Entrapment between sacrospinous and sacrotuberous ligaments is the most common site of pudendal nerve entrapment. Pudendal nerve damage during labour: prospective study before and after childbirth. A Pinched Nerve in Hip - Cause, Symptoms, Treatment, Exercise You may have pain when you move, or you may walk with a shuffle. Is This Condition the Secret Source of Your Chronic Pelvic Pain? Symptoms of Pudendal Neuralgia. Have you ever awoken from a sound sleep unable to find your arm in space? Lastly, entrapment in Alcock's canal results in tenderness and spasms of the obturator internus muscle. The pudendal nerve block under image-guidance has lead to a minimal patient discomfort, an increase in physician and pa-tient safety and a favorable outcome. I have scrotal, anal, perrineum, penile, and inner thigh numbness. However, when the same . For over a year Ive had to stop many activities because they aggravated the pain. [19]The symptoms depend on the precise site and severity of the entrapment. I have been experiencing pain in my rectal/coccyx area for years. nerve. Also known as Alcock's canal syndrome, cyclist syndrome, or pudendal nerve entrapment syndrome, it affects both men and women and presents as pain in the dermatomal distribution of the pudendal nerve, including the penis, scrotum, vulva, clitoris, perineum, and . 24/7. A pinched nerve happens when tissues press on the nerve, causing tingling or even weakness. Pudendal nerve entrapment (PNE) syndrome is a rare and under-diagnosed condition associated with chronic pain, sexual dysfunction and impaired sphincter control due to compression of the pudendal nerve. I am currently in PT at NYU but Ive been going for a month with not much improvement. Does your sleep positioning make the nerves in your arm cranky? In time, your cervical spine will become limited in its ability to sleep with that much rotation. Desrochers G, Bergeron S, Khalif S, Dupuis MJ, Jodoin M. Provoked vestibulodynia: psychological predictors of topical and cognitive-behavioral treatment outcome. 3 Ways to Sleep with a Pinched Nerve - wikiHow [ 1] However, the procedure did not become popular until 1953-54, when Klink and Kohl implemented the modified . Sports enthusiasts who regularly have significant and repetitive falls, such as skiers and snowboarders, may develop similar pelvic scarring due to frequent pelvic bruising and hematoma formation. Introduction. Pudendal Neuralgia - PubMed long term pain. http://creativecommons.org/licenses/by-nc-nd/4.0/ [26][37] Frustration and depression are particularly common in patients with chronic neuropathic pain who have not enjoyed any relief from earlier treatments. The clinician needs to realize that it is exceedingly mandatory to get a thorough history and perform a detailed physical examination to reach a diagnosis. Quantitative sensory testing and mapping: a review of nonautomated quantitative methods for examination of the patient with neuropathic pain. Stomach sleepers beware! Here are some of the most common reasons why irritation can occur: Childbirth - it can be irritated from over stretching in delivery Pelvic surgery Hip surgery Bone breakage in the pelvic area A growth (cancerous or non-cancerous) putting pressure on the pudendal nerve Neural sensitivity and ischemia so I drove 5 hours and he diagnose me with Pudendal neuralgia. A typical combination would be a tricyclic antidepressant (amitriptyline), an SSNRI (duloxetine), and a neurotransmitter analog (gabapentin and/or pregabalin). Blocking the pudendal nerve with injection of local anesthetic is used for vaginal deliveries and for minor surgeries of the vagina and perineum. I am a healthcare professional that has unfortunately become a patient. In the treatment planning of patients with chronic pelvic pain, it is crucial to understand that all pudendal neuralgias are not the result of nerve entrapment. People with pudendal nerve pain often can't tolerate sitting for more than a few minutes. 8 Signs Your Pelvic Pain May Be Nerve Damage - Tim Tollestrup MD Its so nice to have my life back. I am on gabapentin. La pudendal neuralgia, also called pudendal pain or Alcock canal syndrome is a chronic neuropathy that results in compression of the pudendal nerve. Sleep Is Medicine for Pelvic Pain I feel desparate. It all depends on how you sleep. The pudendal nerve carries sensations from the external genitals and the skin around the anus and perineum. Other conditions merit consideration before making a final diagnosis. I have sitting pain that seems to be where sit bones are and clitorial pain and intense itch. Diagnostic nerve blocks: In females, an unguided block can be performed vaginally, and in males, transperineally. Masheb RM, Kerns RD, Lozano C, Minkin MJ, Richman S. A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. The primary treatment options include conservative measures, physical therapy with or without TENS, pharmacological therapy, ultrasound or CT-guided nerve blocks, nerve decompression surgery, and neuromodulation. It doesnt seem like dryness is a symptom of this although others match up? Could this also cause damage to pelvic floor muscles? This may be why theres some relief but it isnt the full picture. Pudendal Neuralgia: Causes, Symptoms, Diagnosis, and Treatment Learn about the symptoms, diagnosis, and treatments for pudendal neuralgia, which can cause pain, discomfort, or numbness in your. This describes our 26 year old son to a T. He recently moved to San Diego and seems to be spiraling into depression as he cant deal with his condition-who can you recommend in the San Diego area? The pudendal nerve travels alongside key pelvic muscles and is made up of . Thank you. Michele Karst. You may have numbness that can spread down your leg. I would recommend checking out the http://www.pelvicpain.org website to see if theres someone in your area (or even in a closer radius). Coud I enquire if either; 1. Sexual dysfunction due to pudendal neuralgia: a systematic review Pudendal Nerve - Physiopedia My pudendal nerve is so pinched and prone to spasms that I can - reddit hi Im also in the boston area and dealing with similar issues as your son (im 26). Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, Leborgne J. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Treatment options include medication, physical therapy, lifestyle changes or surgery. First time, both sides, I was numb in my whole butt and pelvis for several days from too much anesthetic but it lasted for 5 months. 10 years of development. New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis. The presence of superficial perineal sensory impairment indicates a sacral root-lesion rather than pudendal nerve entrapment. [3] It passes medial to and under the sacrospinous ligament at the level of the ischial spine to re-enter the pelvic cavity through the greater sciatic foramen. I am 76 and pain has even worsened. It also prevents your legs from rotating during the night. No benefit is seen from further dosage increases, Gabapentin (with or without pregabalin), starting at 300 mg TID and gradually increasing up to a maximum of 900 mg TID, Pregabalin (with or without gabapentin), starting at 75 mg BID and gradually increasing up to 300 mg BID, Clonidine 0.1 mg HS not only helps with pain but is useful as a sleep aid, Compression by an external source, including a benign or malignant tumor or metastasis, Superficial infections of the skin in the dermatomes covered by the pudendal nerve, Neuropathy of the sacral region is caused by damage to the sacral nerve plexus, Childbirth trauma that causes a stretching of the perineum, Complex regional pain syndrome is a chronic pain condition that causes pain in one of the limbs and usually occurs after an injury.