Pudendal Nerve Pulsed Radiofrequency Ablation

Pulsed radiofrequency is a modern neuromodulation technique that:

• Delivers short bursts of electrical energy

• Maintains a controlled temperature (typically 42°C)

• Avoids thermal nerve destruction

• Alters abnormal pain signalling

Unlike continuous radiofrequency (which creates heat lesions), PRF delivers electrical pulses separated by pauses, allowing heat to dissipate and reducing the risk of nerve damage

The goal is neuromodulation, not nerve destruction.

The pudendal nerve arises from spinal roots S2–S4 and supplies:

• Perineum

• External genitalia

• Anal sphincter

• Pelvic floor muscles

Common sites of entrapment include:

• Between sacrospinous and sacrotuberous ligaments

• Within Alcock’s canal

• Post-surgical or post-childbirth scarring

Entrapment or irritation can lead to:

• Burning perineal pain

• Sitting intolerance

• Sexual dysfunction

• Bladder or bowel discomfort

PRF is typically offered when:

✔ Pain is located in the pudendal distribution
✔ Pain worsens with sitting and improves when standing
✔ Diagnostic pudendal nerve block provides temporary relief
✔ Conservative treatments have failed

International diagnostic criteria (Nantes criteria) emphasise relief with diagnostic block as a key confirmation step

1. Early Clinical Experience (2009)

One of the earliest published reports described successful treatment of refractory pudendal neuralgia using pulsed radiofrequency. The patient had severe sitting intolerance and failed multiple therapies. After PRF, she was able to sit for several hours, reduce opioid medication, and maintain improvement at 18 months follow-up. No complications were reported.

Reference:
Rhame EE, Levey KA, Gharibo CG. Successful treatment of refractory pudendal neuralgia with pulsed radiofrequency. Pain Physician. 2009;12:633–638.

2. Ultrasound-Guided PRF Case Series (2014)

A case series demonstrated that ultrasound-guided pudendal nerve PRF produced sustained pain reduction in patients with refractory pudendal neuralgia. Patients experienced significant improvements in perineal pain and sitting tolerance, with benefits lasting up to 6 months or longer. No major adverse events were reported.

Reference:
Han SM, Moon DE, Kim YH, et al. Ultrasound-guided pudendal nerve pulsed radiofrequency in patients with refractory pudendal neuralgia: Three case reports. Anesthesia and Pain Medicine. 2014;9:250–253.

3. Randomised Controlled Trial (2018)

A prospective randomised controlled trial compared pudendal nerve block alone versus pudendal nerve block combined with PRF.

Key findings:

• Both groups improved immediately after treatment.

• The PRF group had significantly lower pain scores at 2 weeks, 1 month, and 3 months.

• Clinical effective rate at 3 months:

  • 92.1% in the PRF group

  • 35.9% in the nerve block–only group

• No severe adverse events were observed.

This study provides strong evidence that PRF offers longer-lasting benefit than injections alone.

Reference:
Fang H, Zhang J, Yang Y, et al. Clinical effect and safety of pulsed radiofrequency treatment for pudendal neuralgia: A prospective, randomized controlled clinical trial. Journal of Pain Research. 2018;11:2367–2374.

4. Long-Term Follow-Up Outcomes (2021)

A long-term case series (median follow-up 4 years) reported:

• 79% of patients described their condition as “very much better” at 3 months

• 89% maintained improvement at long-term follow-up

• PRF treatments were safely repeated when pain recurred

• No serious neurological complications were observed

This supports both durability and safety over time.

Reference:
Krijnen EA, Schweitzer KJ, van Wijck AJM, Withagen MIJ. Pulsed radiofrequency of pudendal nerve for treatment in patients with pudendal neuralgia: A case series with long-term follow-up. Pain Practice. 2021;21(6):703–707.

5. Pudendal PRF in Interstitial Cystitis / Bladder Pain syndrome-Associated Perineal Pain

Pudendal PRF has also been shown to significantly reduce pain scores in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with pudendal involvement. Median VAS scores reduced significantly at 1, 3, and 6 months post-procedure.

Reference:
Peking University People’s Hospital group. Pudendal nerve pulsed radiofrequency for refractory IC/BPS-associated perineal pain. Pain Research and Management.

Pain relief may:

• Begin within days to weeks

• Last several months

• Sometimes extend beyond a year

• Be repeated if pain recurs

Some patients require repeat PRF ablation every 3–6 months initially, with longer intervals over time

Importantly, PRF ablation may:

• Improve sitting tolerance

• Reduce medication requirements

• Improve mood and depression scores

• Improve sexual and pelvic function

Across published studies:

• No major neurological complications reported

• No long-term incontinence

• No serious nerve injury

• Minor side effects (rare):

  • Temporary soreness

  • Short-term numbness

  • Mild bleeding

Because PRF does not thermally destroy the nerve, it is considered safe treatment. It works by modulating abnormal pain signalling pathways while preserving the structural integrity and normal motor and sensory function of the nerve.

PRFL treatment is generally avoided in patients with:

• Active infection

• Coagulopathy or anticoagulation (relative contraindication)

• Allergy to local anaesthetic (very rare)

• Pregnancy

• Unclear diagnosis

Pudendal interventions are technically demanding.

Many clinicians:

• Do not perform ultrasound-guided pudendal procedures

• Rely solely on blind or landmark techniques

At Pain Spa:

• Advanced ultrasound expertise

• Specialist interventional pain consultant

• Careful diagnostic pathway before PRFL treatment

• Evidence-based patient selection

• Multidisciplinary pelvic pain approach

PRFL treatment is offered only when clinically appropriate, following structured assessment.

Is PRF the same as burning the nerve?

No. Pulsed RF ablation does not destroy the nerve. It modifies abnormal pain signalling while preserving function.

Will I lose bladder or bowel control?

No. Published studies report no long-term continence problems with Pulse RF ablation.

How many treatments will I need?

Some patients require one treatment; others may benefit from repeat PRF every few months initially.

Is this better than surgery?

PRFL treatment is far less invasive than decompression surgery and should be considered before other invasive treatments.