[Somatic perineal pain other than pudendal neuralgia].
In addition to the well-established syndrome of pudendal compression, and given the rich nerve trunk innervation of the perineum, pain originating in other nerve trunks can occur and must be remembered. Nerves originating high in the thoracolumbar area (ilioinguinal nerve, iliohypogastric nerve, genitor femoral nerve) can be the seat of traumatic lesions occurring during surgical approaches through the abdominal wall or can undergo compressions when crossing the fascia of the large abdominal muscles. Misleading perineal irradiations do not resemble pudendal neuralgia and should suggest pain in these trunks whose cutaneous territories are not solely perineal and whose clinical expression as pain is does not occur in the seated position. Similarly, painful minor intervertebral dysfunction of the thoracolumbar junction is not simply in the mind and should be considered, searched for, and treated. Related more to pudendal neuralgia, pain in the inferior cluneal nerve, triggered by the seated position, should be considered when the pain reaches the lateral anal region, the scrotum, or the labia majora but not involving the glans penis or the clitoris. Specific treatments (physical therapy, infiltrations, surgery) have proven effective.
Robert
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R
Service de neurotraumatologie, Hôtel-Dieu, CHU de Nantes, 2, place Alexis-Ricordeau, 44035 Nantes cedex 1, France. roger.robert@chu-nantes.fr
Labat
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JJ
Riant
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T
Louppe
J-M
JM
Lucas
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O
Hamel
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O
D005260:Female; D005831:Genital Diseases, Female / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005832:Genital Diseases, Male / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005835:Genitalia / Q000294:innervation; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D010502:Perineum; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery