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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5657
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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I am 50 years old man. I have had classis symptoms of pudendal

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I am 50 years old man. I have had classis symptoms of pudendal neuralgia for a long long time which has been misdiagnosed as various deseases depending on which specialist iI am seeing. I have been to urologists, gastroenterologists, psychiatrists, yoga guru, ayurvedacharya, homeopath, hakim, acupuncturist and hypnotist in a thirty year period. All this time the trouble has kept worsening. I have undergone many numbers of MRI, CAT scans, ultrasounds, nerve conduction tests, barium enema, endoscopy, urethroscopy, without any significant finding. Only finding in MRI was disc bulge at L4-5, which the doctor said is common enough.
I don't know what to do. I read that there is a specific EMG done for pudendal nerve. I doubt if this is available in UAE where I am living presently or in India which is my home country.
My case has become so bad that sitting for any duration is not tolerable and I have found by hit and trial that lying down on my stomach is the least painful position for me.
Any thoughts on the course of action I should follow?

Dr. Bob :

Have you considered a pudendal nerve block?

Dr. Bob :

Image-guided pudendal nerve block is the most important diagnostic test following history and physical examination for patients with suspected pudendal neuralgia. The nerve is blocked by a local anesthetic (e.g. marcaine) to see if symptoms can be eliminated by numbing the nerve. The block is done where the nerve is passing between the two ligaments or in the Alcock's canal.

Dr. Bob :

This series of slides shows how the procedure is typically done:

Dr. Bob :

Let me know if you have any follow up questions.


Dear Dr.


I already am suffering with the numbness of the perineal region in general and the tip of the penis in particular. I also have the heaviness, dull ache, pressure, nausia, bloating sensation also. Cannot lie on my back and sides otherwise symptoms become very severe. Symptoms become very very sever after erection and ejaculation. Will nerve block be conclusive in such a case? Is there any side effect of using this diagnostic technique? Can you let me know if there are any facilities in UAE or India providing this procedure?

Dr. Bob :

Yes, nerve block can eradicate such symptoms if done correctly. I could further research this for you, but you would need to remove the "poor" rating you provided. :(

Dr. Bob and other Neurology Specialists are ready to help you
Customer: replied 4 years ago.

I am waiting for further information from you as requested in last question.

Hi Syed.

A pudendal block is considered to be ‘diagnostic’ when relief of symptoms is present at follow up two hours after the injections, or, for a few days in some cases. In other words, if a local anesthetic relieves the pain, the source of the pain, and the effectiveness of the block are confirmed.

The same pudendal block that is ‘diagnostic’, or a subsequent injection with a corticosteroid, is considered to be ‘therapeutic’ if the relief is prolonged for days, weeks or months. Permanent relief is not uncommon, depending on duration and severity of symptoms.

When a series of blocks is diagnostic but has a limited duration of effective pain and symptom control, the next step is often surgical decompression of the pudendal nerve.

There are risk to any procedure or surgery, of course, and an experienced urological surgeon could go over them with you. You would do best consulting one at the nearest academic medical center.