Inguinal, Genital and Perineal Neuralgias

What is Inguinal, Genital and Perineal Neuralgia?

These conditions are different forms of nerve pain affecting the lower abdomen, groin, genital area, and perineum. The nerves involved are the ilioinguinal, iliohypogastric, genitofemoral, and pudendal nerves. When one of these nerves is trapped or irritated, it fires abnormally and produces burning, cramping, or electric shock-like pain in the area it supplies.

The most common trigger is nerve entrapment after surgery. Hernia repair, pelvic surgery, kidney surgery, and abdominal procedures can all catch or scar a nerve. Blunt trauma, the stretch of pregnancy, and prolonged pressure on the pudendal nerve from sitting or cycling are other recognised causes.

Pain often worsens with certain movements. With ilioinguinal neuralgia, straightening the back stretches the nerve, so many patients hold a slightly bent posture to ease the discomfort. Pudendal neuralgia typically worsens on sitting and eases on standing.

Symptoms

• Burning, stabbing, or electric pain in the groin, lower abdomen, or inner thigh
• Pain radiating into the genitalia or perineum
• Tenderness and numbness over the affected nerve territory
• Pain that worsens with specific movements, posture, or prolonged sitting
• A sensation of pressure or a foreign body in the perineum (with pudendal involvement)
• Relief when bending forward or changing position

How We Treat It

Accurate diagnosis comes first, because the four nerves have overlapping territories and the right treatment depends on identifying which one is involved. We use the history, a careful physical examination, and where needed ultrasound or MRI to map the entrapment and rule out other causes. A diagnostic nerve block is often the most direct way to confirm the source.

Ultrasound-guided nerve blocks are the mainstay of our treatment. By placing local anaesthetic and steroid precisely around the affected nerve, we interrupt the abnormal pain signalling and reduce the surrounding inflammation. For pain that returns after blocks give good but temporary relief, radiofrequency ablation can provide a longer-lasting result by quieting the nerve for an extended period. We pair these procedures with activity modification and, where helpful, neuropathic pain medication to settle the nerve while function recovers.