Diagnostics of pudendal neuralgia: Nantes criteria.
Neuropathy of the pudendal nerve is a condition that requires diagnostic assessment consisting of several stages. It lacks specific signs, so before making a diagnosis, it is necessary to ensure that all characteristic symptoms are present and to exclude other etiologies of pelvic pain.
In 2006, a multidisciplinary working group in the French city of Nantes identified five main criteria that should characterize the course of the disease. If any of the specified phenomena are not observed, it is necessary to postpone the treatment of pudendal neuropathy and continue diagnostic work, focusing on other possible scenarios.
With this pathology, it is difficult to immediately make a correct diagnosis, and inattention on the part of the doctor leads to very serious errors. This is especially true for diseases that do not have specific clinical signs, which would allow one to confidently determine: this patient has a damaged pudendal nerve, and they need surgery. Unfortunately, diagnosing sexual neuropathy requires a lot of attention and additional research.
The patient describes painful sensations resembling signs of compression:
— It feels like someone, sorry, doctor, is biting or stinging my scrotum. And it doesn't completely go away, although it gets easier in some positions.
— Is the pain localized exclusively in the scrotal area?
— I wouldn't say so. Perhaps more from the coccyx to it or slightly above. In general, it hurts almost everywhere. It's difficult to go to the bathroom because of this.
So far, everything aligns — the symptoms resemble those of pudendal neuralgia. During the examination, the patient demonstrated a normal reaction to palpation of the affected area — no decrease in sensitivity was observed. It seems worth prescribing additional tests to confirm the diagnosis, primarily considering attempting a diagnostic blockade under ultrasound control.
— Tell me, how do you sleep? Does the pain interfere with your sleep, waking you up at night?
— Yes, I often wake up in the middle of the night from pain and then can't find a comfortable position to fall asleep again...
However! It seems the blockade may not be necessary after all. The diagnosis of "pudendal neuropathy" is likely if all five Nantes criteria are present, but there is a discrepancy here. Neuralgic pain in pudendal nerve involvement typically does not interfere with sleep — moreover, many patients admit that they cannot wait for the night when they feel worse. Because the pain diminishes during sleep and is usually less pronounced afterward.
I ask new questions, observe the patient's posture. He sits relaxed on the chair, not fidgeting, not favoring one buttock. Perhaps the most important question:
-How long can you sit on the chair?
-As long as needed. The pain can flare up when I sit, stand, lie down... It doesn't matter. It eases with a hot shower.
And here we have excluding signs. It seems we need to look for other causes, such as myofascial pelvic pain syndrome.
— I'm afraid we still have to determine the cause of your condition. New examinations are necessary...
Nantes criteria
This is a list of five signs that a doctor pays attention to primarily:
1. There is pain (burning, tingling, sensation of a foreign body, etc.) in the area innervated by the pudendal nerve, from the anus through the entire perineum to the external genitalia.
AVAILABLE TIME
