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Pudendal Nerve Palsy

Pudendal Nerve Palsy. Pudendal Nerve Palsy. PNP is a severe pain on one side of the perineum, which is typically increased during sitting and reduced on a toilet seat.  It is also associated with increased latency of the pudendal nerve following vaginal delivery. Causes/Risk Factors.

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Pudendal Nerve Palsy

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  1. Pudendal Nerve Palsy

  2. Pudendal Nerve Palsy • PNP is a severe pain on one side of the perineum, which is typically increased during sitting and reduced on a toilet seat.  It is also associated with increased latency of the pudendal nerve following vaginal delivery.

  3. Causes/Risk Factors • Hypertonic OI muscles (restricting space in Alcock's canal) • Compression of the deep dorsal vein of the clitoris  • Vaginal delivery associated with a heavy fetus or a prolonged second stage of labor

  4. Signs and Symptoms • Persistent and unwanted genital arousal  • Pelvic engorgement  • Pelvic and vulvar area heaviness and pressure after standing  • Hypertonus pelvic floor musculature  • Multiple trigger points  • Urinary and/or anal incontinence  • Pudendal latency 

  5. PT Implications and Treatments • STM  • Persistent Genital Arousal Disorder PGAD • V-brace (designed to support the vulva in a manner similar to a male athletic belt) • Avoid prolonged standing • Perform daily pelvic floor exercise of 20-30 5 second contractions • Regular swimming - to improve LE circulation

  6. References • Henry, M.M. The Role of Pudendal Nerve Innervation in the Female Pelvic Floor Function. Obstetrics and Gynecology 6:324-325, 1994. • Rosenbaum, T.Y. Physical Therapy Treatment of Persistent Genital Arousal Disorder During Pregnancy: A Case Report. J Sex Med 7:1306-1310, 2010.  

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