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What is Pudendal Neuralgia

Anatomy of the human pelvis 

Pudendal neuralgia is a pelvic condition that causes pain, discomfort, or numbness in your pelvis or genitals. Experts believe it is a rare condition, and it is often overlooked when evaluating chronic genital or pelvic pain disorders. 

The pain caused by pudendal neuralgia is typically associated with many disorders such as  vulvodynia,  interstitial cystitis, prostatodynia, proctalgia fugax,  pelvic floor dysfunction, and many more. All of these disorders can have the same symptoms as pudendal neuralgia.

The pudendal nerve runs from the back of the pelvis to near the base of your penis or vagina, where it branches off into other nerves. It sends messages to the brain from your genitals, anus, and other nearby body parts. It controls the sphincter muscles that open and close when you use the bathroom, making it harder for people to use the restroom, have sex, or sit down.

Pudendal Neuralgia Symptoms

You will usually feel the symptoms in the lower body, genitals, or perineum, which is between the genitals and anus. Some common feelings are sharp or burning pain, more sensitivity, numbness, or a swollen feeling. They may worsen when you sit down or may feel them on both sides of your body going into your belly, buttocks, or legs. 

You may also feel pain during intercourse and pain that radiates in the abdomen to mid to lower back.

Pudendal Neuralgia in People

Typically, patients with vaginas with pudendal neuralgia experience severe perineal burning, electrical pain, and chronic pain around the genitals, especially the vulva and the clitoris. This feeling is often described as ‘‘sitting on a rock’’. Unfortunately, these patients face greater abdominal and pelvic injury that will likely cause neuropathic pain. 

Estimates of chronic pain following a cesarean or vaginal delivery range from 10–20%. Neuropathic pain from gynecological procedures may be associated with a 5–32% risk.

On the other side, people with a penis typically have pain more focused around the scrotum or end of the penis. The most common cause by far in these patients is excessive bicycling.

If you have pelvic pain, book an appointment with your doctor and get a physical examination. Usually, the doctor presses a finger into your vagina or rectum, putting pressure to check the nerve on it. There is also the possibility of getting an imaging test with an MRI for your internal organs. 

Pudendal Neuralgia Causes

This condition happens when a major nerve in the lower body is damaged or irritated, making it hard to perform daily activities. 

Pudendal neuralgia can cause weakness, pain, numbness, burning sensations, stabbing, or electric shock sensations. This is often due to damage to one of these four nerves:

  1. Pudendal nerve
  2. Iliohypogastric nerve
  3. Ilioinguinal nerve
  4. Genito-femoral nerve

Common causes of pudendal neuralgia can be diabetic neuropathy, which can affect up to 70 percent of people with diabetes, excessive compression-like prolonged sitting or bicycling, extreme stretching during a surgical procedure, and cuts or nicks during abdominal surgery. 

Pudendal Neuralgia Treatment

To know how to treat pudendal neuralgia, you have to consider the type of nerve damage, symptoms, location, and level of pain. If the doctor can identify the underlying cause of your pelvic neuralgia, then with proper treatment, your nerves may be able to recover and regenerate.

Most people with pudendal neuralgia get treatment with physical therapy, lifestyle changes, and medicine combined. Specific exercises can make this condition worse, such as squats or cycling. Instead, sitting up straight or standing more often can help relieve nerve pain as it takes the pressure off the pudendal nerve.

Some medicines your doctor can prescribe are muscle relaxants to relieve the symptoms. Drugs used to treat epilepsy or depression are often used and might also help. Typically, doctors confirm the pudendal nerves are causing pain to the patient by using an ultrasound machine to see the nerves and guide a thin needle to them through your buttocks to turn them off temporarily via a local anesthetic injection. 

Sometimes this treatment, called ultrasound-guided pudendal nerve block, is sufficient to cure the issue. If insufficient, you may be a candidate for other procedures such as low volume caudal epidural injections, pulsed radiofrequency ablation of the pudendal nerves, or spinal cord stimulation trial over a particular area of the spinal cord called the conus meddularis.

In rare cases, your doctor may recommend surgery to remove anything that presses on the nerve. There is also the possibility to get a small electrical device put under your skin to stimulate the nerve and interrupt the pain signals it sends to the brain.

Pudendal Neuralgia Physical Therapy

Physical therapy for pudendal neuralgia includes identifying poor movements that may contribute to the symptoms. Once you determine what activities trigger pain, you can look for treatments and exercises that can correct the body mechanics, position to facilitate healthy muscle contraction, and achieve relaxation.

Pelvic Floor Exercises

This is the most popular strategy used by physiotherapists who specialize in pelvic floor dysfunction and disorders. This is a non-invasive approach that should be considered before trying more aggressive methods. During these  exercises for the pelvic floor, external-driven techniques are used to mobilize the sacroiliac joints and manage pudendal nerve involvement.

Exercises

Some physical activities that can aid relax tensed pudendal nerve and will provide temporary relief are:

  1. Wide leg bridges
  2. Standing backward leg lifts
  3. Side-lying hip abduction and extension
  4. Hip extension in the quadruped position
  5. Cobra pose
  6. Arch Backs

Pudendal Neuralgia and CBD

There is an abundance of anecdotal evidence suggesting that medical cannabis has immense therapeutic potential in people’s health. Many patients have spent years managing their pain with medication which has not helped them relieve their symptoms. 

Fortunately, opiate prescriptions have become their principal option for some patients that can take away the pain. However, it depends on what kind of condition you have to treat that significant pain and discomfort. The type of pain you are going to treat will determine which cannabinoids you should use.

CBD

CBD is not a psychoactive like THC, but it can positively influence your mood and help manage any discomfort and pain. Additionally, CBD can boost opioid-based analgesic effects, enabling patients to achieve efficacy with lower doses of opioids, reducing any risk of addiction.

CBDa

CBDa is a non-impairing cannabinoid that has anti-inflammatory properties, which may be helpful for arthritic pain. While CBDa has not been studied rigorously as CBD or THC, observational reports suggest that it can help reduce mid pain and fatigue.

CBG

CBG is a non-impairing cannabinoid that can decrease anxiety and muscle tension. Also, it has anti-inflammatory properties that can help patients who suffer from intestinal bowel disease and depression.

Once you have identified the cannabinoids that might help treat your pain, there are numerous different delivery methods that you can use to consume cannabis and be influenced by the benefits they offer as each of them provides a unique experience and set of effects.

Topical Administration

Topicals can provide local relief within minutes of application, and they can last several hours. Topicals can give relief to hands, neck, ankles, and feet. Topicals penetrate only the top layers of the skin, typically do not reach the bloodstream, and therefore will not provide systemic relief. 

It is recommended for patients with arthritic pain to start with a CBD-dominant topical for pain as it penetrates the skin more appropriately.

Ingestion

Ingesting CBD for pudendal neuralgia can provide systemic relief for patients. The effects of ingested cannabis last longer and, over time, can reduce inflammation. 

Patients report that when they use cannabis regularly and consistently, they can reduce the severity and intensity of their symptoms.

Sublingual Administration

Patients can use sublingual products to provide relief between edible doses when inhalation is not an option. Cannabis products are often extracted into an oil and marketed as tinctures that follow the ingestion pattern, regardless of how long you hold them under your tongue. 

Most sublingual products are formulated to be water-soluble to be absorbed rapidly into the mouth and take effect within 15 minutes.

Transdermal Administration

Transdermal products are similar to topicals except that they have an added agent that helps the cannabinoids penetrate the skin and enter the bloodstream, mostly avoiding the first-pass metabolism. A transdermal patch can provide eight to twelve hours of relief and are often more consistent and reliable than edible products. 

Inhalation

If your pain is constant or fluctuates in intensity, inhalation may be the best way to control the pain. Inhaling cannabis can relieve pain quickly and can give you the most control over your dose. Moreover, it provides immediate relief and is especially effective for patients treating nausea, and cannot ingest other forms of medication. 

Rectal Administration

Some medical practitioners and cannabis manufacturers suggest that rectal administration is advantageous because patients can take larger doses while avoiding psychoactivity. Patients might consider this route if they suffer from conditions that can benefit from a topical cannabis administration, such as fissures or hemorrhoids. Several studies and researches have demonstrated that there are diverse health issues where cannabis can be beneficial.

CBD Lube for Pudendal Neuralgia

As we mentioned above, CBD is a great option when treating pain. Because of its anti-inflammatory properties, many manufacturers add this compound to their lubes for a smooth experience.

In case you experience pain during sex due to pudendal neuralgia, we recommend using the soothing  GoLove’s CBD lube. This formula will help you feel at ease, relaxing your pelvic muscles. As a result, you will be able to experience intimacy without worrying too much about your pain. 

Remember to talk with your doctor to know the best ways to avoid pain or discomfort during sex. You don’t have to put off pleasure if you suffer from pudendal neuralgia. With the right treatment and discipline, you will eventually be able to overcome this uncomfortable condition.

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