Pain Management

We are all familiar with acute pain, meaning pain that comes on in the short term and stays for a variable of period of hours or days and then disappears. Common examples include broken bones or injuries sustained while playing sport.

A lot of the time, the original insult (infection, ectopic pregnancy, cancer, birth injury or surgical trauma) has resolved, but the pain persists. This is where treatment becomes tricky and frustrating, especially for the patient.


Pain is a complicated phenomenon that is not entirely understood by anyone, but we are gradually learning to understand what happens in the pelvis and, in particular, in the pain centres within our brains.

Due to its multi-layered nature, persistent pelvic pain requires a multidisciplinary approach whereby specialists in different fields (particularly pain medicine, psychology, physiotherapy, and gynaecology, to name a few) need to put their heads together.

Where possible, assessments of women with chronic pelvic pain are made by a team of specialists working cohesively, so an overall assessment of the genesis of the pain can be done and its progression over months or years can be assessed.

Management of that pain involves the various disciplines, such as physiotherapy for pelvic floor problems, drug therapy for specific pain issues, gynaecological intervention for endometriosis and related issues, and conventional painkillers according to the type of pain involved.

The whole programme begins with a thorough assessment of the pain by the team members. A comprehensive strategy to tackle the problem is something that needs to be agreed upon by everyone, particularly the patient, before therapy begins.

Pudendal nerve desensitization

Pudendal nerve desensitization is a treatment approach that targets the pudendal nerve, which is a major nerve located in the pelvic region responsible for providing sensation to the genitals, perineum, and anal area. This procedure involves injecting a combination of local anaesthetic around the pudendal nerve to reduce inflammation, block pain signals, and alleviate symptoms associated with pelvic pain, vaginismus, and vulvodynia. Let's explore how pudendal nerve desensitization can be effective in treating these conditions:

1. Pelvic Pain

  • Mechanism of Action: Chronic pelvic pain can be caused by various factors, including nerve compression or irritation. Pudendal nerve desensitization aims to reduce nerve sensitivity and alleviate pain by blocking the transmission of pain signals along the pudendal nerve pathway.
  • Effectiveness: By targeting the source of pelvic pain, pudendal nerve desensitization can effectively reduce pain intensity and frequency, improving overall quality of life for individuals suffering from chronic pelvic pain.

2. Vaginismus

  • Mechanism of Action: Vaginismus is a condition characterized by involuntary muscle spasms of the pelvic floor muscles, leading to pain and difficulty with vaginal penetration. Pudendal nerve desensitization can help relax these muscles by reducing nerve sensitivity and blocking pain signals, making penetration less painful and improving sexual function.
  • Effectiveness: Pudendal nerve desensitization has shown promising results in alleviating symptoms of vaginismus, particularly in cases where conservative treatments such as pelvic floor physical therapy have been unsuccessful.

3. Vulvodynia

  • Mechanism of Action: Vulvodynia is chronic pain or discomfort in the vulvar area without an identifiable cause. It can be associated with increased nerve sensitivity and inflammation. Pudendal nerve desensitization aims to reduce nerve hypersensitivity and inflammation in the vulvar region, leading to decreased pain and improved comfort.
  • Effectiveness: Pudendal nerve desensitization has been reported to provide significant relief for individuals with vulvodynia, particularly in cases where other treatments, such as topical medications or pelvic floor therapy, have been ineffective.

Overall, pudendal nerve desensitization can be an effective treatment option for pelvic pain, vaginismus, and vulvodynia, particularly for individuals who have not responded to conservative therapies with a success rate of 80%. However, it's essential to consult with a healthcare provider who specializes in pelvic pain management to determine if this procedure is appropriate for your specific condition and to discuss potential risks and benefits. Additionally, a comprehensive treatment approach may involve combining pudendal nerve desensitization with other therapies, such as physical therapy, medications, or psychotherapy, to optimize outcomes and improve overall pelvic health.

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