Re: Popeney C,Ansell V, Renney K. 2007 pudendal nerve entrapment as an etiology of chronic perineal pain: Diagnosis and treatment. Neurourol Urodynam 26 : 820-3
Abstract
Popeney et al.1conducted a detailed study on 58 patientssuffering from chronic perineal pain, treated by surgicaldecompression of the pudendal nerve with the positivetreatment response in 60% of cases. In the discussion of theirresults, they mentioned a present-day problem of the special-ists in the pudendal nerve field: whether there are some otherplaces where one or more branches of the pudendal nerve canbe compressed and thus mimic the clinical picture of thepudendal nerve trunk entrapment inside the pudendalcanal or in a close proximity to ischial spine.
One possibleanatomical site of such an out-of-pudendal-canal compressionis the subpubic concavity, where the branch of the pudendalnerve, the dorsal nerve of penis or dorsal nerve of clitorisis running inside the tight osteofibrotic canal2in a closeproximity to bone.3Previously, we have identified anddescribed in detail a groove on the pubic bone whichaccommodates the dorsal nerve of penis in males or dorsalnerve of clitoris in females and termed it the sulcus nervidorsalis penis/clitoridis.3Later, we introduced a hypothesisthat the clinical signs of a sub-group of patients with thesymptoms of the Alcock's syndrome might be caused by anoveruse injury in cyclists-a repetitive prolonged pressure ofthe nose of the saddle against the site where the dorsalnerve of penis runs adjacent to the ventromedial border of theischiopubic ramus-in the sulcus nervi dorsalis penis.4Thesedata indicate the close proximity of pubic bone and the dorsalnerve of penis might play a causative role in the developmentof the dorsal nerve of penis/clitoris entrapment. Suchcompression should be suspected when the decreased glan-dular and penile sensitivity together with the genital numb-ness and the erectile dysfunction in males or the decreasedclitoridal sensitivity and the genital numbness in femalesoccur.
Contrary, when these symptoms do not occur, thecompression of dorsal nerve of penis/clitoris should notbe suspected. Hypothetically, the simultaneous presence ofthe compression of pudendal nerve trunk together with thedorsal nerve of penis/clitoris compression might cause diag-nostic challenge.
Only the future clinical data might verifyours and other's hypotheses of the pathogenic role of closeproximity of the pubic bone and dorsal nerve of penis/clitorisin a sub-group of patients suffering from pudendal nerveentrapment syndrome.