How do you distinguish?

[notmybestday]

Hi all --

How do you distinguish between pudendal nerve conditions and vulvodynia? My vulva is sore most of the time, so of course it hurts to sit for long periods of time or apply any kind of sustained pressure to it. How does this differ from pudendal nerve conditions? In the kind of pain?

Also, could someone distinguish between pudendal neuralgia and pudendal nerve entrapment? My understanding is that pudendal neuralgia is inflammation of the nerve and not necessarily true entrapment and thus does not necessarily require decompressing surgery. Could someone elaborate?

Thank you so much, as always.

S.

[leelee88]

Sorry I cannot help you on this one. If you do not get a reply you could PM Kara29.. She has both and maybe she could help..

[Kara29]

PN is inflmation and PNE is actual entrapment and compression of the Pudendal Nerve. The way they diagnose this is through and EMG or something called a Motor Latency Test........I'm not sure about this b/c I was diagnosed with the EMG and a Nerve Block. There are actually two parts of the Pudendal Nerve and upper and lower portion, so if you are having blocks done.....ask your doc if they can test both the upper and lower parts. Mine is trapped in the uncommon upper part the the PN. Again, your specialist will discuss all of this with you. I will be happy to help you find a PNE Specialist in or around you. There are only 3-4 PNE Specialists in the United States. If you tell me your general location, I can try to find someone near you. I am only comfortable with my Specialist for several reasons: He's and OBGYN, so he can help with the Vulvodyina/Vestibulitis symptoms as well as the PN/PNE symptoms all at once. He's great for ruling out what it is or isn't..............

These conditions are really hard to diagnose that is why it's important to find a specialist. My Favorite is an OBGYN and PNE Specialist from NH. He's awesome for information.

I can give you a list of traditional symptoms of PNE, but remember we are all very different and it even happens to Men.

Primary symptoms of Pudendal Neuralgia include:

· Pelvic pain with sitting that may be less intense in the morning and increase throughout the day. Symptoms may decrease when standing or lying down. The pain can be perineal, rectal or in the clitoral / penile area; it can be unilateral or bilateral.

· Sexual dysfunction. In women, dysfunction manifests as pain or decreased sensation in the genitals, perineum or rectum. Pain may occur with or without touch. It may be difficult or impossible for the woman to achieve orgasm. In men, dysfunction presents as pain during erection, difficulty sustaining an erection or painful ejaculation.

· Difficulty with urination / defecation. Patients may experience urinary hesitancy, urgency and/or frequency. Post-void discomfort is not uncommon. Patients may feel that they have to ‘strain’ to have a bowel movement and the movement may be painful and/or result in pelvic pain after. Constipation is also common among patients with pudendal neuralgia. In severe cases, complete or partial urinary and/or fecal incontinence may result.

· Sensation of a foreign object being within the body. Some patients will feel as though there is a foreign object sitting inside the vagina or the rectum.

It is important to note PN is largely a “rule out” condition. In other words, because its symptoms can be indicative of another problem, extensive testing is required to ensure that your symptoms are not related to another condition. Common conditions that should be evaluated include coccygodynia, piriformis syndrome, interstitial cystitis, chronic or non-bacterial prostatitis, prostatodynia, vulvodynia, vestibulitis, chronic pelvic pain syndrome, proctalgia, anorectal neuralgia, pelvic contracture syndrome/pelvic congestion, proctalgia fugax or levator ani syndrome.

In addition to eliminating other diagnoses, it is important to determine if the pudendal neuralgia is caused by a true entrapment or other compression / tension dysfunctions. In almost all cases, pelvic floor dysfunction accompanies pudendal neuralgia. Electrodiagnostic studies will help the practitioner determine if the symptoms are caused by a true nerve entrapment or by muscular problems and neural irritation. It is crucial to a successful treatment outcome to acknowledge both dysfunctions and treat accordingly. In the event of a true entrapment, surgical decompression followed by post-operative physical therapy will be necessary to restore patient health. In cases of pudendal neuralgia, pudendal nerve blocks and physical therapy can alleviate the symptoms and resolve the original problem.

A diagram was created and copyrighted by Dr. Jacques Beco in 1998 which clearly illustrates the pathway of the pudendal nerve. In this diagram, we have overlayed the most likely sites of a nerve entrapment. This original diagram is available on www.pudendal.com.

NOTE: This information was authored and approved by the physicians on our Board of Directors, but it is not a substitute for a visit with your physician.

The EMG is done in the Doctor's office. They hook up a bunch of electrodes to your pelvic area and clitoris and rectal area. If you have more questions regarding this procedure pm me. Or contact one the the specialists that are on the North American Physicians Listing Site. http://www.spuninfo.org/index_files/Page771.htm

Your best bet is to find a Specialist in PNE and Chronic Pelvic Pain Disorders. I will be happy to assist you with the PNE Specialist. If you don't want to post any private info here you can Private Message me and we can talk that way.

I want you to know that you are not alone with your symptoms. Many of us on the ICN share some or all of these symptoms. It's not wise to self diagnose yourself, which is why I want to help you find a PNE/Chronic Pelvic Pain Specialist.............

For a Lisiting of North American Physicians you can go to this site: http://www.spuninfo.org/index_files/Page771.htm

This information is quoted from the The Society for Pudendal: http://www.spuninfo.org/index.htm


Well Wishes and Warm Hugs,

Kara

I was thinking, many women are diagnosed with something called Vestibulitis as well as PNE, sometimes the symptoms are similar and often overlap with PNE symptoms.



Patient Information: Vulvar - Vaginal Disease
Vestibulitis

What is vulvar vestibulitis?
Vestibulitis is a condition which causes redness and pain of the vestibule. Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands. Vestibulitis may include all the area around the opening of the vagina but ismost commonly seen in the lower part.

Vulvar vestibulitis occurs in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.

Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.

What are the signs and symptoms of Vulvar Vestibulitis?

* Severe pain with pressure (for example: biking, exercise, tight fitting clothes ).
* Vaginal entry such as tampon use or intercourse.
* Burning, stinging, irritation, or raw sensation within the vestibular area.
* Vestibular redness
* The urge to urinate frequently or suddenly
How is vulvar vestibulitis diagnosed (identified)?
Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with vulvar vestibulitis. Pain is usually felt if the vestibule area is touched with a cotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.


I've had a Vestibulectomy and I am having the PNE Decompression Operation sometime in the spring and summer................Please PM me if you want to talk further.