Journal of the European Society for Gynaecological Endoscopy


Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression

N. Habib2, G. Centini2, J. S. Klebanoff3, R. Fernandes4, M. Giorgi2, G. N. Moawad5, J. Bakar1

1 Department of Obstetrics and Gynaecology, Francois Quesnay Hospital, Mantes-La-Jolie 78201, France
2 Department of Molecular and Developmental Medicine, Obstetrics and Gynaecological Clinic, University of Siena, Siena 53100, Italy
3 Department of Obstetrics and Gynaecology, Main Line Health System, Wynnewood 19096, United Sates of America
4 Discipline of Gynaecology, Department of OBGYN, Instituto do Câncer do Estado de São Paulo ICESP, FMUSP, Sao Paulo 01246-000, Brazil; 5Gynaecology Department, George Washington University School of Medicine and Health Sciences, Washington 20052, United Sates of Americ


Pudendal nerve, neuralgia, neurolysis, pelvic pain, laparoscopy

Published online: Jun 30 2023


Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs. The diagnosis is made using Nantes Criteria, in conjunction with the patient’s clinical history and physical findings. Clinical examination with an accurate assessment of the territory of the neuropathic pain is mandatory to set the therapeutic strategy. The aim of the treatment is to control the symptoms and it usually starts with conservative approaches which include analgesics, anticonvulsants, and muscle relaxants. Surgical nerve decompression can be proposed after failure of conservative management. The laparoscopic approach is a feasible and appropriate technique to explore and decompress the pudendal nerve, and to rule out other pelvic conditions that can cause similar symptomatology. In this paper, the clinical history of two patients affected by compressive PN is reported. Both patients underwent laparoscopic pudendal neurolysis suggesting that the treatment for PN should be individualised and carried out by a multidisciplinary team. When conservative treatment fails, laparoscopic nerve exploration and decompression is an adequate option to propose and should be performed by a trained surgeon.