New procedure gives hope of relief for women with pelvic pain

As many as one in four women in the U.S. suffer from chronic pelvic pain. A lot of times medication, steroid injections or physical therapy will help, but for women whose pelvic pain comes from the pudendal nerve, the pain goes much deeper. Now, an Atlanta doctor is trying a procedure that may be the non-invasive cure millions of women are looking for.

Kristan Leeper can clearly remember the moment her pelvic pain started.

“Feels like somebody is stabbing me with a hot poker,” Leeper said.

It marked the beginning of a two-year search for relief from pain caused by her pudendal nerve.

“From gynecologists, orthopedists as well as chiropractors. I went on to see physical therapists. So I had a right hip surgery. I had a total of eight nerve blocks, or steroid injections,” Leeper explained. Initially, I’d get some relief and then within a two-week period, my pain would skyrocket.”

Leeper’s search led her to Dr. J. David Prologo, an interventional radiologist at Emory Johns Creek Hospital in Atlanta.

Dr. Prologo said, “For years people would have thought that if we could somehow shut down this nerve, that this would work. But there’s no way to get to the nerve until you start using image guidance.”

Dr. Prologo has been freezing away other types of nerve pain for years but when a patient asked him to freeze her pudendal nerve to stop her pelvic pain, he hesitated but after consulting colleagues in urology and gynecology decided to go forward, even though it had never been done.

“This nerve that was so hypersensitive causing her so much pain and debilitation; we shut down the signals in that nerve and her pain went away,” Dr. Prologo explained.

Women from all around the world are now reaching out to Dr. Prologo. After feeling pudendal neuralgia pain for so many years, finally, a little hope.

“I hadn’t felt that way in such a long time,” Kristan said.

Dr. Prologo began documenting his work on women with pudendal neuralgia pain and 95 percent of them said their pain was completely gone. And after about 60 patients, there haven’t been any side-effects.

RESEARCH SUMMARY

TOPIC: Relief for Pelvic Pain

REPORT: MB #4082

BACKGROUND: As many as one in four women suffer from chronic pelvic pain. Pudendal neuralgia (PN) is a condition in which there is pain in the lower central pelvic regions due to the pudendal nerve. Symptoms can include pelvic pain, sexual dysfunction, and difficulty with urination. People who suffer from PN may also have difficulty with defecation and a feeling that a foreign object may be in the body. Pain may be worse upon sitting and less when standing or laying down. PN can be triggered by bicycling, squatting exercise, direct falls on the tailbone, repeated vaginal infections and chronic constipation. The pain could be a stinging, burning, stabbing or cramping sensation.

(Source: http://www.ichelp.org/about-ic/associated-conditions/pudendal-neuralgia/)

TREATMENT: Image guided anesthetic and steroid blocks of the pudendal nerve are commonly used for treatment of PN. Symptoms often return once the local anesthetics wears off and steroids may or may not relieve symptoms for a longer period of time. If steroids do relieve the pain, it usually begins to improve about two weeks after the block, with improvements continuing for up to four to five weeks. Two to three steroids injections may be sufficient, alone, to cure the problem. After the injection, the pain may worsen for a period of two to ten days due to the steroids.

(Source: https://www.urmc.rochester.edu/medialibraries/urmcmedia/imaging/patients/documents/pudendal_neuralgia_brochure.pdf )

NEW TECHNOLOGY: The option to freeze the pudendal nerve may be bringing relief to millions of women who didn’t find relief from steroid injections or other treatment for pudendal neuralgia. Dr. J. David Prologo, an interventional radiologist at the Emory School of Medicine had been freezing nerve pain for years, but was quite hesitant to use the same technique on the pudendal nerve. He just finished a study freezing dorsal penile nerves for premature ejaculation when a female patient asked if he would perform the procedure on her to stop her PN symptoms. After consulting colleagues in urology and gynecology and researching current treatments for PN, he decided to go forward with the procedure. Dr. Prologo started documenting his work on the women he treated for PN. So far, 95% of the women he has treated have said that their pain is completely gone and 60% of them have not experienced any side-effects.

(Source: Dr. J. David Prologo)