Pelvic pain: Treat it with a Team Focus!
Pudendal neuralgia: commonly described as a stabbing, burning, aching, irritating type of pain in the area from the anus to the penis or clitoris. Although it is more common in people with vulvas than people with penises, pudendal neuralgia does happen in all individuals.
I see pudendal neuralgia as a health condition that can seriously affect your quality of life because it challenges so many functional daily activities.
It can affect:
driving
having coffee with friends
deskwork
breast/chestfeeding
going to the washroom
and much more!.
You name it! A lot of life can be negatively affected by pudendal neuralgia.
There’s a lot of information out there about the causes, symptoms, and how to diagnose it so I won’t elaborate on that. I wanted to share a client case from a few years ago and how we went about treating it:
I had a client with a penis who was referred to me by a sex psychologist. The first subjective complaint was sexual dysfunction but as the sessions progressed, it seemed like there was a unique presentation like pudendal neuralgia. Beyond the subjective concerns and external examination, the client had super tight pelvic floor muscles especially the Obturator Internus muscles. Sure, there was a charged up central nervous system that needed some downregulation (aka brain was wired and tired, and needed to be brought down two notches) but it was clear that his burning pelvic pain was real and debilitating.
I was convinced that the symptoms were so similar to those of pudendal nerve entrapment. I asked if any sacral MRI had been completed before and none had been done. It was a difficult process and the client had to jump through some hoops, but I eventually linked up with his family doctor and pushed for a referral to a specialist in pudendal nerve entrapment. Eventually my client was able to see this specialist and interestingly, my suspicion was confirmed. His condition was an entrapment of the pudendal nerve, causing significant pelvic pain, which led to sexual dysfunction.
The patient was relieved to know what condition he had and that there was help after a decade of feeling lost. Through work alongside pudendal nerve specialists for nerve blocks, medications and physiotherapy sessions with me, he was able to find relief from his condition. He went from a sex psychologist to a physiotherapist to a neurologist and back to a physiotherapist.
The take home message is: A physiotherapist can work within their scope of practice but also have the competence to give you suggestions to seek more medical attention or different services. As a client, if you feel in your gut that something more is happening to you, just be honest to yourself and your medical support team. There are options out there for you!