Evidence and experience
What the evidence and two decades of surgical experience say about vulvodynia nerve pain.
Vulvodynia is a description of a symptom, not an explanation of a cause. When burning vulvar or perineal pain follows the territory of the pudendal nerve, worsens with sitting and includes rectal or clitoral involvement, an entrapment should be excluded before long-term symptomatic treatment is accepted.
Childbirth, pelvic surgery, cycling, a fall onto the buttocks or prolonged straining can all injure or tether the nerve. The pain frequently starts months after the event, which is one reason the connection is so often missed.
Our female patients are assessed by a surgeon who treats this condition every week, with time allowed for a full history — because the history, more than any single scan, is what points to the diagnosis.
Dr Bollens is a professor of urology, a proctor in pelvic surgery and a published author on pudendal neuralgia.