Obstetrics & Gynecology
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*#1 clinical trials program for gynecologic cancer patient recruitment in NYS (and ranks #10 nationally, according to the GOG Foundation)
**NYU Langone’s Tisch Hospital, NYU Langone Hospital—Brooklyn, and NYU Langone Hospital—Long Island
Complex Case Spotlight
Nerve Block Relieves Chronic Vaginal Pain from Pudendal Neuralgia
Ruling Out Other Causes of Vaginal Pain
After a woman in her early 40s presented to NYU Langone with persistent stress urinary incontinence and vaginal pain, Dr. Rosenblum and Dr. Kirpekar ruled out causes such as interstitial cystitis, persistent genital arousal disorder, endometriosis, and a vaginal or urinary tract infection. Damage along the tri-branched pudendal nerve’s route through the pelvis can mimic many other conditions.
A diagram of the 3 main terminal branches of the pudendal nerve.
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Asking Questions Key to Differential Diagnosis for Pudendal Neuralgia
With no imaging or clinical diagnostic tests for pudendal neuralgia, asking detailed questions may be the best way to help diagnose it. “Vaginal birth can trigger it, and I always ask about a history of physical and/or sexual trauma, especially if the patient remembers when the pain started,” Dr. Rosenblum says. Another clue: Sitting for long periods can compress the nerve and worsen the pain.
Five main diagnostic criteria for pudendal neuralgia.
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Pudendal Nerve Block: Both Diagnostic and Therapeutic
After tests and questions pointed toward pudendal neuralgia, Dr. Kirpekar used an X-ray-guided nerve block to successfully diagnose and treat the patient. If effective, patients should report immediate pain relief, particularly the burning sensation. On average, her patients find relief from the medication for 6 months or more.
If indicated, a pudendal nerve block can offer rapid relief—and a definitive diagnosis.
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