Pudendal Endometriosis

Pudendal Nerve Endometriosis – A Comprehensive Guide

What is Pudendal Nerve Endometriosis?

Pudendal nerve endometriosis is a rare form of deep infiltrative endometriosis caused by the implantation of endometrial tissue around or along the pudendal nerve. It is one of the significant causes of chronic pelvic pain syndrome.

Anatomical Significance

The pudendal nerve is responsible for the sensory and motor innervation of the perineum, vagina, vulva, and anal region. Therefore, its involvement leads to very specific symptoms.

Most Typical Findings

Perineal pain that increases with sitting, burning, stinging sensations, and tenderness in the genital area are the most characteristic findings.

Pain Characteristics

Pain typically increases when sitting and decreases when standing or lying down. Patients often have difficulty sitting.

Relationship with Menstruation

A significant increase in symptoms during the menstrual period is an important clue for endometriosis.

Accompanying Symptoms

Pain during sexual intercourse (dyspareunia), pain during urination, pain during defecation, and a sensation of pelvic pressure may be observed.

Neurological Findings

Numbness, tingling, and rarely, decreased muscle control may be observed.

How is it Diagnosed?

Clinical history is very important. MRI and pelvic nerve imaging methods can be helpful, but diagnosis is mostly made based on clinical suspicion.

Differential Diagnosis

It can be confused with pudendal nerve entrapment, chronic pelvic pain syndrome, and neuropathic pain.

Treatment Approach

Treatment should be multidisciplinary. Medical treatment, pelvic floor physiotherapy, and surgery in selected cases may be applied.

Surgical Treatment

Excision of endometriosis foci is performed using nerve-sparing surgical techniques. It should be performed in experienced centers.

Conclusion

Pudendal nerve endometriosis is a rare but condition that seriously affects quality of life. It should always be kept in mind, especially in cases of pelvic pain that increases with sitting and is related to menstruation.