A 25-Year-Old Cyclist with Persistent Perineal Pain

Pudendal neuralgia is an uncommon, painful condition caused secondary to inflammation or entrapment of the pudendal nerve. The prevalence of pudendal neuralgia is reported at 1:100,000 but is often underdiagnosed. This pain is described as a pain along the perineum radiating to the genitals with associated numbness and in some cases erectile dysfunction. Diagnosis of this condition is one of exclusion with available diagnostic criteria and complementary diagnostic neurophysiologic testing or imaging. Diagnosis of pudendal neuralgia or entrapment is oftentimes delayed secondary to clinical signs which overlap with other conditions. Treatment options range from conservative medical management with anti-inflammatory or neuropathic pain medications, interventional pain therapies with pudendal nerve blocks and radiofrequency ablation, and ultimately surgical decompression. Adjunct therapies include stretching, cessation of exacerbating activity, and adjustments to cycling equipment.