His and Her Health

Dr Goldstein -
What is your opinion on Pudental Nerve Blocks for someone who has stinging, shooting, sharp natured pain in the vestibule as well as all over the labia majora and mons pubis and at times felt on the edge of the thighs as well?
Can repeated blocks break the pain cycle?
Thanks PK

<small>[ 04-26-2008, 11:23 AM: Message edited by: Moderator ]</small>

I use pudendal nerve blocks when I have identified pudendal neuropathy and all pelvic floor dysfunction has been treated. I push on the pudendal nerve to see if it is painful, if it is, then pudendal nerve blocks can help.

Dr G,

Why does all pelvic floor dysfunction have to be treated prior to a pudendal nerve block?

Again,I don't want to answer in place of Dr. Goldstein, but I will try to respond to your question Brit. PFD relates to the muscles. If PFD exists and is causing pudendal nerve irritation it means the muscles are tight and pressing on the nerve (not necessarily "entrapped"-very different). What I beleive Dr. Goldstein is saying is that when the muscles are more relaxed and more in a state of normalcy, and he presses on the nerve and it is still painful, then he does the block. If the muscles are still tight, they will still press on the nerve, with or without the block.

Again, Dr. Goldstein, sorry I am answering these first. I hope you can add on.
niva

Ms Herzig,

I read this old post and do have some questions.
Nerves do send messages to muscles so I am not completely grasping the concept that the muscles have to be completely out of spasm to do the nerve block? Can you explain please.
Also I suffer from vestibule pain at the lower part when I sit it seems to get the ball rolling so to speak in regard to the pain. How can I decipher whether the skin pain is causing the muscles to spasm or vica versa ( pt is completely not effective because when the area is touched it just starts this horrible pain cycle). But am wondering which to address first and how do you know? thank you

Ms Herzig,

I read this old post and do have some questions.
Nerves do send messages to muscles so I am not completely grasping the concept that the muscles have to be completely out of spasm to do the nerve block? Can you explain please.
Also I suffer from vestibule pain at the lower part when I sit it seems to get the ball rolling so to speak in regard to the pain. How can I decipher whether the skin pain is causing the muscles to spasm or vica versa ( pt is completely not effective because when the area is touched it just starts this horrible pain cycle). But am wondering which to address first and how do you know? thank you

boden1,
I have had patients get nerve blocks even as PFD is still existing, so I am not sure on the reasoning of it all needed to be gone. I don't (as a PT) make the decision for patients to have a nerve block. I refer patients to the proper physician to make that decision.
If touch is not possible right now, perhaps some leg stretching, pelvic girdle (inner, outer, posterior thigh, abdomen and back) myofascial release.
Sounds like you need to be addressing both!

when the vestibule hurts, how can you tell if its a case of too many nerves there or just the muscle compressing the pudendal nerve. I am taking nerve pain meds now that are helping, so I am wondering if I am the case of nerve proliferation that may be a vestiulectomy or am I the case of nerve compression?

Are you being treated by a vulvar specialist (MD)? They should be able to answer your nerve quantity question.

I will have to, thank you