Is PN always one sided?

[sweetMama]

Hello

My pain of PN is actually on both sides. I am not sure I understand it. If it is nerve damage, I would assume it will be one sided?
When I have sciatica, it is on one leg usually, not both sided.

[April]

Hi SweetMama,

It is unusual to have entrapment on both sides, but one-sided entrapment creates pain on both sides. The side with the entrapment may get sharp or stabbing pain but send burning pain throughout the pelvic floor. But pn pain can very often be caused by things other than entrapment, so in those cases I think the pain can easily be similar on both sides.

April

[sweetMama]

I had hysterectomy 2 months ago and started to feel the pain 1 month into recovery.
It is strange but most of my pain is either with clitoris or honestly both sides almost the same.
I don’t get it

[Violet M]

Often with an entrapment you are more likely to have worse pain on one side, but it is possible to be entrapped on both sides. Like April said, you can have pudendal neuralgia without entrapment, or over time the pain can spread throughout the pelvic, especially if the pelvic floor muscles become tense from the pain. Some other typical signs of entrapment are pain with sitting and a reduction in pain at least temporarily with a nerve block. Each person is different though, and not everyone has "typical" symptoms. Have you been evaluated by a pelvic floor PT yet or had diagnostic pudendal nerve blocks yet?

Violet

[sweetMama]

Often with an entrapment you are more likely to have worse pain on one side, but it is possible to be entrapped on both sides. Like April said, you can have pudendal neuralgia without entrapment, or over time the pain can spread throughout the pelvic, especially if the pelvic floor muscles become tense from the pain. Some other typical signs of entrapment are pain with sitting and a reduction in pain at least temporarily with a nerve block. Each person is different though, and not everyone has "typical" symptoms. Have you been evaluated by a pelvic floor PT yet or had diagnostic pudendal nerve blocks yet?

Violet

My worst pain is with sitting
I have started pelvic floor pt but not sure they will diagnose me?
I have not had yet pudendal nerve blocks. Trying pt and gabapentin for few more weeks I guess.
But it is also very hard to find locally pt that really is skilled in this condition. I had 3 sessions so far and all 3 aggravated my pain I think because she keeps trying to do too much on me at once ( like triggers massage ) and I end up not knowing what triggered it.

[Violet M]

Pelvic floor PT aggravated my pain before PNE surgery too. I decided to stop doing it because I couldn't see the point in aggravating an already irritated nerve.

It depends on the PT as to whether they will give you a diagnosis. Mine diagnosed me when the local doctors had no clue. She pressed on the nerve at the ischial spine and Alcock's canal and figured out right away that the pudendal nerve was irritated. After the PT session I went home and started reading about PN/PNE on the forums and was shocked at how my symptoms fit exactly.

So, basically I think it's good to get an evaluation by a PT but if the treatments cause a flare-up it I think you would want to consider discontinuing it

Violet

[adelphos2]

Violet is right that PN does not necessarily mean entrapment. The five essentials diagnostic criteria for PN are: (1) Pain in the anatomical territory of the pudendal nerve. (2) Worsened by sitting. (3) The patient is not woken at night by the pain. (4) No objective sensory loss on clinical examination. (5) Positive anesthetic pudendal nerve block. Other clinical criteria (like tenderness over the course of the pudendal nerve) can provide additional evidence in favor of the diagnosis of pudendal neuralgia, but tenderness alone is not diagnostic.

[Violet M]

Just based on my own experience, I did not perfectly meet the Nantes criteria. https://www.pudendalhope.info/wp-conten ... iteria.pdf
But nerve decompression surgery made me 90% better and I am 100% certain my ligaments were compressing the nerve. So, while I think these criteria can be very helpful and can be used as a guideline to some extent, I don't think they can be used with 100% accuracy in determining whether you have an entrapment.

Adelphos, you had mentioned the criteria might be amended. Is there any more you can tell us about that?

Violet

[adelphos2]

There is a group looking at creating a revised criteria. The Nantes criteria is for pudendal neurlagia, NOT for pudendal entrapment. They can co-exist but are not the same.

[Violet M]

There is a group looking at creating a revised criteria. The Nantes criteria is for pudendal neurlagia, NOT for pudendal entrapment. They can co-exist but are not the same.

I agree that pudendal neuralgia and pudendal nerve entrapment are not the same. Pudendal nerve entrapment is one of the possible causes of pudendal neuralgia, but there are other things that can cause pudendal neuralgia - like lyme disease or muscle tension.

Maybe I am reading it wrong, but my understanding is that the Nantes Criteria are a set of criteria to determine if you have a nerve entrapment that is causing pudendal neuralgia. Here are some direct quotes from the article which can be found at
https://www.pudendalhope.info/wp-conten ... iteria.pdf

The title of the article is "Diagnostic Criteria for Pudendal Neuralgia by
Pudendal Nerve Entrapment (Nantes Criteria)"

"ESSENTIAL CRITERIA FOR THE DIAGNOSIS OF
PUDENDAL NEURALGIA BY PNE
These five criteria are considered to be essential and must
therefore all be present in order to conclude on a diagnosis
of pudendal nerve entrapment syndrome or compressive
pudendal neuralgia."

"Conclusion: The diagnosis of pudendal neuralgia by
pudendal nerve entrapment syndrome is essentially clinical. There are no specific clinical signs or complementary test results of this
disease. However, a combination of criteria can be suggestive of the diagnosis."