Health Organization for Pudendal Education

Hello all:

I guess i should at this point change my user name as my daughter is now 8mos old! I had minor vaginal pain diagnosed as VV prior to my pregnancy, controlled with 300mg neurontin, no sitting pain.Since I delivered last April via c-section, about 3 mos post op, my OBGYN suggested I try PT due to the continued left sided deep groin pain by my pubic ramus. Also had intermittent vaginal wall pain but NO sitting pain. Started PT in July and by September my symptoms were much worse. Developed sitting pain which consists of pain inside sits bone against pubic rami, and left sided vaginal wall pain. Saw Dr. Conway back in November, did an internal exam which did not elicit any pain wherever he poked; I do have a tenderness on the left vaginal wall which is where I feel it when I sit ,but it was not anywhere he poked for lack of a better word.. I can actually reach it to massage it. Anyway, he is leaning toward ilioinguinal possibly due to the c-section. I doubt his theory though because of this new sitting pain symptom; He did an EMG and the results were Ilioinguinal Left 7.97 and Right 3.35, Alcocks/Falciform Process Left 2.63 and Right 1.42. He still feels this could be ilioinguinal b/c he didn't feel the pudendal EMG results were that extreme. I am going for a second ilioinguinal block jan. 2 to see if this will help. Does anyone have any thoughts on the EMG results? I can't find any information for what is 'normal'.

That doesn't make any sense...they really need to give you a number for what is normal when they do the test, so you know what your results mean.

When I had the PNMLT done by two different doctors, they always said that a score less than 5.0 meant normal, and higher than that meant there was a problem with that nerve, that it couldn't conduct the impulse as fast for some reason.

I hope someone has an answer for you; I almost wonder if it might be worth a separate neurology consult, to get an idea from somebody who does nothing but nerves.

Good luck, congratulations on your new child, and let us know what you find out.

Hi Celeste,

I hope so too that someone has some other input.

Hi Pregmom,
According to my EMG report, the normal range for the ilioinguinals is 3.5 - 6.0 ms. I don't know for sure if that also applies to the other areas, but my readings were as follows:
Ilioinguinals: Left = 3.83 ms, Right = 6.7 ms
Alcocks Canal/Falciform Process: Left = 1.0 ms, Right = 4.8 ms
SS/ST Ligaments: Left = 2.40 ms, Right = 2.60 ms
Report Impression:
1. Pudendal nerve conduciton delay on the left at the level Alcocks Canal/Falciform Process
2. Bilateral pudendal nerve conduction delay at SSL
3. Moderate denervation at the V-EAS (perineal branch)

pregmom wrote:I am going for a second ilioinguinal block jan. 2 to see if this will help.

What was the result of the first block? Any relief? Who did it?

Celeste wrote: I almost wonder if it might be worth a separate neurology consult, to get an idea from somebody who does nothing but nerves.

If you find someone, please let me know! I've seen several neurologists, none of which treat or even acknowledge pelvic nerves. The last one I saw in November said
"he didn't believe in ilioinguinal neuralgia". Others have told me I have "visceral hypersensitivity".
Hugs,
Karyn

I'm not sure what type of PT you had but you might want to get a second opinion from a physical therapist who is experienced at diagnosing pudendal neuralgia and locating the source of your pain. I had vaginal wall pain and my diagnosis was PNE with a successful PNE surgery. EMG only measures the motor function of the nerve, not the sensory function and some docs feel that the pudendal nerve motor latency test is unreliable for diagnosing PNE. Have you had any nerve blocks to confirm the diagnosis yet?