1. Pudendal Nerve Palsy

2.  PNP is a severe pain on one side of the perineum, which is typically increased during sitting and reduced on a toilet seat. It is also associated with increased latency of the pudendal nerve following vaginal delivery.

3. Causes/Risk Factors  Hypertonic OI muscles (restricting space in Alcock's canal)  Compression of the deep dorsal vein of the clitoris  Vaginal delivery associated with a heavy fetus or a prolonged second stage of labor

4. Signs and Symptoms  Persistent and unwanted genital arousal  Pelvic engorgement  Pelvic and vulvar area heaviness and pressure after standing  Hypertonus pelvic floor musculature  Multiple trigger points  Urinary and/or anal incontinence  Pudendal latency

5. PT Implications and Treatments  STM  Persistent Genital Arousal Disorder PGAD  V-brace (designed to support the vulva in a manner similar to a male athletic belt)  Avoid prolonged standing  Perform daily pelvic floor exercise of 20-30 5 second contractions  Regular swimming - to improve LE circulation

6. References  Henry, M.M. The Role of Pudendal Nerve Innervation in the Female Pelvic Floor Function. Obstetrics and Gynecology 6:324-325, 1994.  Rosenbaum, T.Y. Physical Therapy Treatment of Persistent Genital Arousal Disorder During Pregnancy: A Case Report. J Sex Med 7:1306-1310, 2010.