Health Organization for Pudendal Education

After 3 pudendal blocks (all confirmed PN, none offered any lasting relief once the lidocaine wore off), a pulsed RF procedure that did nothing but flare up pain for a week, and months of pelvic floor PT, my doctor suggested trying one of these:

- Ganglion Impar Block - apparently this is supposed to try to give a "reset" to the sympathetic nervous system in the pelvic floor area

- Caudal Epidural Steroid Injection - a different attempt to "reset" any over active sympathetic nerve response in the nerves originating in the sacrum (which includes the pudendal nerve)

Has anyone had success with either of these for PN in the perineum?

Thanks,
Bart

Hi Bartland,

I did a search on "ganglion impar block" on this forum and after skimming through a bunch of pages of posts, it seems like most people did not get any long-term improvement and some had worsening of symptoms from it. So, if it were me, I would want some pretty convincing statistics from my doctor and some studies/publications showing that they are effective before going through with it. I'm sure they won't want to hear this. From reading this forum for many years, my impression is that numerous injections are not the answer. Some of them may provide short-term pain relief, and some of them may be excellent diagnostic tools, but too many can actually worsen symptoms.

I remember one women who had temporary pain relief from a ganglion impar for coccyx/rectal pain and she went on to have a phenol injection which did give some long-term relief. But I haven't heard of it for pudendal neuralgia. Hopefully I am wrong and a bunch of people will come on the forum who have had success.

I haven't heard of great successes with caudal injections either. But your doctor may have had good success with it so I'm not saying it never works. One risk with a caudal epidural steroid injection is arachoniditis. I have known people with arachnoiditis and it is not good. So please ask the physician what the risks are vs. the benefits and if you decide to go ahead with it, do so with your eyes wide open. Some steroids may be less risky than others so ask about that too. Depe-medrol may be associated with arachnoiditis. The risks are probably slight, but you need to know what they are.

Now, if it means try these injections or have surgery, that is a tough decision. I expect trying one for diagnostic purposes would be less risky than surgery. It's always a risk vs. benefit assessment.

Good luck as you make these tough decisions.

Violet

Thank you do much for your answer Violet. After giving it much thought, I decided to not do either injection. I'm worried about them potentially causing other issues, or simply flaring up my pudendal pain. Now I am looking into getting a DRG implant

There are several people who used to post here who had success with neuromodulation. I think Kit was one of them, if you want to do a search on his posts. Here is one of them.: viewtopic.php?p=60296&hilit=drg#p60296

Violet

Hey Bart, sorry to hear the previous treatments didn't bring you the relief you needed. I've heard of people getting some success with Ganglion Impar Blocks, but it's not super common for PN. I know someone who tried it and said it was like a "reset" button, but the effects only lasted a few weeks. As for Caudal Epidural Steroid Injections, I've not heard of anyone trying it specifically for PN, but it's worth a shot if your doc thinks it could help. Keeping my fingers crossed that one of these options works out for you!