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Outcomes from Surgical Resection of the Perineal Branches of the Pudendal Nerve and Implantation of Proximal End into the Obturator Internus Muscle
Background:
The traditional transgluteal approach for the surgical treatment of “pudendal neuralgia” has been disappointing for those patients with “anterior” pudendal nerve symptoms, such a pain in the labia, vestibule, and perineum. In this study, we describe outcomes from a new surgical approach to resect the perineal branches of the pudendal nerve (PBPN).
Methods:
An IRB-approved prospective study was designed and identified 13 consecutive female patients from 2012 through 2015 who did not have rectal symptoms and who had diagnostic nerve blocks and resection of the PBPN. The average age at surgery was 49.5 years and the average BMI was 26. Mechanisms of injury included episiotomy (31%), athletic injury (25%), vestibulectomy (31%), and falls (13%). Outcomes were the Female Sexual Function Index (FSFI), the Vulvar Pain Functional Questionnaire (VQ), and the Numeric Pain Rating Scale (NPRS). All 13 patients completed these questionnaires after surgery, reporting on their condition before surgery and currently. Data for the FSFI were analyzed only if sexual activity was reported.
Results:
The mean post-operative length of follow-up was 13 months (range: 6 to 42 months). Post-operative significant bruising was the only complication, occurring in 10% of the patients. The overall FSFI significantly improved after surgery (p < 0.05). The specific domains that showed significant improvement were those for arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05). The VQ also significantly improved after surgery (p < 0.001) in 12 of 13 (92%) patients. The NPRS score decreased, on average, from an 8 to a 3 out of 10 (p < 0.0001).
Conclusions:
Resection of the perineal branch of the pudendal nerve with implantation of the nerve into the obturator internus muscle significantly improved the sexual function, vulva function, and pain of women who sustained injury to the perineum.