Need opinions please

[Hiking Spider]

Hi, I'm a 53 y/o female. I'm 10 days post-op from having anterior repair, posterior repair, bladder sling and hysterectomy with SSLF. All of the surgery was done vaginally, so flying blind, OMHO. Immediately after I woke up from surgery I noticed the skin on the right side of my private parts, rectum, lower part of butt and upper thigh was numb. Being dumb as a brick, I thought the surgeon gave me a nerve block so I would be able to sit more comfortably. Anyway, I called the doctor 4 days post-op and asked about the numbness. She had me come in that day. She did an exam to map out the numb parts. She called me later in the day after consulting colleagues and explained I probably had pudendal nerve entrapment. That maybe my anatomy was unique.

Parts that has me so confused.
1. The burning pain I get is where all the skin numbness is. How is that even possible?
2. The pain is the worst when I stand or walk, it rivals child birth! From what I read the pain is supposed to be from sitting. Is it possible that the pudendal nerve is not the culprit?

Does anyone have experience with this?

Thank you so much for listening and any opinions are greatly appreciated!

[Violet M]

It's possible it's not the pudendal nerve although since it's in the area innervated by the PN you certainly have to consider it. The sacral nerve roots are another consideration.

PNE typically is associated with problems sitting but pudendal neuralgia isn't necessarily. I would get a second opinion. Is there a PT in your area who is experienced with PN who could give you an opinion?

That was pretty major surgery you had. There have been cases of pelvic floor repair where the stitch was misplaced and put through the pudendal nerve. I would ask the surgeon if that is a possibility.

Violet

[Hiking Spider]

Thank you so much for the reply Violet!

From looking at nerve maps and the corresponding area affected. It looks to me as the PN, posterior and inferior cluneal nerves are trapped, but I'm just a laymen. My surgeon did say that my nerve anatomy could be unique and she may have sutured it with the SSLF. She also mentioned cutting the suture and see what happens. I am not fond of this idea as it would not suspend the apex of my vagina causing it to prolapse. I feel stuck between a rock and a hard place! I will be meeting with the surgeon on Friday to discuss this further. Another possibility is the bladder sling is hitting one of the other nerves branches. Still not a good outcome. If they remove the sling, then what?

[Violet M]

Well, it is a tough situation to be in. Sometimes it's a matter of trade-offs and deciding which symptoms are the worst. For me -- I have chosen to live with pelvic floor prolapse instead of risking going back to the severe pain I lived in at one time. My gyn's have told me there is too much risk in doing pelvic floor repair surgery because it could flare-up the pelvic pain again. So I manage pretty well wearing spanx to hold things together. So I guess the decision you would need to make is whether you want to try some things like PT to get the pelvic floor to calm down, and waiting it out a little longer to see if the numbness subsides with a little more time. It could take months for the numbness to subside. Is it something that you feel you could live with?

Violet