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Pudendal Nerve

nervus pudendus

The pudendal nerve is the primary nerve of the perineum, supplying the external sphincters, perineal muscles, and genital skin. Its course through Alcock canal makes it susceptible to compression from prolonged cycling, childbirth trauma, and pelvic floor dysfunction. Pudendal neuralgia is a chronic pain syndrome from its entrapment that produces severe perineal pain worsening with sitting and relieved by standing.

Region: Pelvis & Hip

Anatomical Data

Origin, Insertion & Supply

Origin	Sacral plexus (S2, S3, S4)

Clinical Relevance

Clinical Notes

Pudendal neuralgia is an underdiagnosed condition producing perineal, genital, or rectal pain that is worse when sitting and relieved by standing or sitting on a toilet seat. The Nantes criteria require pain in the pudendal nerve territory that worsens with sitting, is not worse at night, has no objective sensory loss, and is not improved by local anaesthetic nerve block. Treatment includes pelvic floor physiotherapy, nerve block under imaging guidance, and in refractory cases decompression surgery at Alcock canal.

Pathology

Common Injuries & Conditions

Pudendal Neuralgia

Chronic perineal pain from pudendal nerve entrapment in Alcock canal producing sitting-provoked pain in the perineum, genitalia, or rectum, managed with pelvic floor physiotherapy and diagnostic nerve blocks.