The pudendal nerve is the primary perineal nerve, supplying the external sphincters, erectile tissue muscles, and perineal sensation. Pudendal neuralgia from nerve entrapment at the ischial spine (between sacrospinous and sacrotuberous ligaments) or in Alcock's canal produces burning perineal pain worsened by sitting, relieved by standing, and reproduced by the Carnett test and injection at the ischial spine.
| Origin | Sacral plexus (S2, S3, S4) |
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Pudendal nerve block at the ischial spine (Alcock's canal block) is the primary diagnostic and therapeutic intervention for pudendal neuralgia. CT-guided or ultrasound-guided injection confirms diagnostic response — >50% pain relief confirms the diagnosis. Surgical pudendal nerve decompression through the transperineal or transgluteal approach is performed for refractory cases.
Pudendal nerve entrapment producing burning perineal pain worsened by sitting managed with Alcock's canal block and surgical decompression for refractory cases.
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