From the Research
Increased blood flow to the pudendal nerve can cause pain due to compression or irritation of the nerve, a condition known as pudendal neuralgia, as supported by the most recent study in 2025 1.
Mechanism of Pain
The pudendal nerve runs through a narrow anatomical tunnel (Alcock's canal), making it particularly vulnerable to compression. When blood vessels in this area become engorged or dilated, they can directly press against the nerve fibers, triggering pain signals. Additionally, increased blood flow may exacerbate existing inflammation around the nerve, further sensitizing it to pain. This mechanism is similar to other compression neuropathies where vascular congestion contributes to nerve irritation.
Clinical Presentation
The resulting pain typically manifests as burning, shooting, or stabbing sensations in the genital, rectal, or perineal areas. According to the Nantes criteria, as discussed in a study from 2016 2, the diagnosis of pudendal neuralgia due to pudendal nerve entrapment is based on specific criteria, including pain situated in the anatomical territory of the pudendal nerve, worsened by sitting, and a positive pudendal nerve block.
Treatment Options
Treatment often focuses on reducing pressure on the nerve through physical therapy, anti-inflammatory medications, nerve blocks, or in severe cases, surgical decompression to create more space for the nerve and its surrounding blood vessels. A systematic review and meta-analysis from 2025 1 found that all treatments, including surgery, injections, and pulse radiofrequency treatments, appear to provide relief to a similar extent, but no treatment was clearly superior for pain relief. Emerging techniques such as pulsed radiofrequency ablation, as discussed in a study from 2009 3, may also be promising, but more studies are needed to evaluate safety and effectiveness.
Recent Evidence
A recent review of the current literature in 2025 4 highlights the need for further research to identify the optimal treatment approach and evaluate the effects of pudendal neuralgia on mental health and quality of life. The use of high-concentration capsaicin patch, as studied in 2017 5, may also be a valuable treatment option for patients with chronic pelvic, perineal, and gluteal neuralgia, particularly in the management of coccygodynia.