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From Persistent Pelvic Pain to Lasting Relief: A Pudendal Neuralgia Recovery Journey

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Background

A 50-year-old woman presented to Pain Spa with a three-year history of persistent pelvic pain, consistent with pudendal neuralgia. Her symptoms included burning discomfort in the vaginal and perineal region, hypersensitivity on contact, pain on sitting, and intermittent bladder urgency. Pain tended to worsen throughout the day, particularly with activity, stress, and certain dietary triggers. Sleep remained largely unaffected.

She had undergone an extensive urological work-up including pelvic MRI scan, cystoscopy, blood tests, and pelvic examinations, all of which were reassuring and showed no concerning pathology. She had trialled several conservative treatments—antibiotics, pelvic floor physiotherapy, neuropathic medications, and lifestyle modification—with limited benefit.

Her symptoms, clinical history, and examination findings were highly consistent with pudendal neuralgia.

Assessment

During consultation, the patient described classic neuropathic pain features—burning, hypersensitivity, and pain aggravated by sitting. Although previous investigations had ruled out structural causes, her symptoms suggested pudendal nerve irritation.

She had also been diagnosed previously with pelvic floor hypertonicity, a common feature associated with pudendal nerve irritation and chronic pelvic pain. Psychological distress related to persistent pain was also noted.

Treatment Provided at Pain Spa

Following detailed discussion of treatment options with Dr Krishna, she underwent:

1. Bilateral Pudendal Nerve Blocks (Ultrasound-Guided)

These injections were performed under real-time ultrasound guidance using a combination of local anaesthetic and steroid. The aim was to both confirm the diagnosis and provide therapeutic benefit.

She reported excellent short-term pain relief (6 weeks) following the injections, with a significant reduction in burning pain and hypersensitivity.

2. Pulsed Radiofrequency of the Pudendal Nerve under ultrasound guidance

Given her positive response to the diagnostic nerve blocks, she proceeded to pulsed radiofrequency lesioning of the pudendal nerves under real-time ultrasound guidance a few weeks later. This minimally invasive treatment aims to neuromodulate the nerve without causing permanent damage, offering longer-lasting relief.

She tolerated both procedures well with no complications.

Outcome

At follow-up, the patient reported marked and sustained improvement, with:

  • Significant reduction in pelvic and perineal pain
  • Improved tolerance to sitting
  • Resolution of clothing-related hypersensitivity
  • Improved bladder comfort
  • Better overall function and quality of life

Most importantly, she continued to experience ongoing relief lasting more than six months, a typical positive outcome following pulsed radiofrequency treatment after successful diagnostic nerve blocks.

Discussion

Pudendal neuralgia is a complex and often debilitating condition, particularly when conservative measures fail. In selected patients, ultrasound-guided pudendal nerve blocks, followed by pulsed radiofrequency, can provide substantial and long-lasting relief.

This case highlights the importance of:

  • Careful diagnosis
  • Minimally invasive targeted treatment
  • Adjunct pelvic floor physiotherapy
  • Considering psychological support where appropriate

Early interventional treatment can help prevent chronic central sensitisation and allow patients to return to normal activity with significantly improved comfort.

Conclusion

This 50-year-old female patient achieved excellent long-term outcome with a combination of pudendal nerve blocks and pulsed radiofrequency treatment. Her experience demonstrates the effectiveness of a targeted, evidence-based approach to managing pudendal neuralgia at Pain Spa.

Why Pudendal Nerve Blocks and Pulsed Radiofrequency Require Specialist Expertise

Pudendal nerve blocks and pulsed radiofrequency treatment are highly specialised procedures, requiring detailed anatomical knowledge and advanced technical skill. The pudendal nerve lies deep within the pelvis, close to vascular structures, making the procedure potentially challenging. For this reason, the safest and most effective approach is to carry out these interventions under real-time ultrasound guidance, ensuring precise needle placement and optimal therapeutic effect. At Pain Spa, these procedures are performed by Dr Krishna, whose expertise and extensive experience in pelvic pain interventions significantly enhance the accuracy of the treatment and the likelihood of a successful outcome.

For more information about Pudendal nerve blocks and Pulsed radiofrequency treatment or to find out if this procedure may be suitable for you, please visit www.painspa.co.uk or email us at clinic@painspa.co.uk for further details.