Pain Management Procedures
Pudendal Nerve Block and Radiofrequency Treatment
Pudendal Nerve Block and Radiofrequency Treatment
What is it?
The pudendal nerve carries sensation from the perineum and external genital area and contributes to bladder, bowel, and sexual function. Irritation or entrapment can cause burning, stabbing, or electric pelvic pain, often worse with sitting. A pudendal nerve block places anesthetic near the nerve for diagnosis and temporary treatment. Pulsed or conventional radiofrequency treatment may be considered in selected cases, although evidence and technique vary.
When may it be recommended?
The block may be considered when the history and examination fit pudendal neuralgia and other pelvic, spine, hip, urinary, gynecologic, colorectal, and neurologic causes have been evaluated. Pelvic-floor therapy and medication are often part of treatment. A helpful diagnostic block supports but does not by itself prove nerve entrapment.
What happens?
The nerve is commonly approached through the buttock under fluoroscopy, CT, or ultrasound guidance near the ischial spine or Alcock canal. The skin is cleaned and numbed; contrast may confirm the location, and local anesthetic with or without steroid is injected. Other approaches are used in gynecologic or surgical settings.
What should I expect?
The pelvic or genital area may feel numb, and sitting may feel different until sensation returns. Temporary leg weakness is possible if medication spreads to the sciatic nerve. Relief may be immediate and short-lived or last longer.
Important risks and limitations
Risks include bleeding, infection, medication reaction, nerve injury, temporary bladder or bowel changes, sexual dysfunction, and injury to nearby organs or blood vessels. RFA is less standardized for pudendal pain than facet-joint RFA; the type of energy, expected benefit, and risk of sensory or motor change should be explained in detail.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.