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New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Pudendal nerve injection is used as a diagnostic procedure in the vulvar region and for therapeutic purposes, such as in vulvodynia. Here, we provide a new, easy-to-perform perineal injection technique.

Patients and methods

We analyzed 105 perineal injections into the pudendal nerve with a local anesthetic (LA), procaine in 20 patients. A 0.4 × 40 mm needle was handled using a stop-and-go technique while monitoring the patient’s discomfort. The needle was placed 1–2 cm laterally to the dorsal introitus. After aspiration, a small amount of LA was applied. After subcutaneous anesthesia, the needle was further advanced step-by-step. Thus, 5 ml could be applied with little discomfort to the patient. Anesthesia in the pudendal target region was the primary endpoint of our analysis.

Results

In 93 of 105 injections (88.6 %), complete perineal anesthesia was achieved with a single injection. 12 injections were repeated. These injections were excluded from the analysis. Severity of injection pain, on visual analog scale (VAS) from 0 to 100, was 26.8 (95 % CI 7.2–46.4). Age (β = 0.33, p < 0.01) and the number of previous injections (β = 0.35, p < 0.01) inversely correlated with injection pain. Injection pain and anesthesia were not affected by BMI, the number and the side of previous injections, or order of injection. A reversible vasovagal reaction was common, but no serious adverse effects occurred.

Conclusion

Perineal pudendal injection is an effective and safe technique for anesthesia in diagnostic (vulva biopsy) and therapeutic indications (pudendal neuralgia), and regional anesthesia in perinatal settings.

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Acknowledgments

The authors wish to thank Richard Göllner, University of Tubingen, for helpful advice on the statistical evaluation, Pia Hofheinz, M.Sc., Karlsruhe, for her help in data management, and Ewa Gubb and Helga Gutz, Karlsruhe, for her assistance in the English translation.

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Authors and Affiliations

  1. Gemeinschaftspraxis für Frauenheilkunde und Naturheilverfahren – Dr. med. Stefan Weinschenk, Dr. med. Annerose Scherer, Bahnhofplatz 8, 76137, Karlsruhe, Germany

    Stefan Weinschenk

  2. Department of Gynecological Endocrinology and Fertility Disorders, Women’s Hospital University of Heidelberg, Im Neuenheimer Feld 44, 69120, Heidelberg, Germany

    Stefan Weinschenk & Thomas Strowitzki

  3. The Heidelberg University Neural Therapy Education and Research Group (HUNTER Group) http://www.hunter-heidelberg.com

    Stefan Weinschenk, Markus W. Hollmann & Thomas Strowitzki

  4. Department of Anesthesiology, AMC University of Amsterdam, Meibergdreef 9, Postbus 22660 H1Z-112, 1100 DD, Amsterdam, The Netherlands

    Markus W. Hollmann

Authors
  1. Stefan Weinschenk
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  2. Markus W. Hollmann
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  3. Thomas Strowitzki
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Corresponding author

Correspondence to Stefan Weinschenk.

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Conflict of interest

This study was neither sponsored nor funded. The authors declare no conflict of interest.

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Weinschenk, S., Hollmann, M.W. & Strowitzki, T. New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures. Arch Gynecol Obstet 293, 805–813 (2016). https://doi.org/10.1007/s00404-015-3812-0

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  • DOI: https://doi.org/10.1007/s00404-015-3812-0

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