Pudendal Nerve Block

OVERVIEW

What a pudendal nerve block is and how it works

The pudendal nerve runs from the lower sacral spine through the pelvis and supplies sensation to the perineum, genitals, and the area around the rectum. When this nerve becomes compressed, irritated, or inflamed — a condition called pudendal neuralgia — it can produce burning, aching, or shooting pain in the “saddle” region that often worsens with sitting and eases when standing or lying down. A pudendal nerve block places a small amount of local anesthetic, frequently combined with an anti-inflammatory steroid, near the nerve to “block” these pain messages before they reach the brain.

The injection serves two purposes. As a diagnostic tool, your response helps confirm whether the pudendal nerve is truly the source of your pain — meaningful relief after the block points to the nerve as the culprit. As a therapeutic tool, the same injection may calm inflammation and provide a period of relief, and a good diagnostic response can help determine candidacy for longer-lasting or more advanced options. At Columbia Pain & Spine Institute in Gresham and Portland, Oregon, our fellowship-trained physicians use pudendal blocks as one part of a broader plan for hard-to-treat pelvic pain. This procedure is one of several nerve blocks we offer.

YOUR PROCEDURE

What to expect with a pudendal block

Before the procedure

Your physician will review your symptoms, prior workup, and medications — including any blood thinners, which may need to be adjusted beforehand. The pudendal block is an outpatient procedure performed in the office or at our on-site Burnside Surgery Center in Gresham. Most blocks are done with local numbing alone, though light sedation may be offered for comfort; if you receive sedation, arrange a ride home.

During the procedure

You will be positioned to allow access to the pelvic region, and the skin is numbed. Using image guidance — typically fluoroscopy (live X-ray) or ultrasound — a thin needle is advanced toward the pudendal nerve, often near the ischial spine, a bony landmark close to where the nerve travels. Contrast dye may be used under fluoroscopy to confirm correct needle placement before the anesthetic and any steroid are delivered. The injection itself usually takes only about 10 to 20 minutes.

After the procedure and recovery

• You will rest briefly while we monitor you, then are typically discharged the same day.
• The local anesthetic may produce numbness or noticeably reduced pain within the first hours — an important clue we use to interpret a diagnostic block.
• Mild soreness or temporary numbness in the pelvic area is common and usually settles within a day or two.
• If a steroid was included, its anti-inflammatory benefit may take several days to develop, so relief can build gradually.
• Many people resume routine activities the next day; your team will give specific guidance, and we track your response to plan next steps.

Some patients benefit from a single injection, while others do best with a planned series or by combining the block with pelvic floor physical therapy and other treatments coordinated through your care team.

FAQS

Pudendal nerve block: frequently asked questions

Is a pudendal nerve block diagnostic or therapeutic?

It can be both. Because relief after the injection helps confirm the pudendal nerve as the pain source, the block is often used diagnostically; the anesthetic and steroid may also provide a therapeutic period of relief. Your physician will explain which role applies in your case.

How long does relief from a pudendal block last?

It varies by individual. The local anesthetic works for hours, while a steroid may extend relief for days to weeks or longer. Duration depends on your condition and whether the block is repeated, so we monitor your response over time rather than promising a set result.

Is the procedure painful?

Discomfort is usually brief. The skin is numbed before the needle is placed, and many patients feel only pressure during the injection. Light sedation may be offered for added comfort.