Pudendal block for the treatment of chronic pelvic pain: A randomized control trial

Joris Ramstein, Danielle Markle Price, A Saleh, Felicia Lane
In: Journal of Endometriosis and Pelvic Pain Disorders · 2025 · vol. 17(4) , pp. 184–191 · doi:10.1177/22840265251340366 · W4410840856
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This randomized trial found that pudendal nerve blocks with local anesthetic and steroid did not significantly improve pain or quality of life compared to placebo when added to pelvic floor physical therapy for chronic pelvic pain.

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Abstract

Introduction: Chronic pelvic pain (CPP) affects up to 40% of reproductive-age women and often involves myofascial pelvic pain syndrome (MPPS), a musculoskeletal condition associated with pelvic floor dysfunction. Effective treatment options are limited, and pudendal nerve blocks have been proposed as an adjunct to pelvic floor physical therapy (PFPT). This study aimed to evaluate the impact of adding pudendal nerve blocks to PFPT on pain reduction and quality of life in patients with MPPS. Methods: This prospective, randomized, double-blind trial enrolled women with MPPS referred for PFPT. Participants were randomized to receive either pudendal nerve blocks with local anesthetic and steroid or placebo saline injections weekly for 6 weeks. The primary outcome was pain measured using a visual analog scale (VAS) at 8 weeks. Secondary outcomes included muscle tenderness, pelvic floor strength, and quality-of-life metrics (PFDI, PFIQ, SF-36, and FSFI). Statistical analyses included paired t -tests and mixed-model analysis for repeated measures. Results: Both groups experienced significant improvements in VAS scores ( p < 0.001) and muscle tenderness ( p = 0.003), with no significant differences between the groups ( p = 0.7, p = 0.15). As pain and tenderness decreased, patients reported increased pelvic floor strength, reduced distress, and improved quality of life by week 8. Conclusions: While pudendal blocks did not significantly enhance outcomes over placebo injections, PFPT alone likely drove the observed improvements in pain and quality of life. Future studies with larger sample sizes and additional comparison groups are needed to explore the potential role of adjunctive therapies in managing MPPS.
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Abstract

Introduction:

Methods

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Conclusions

Introduction

Methods

Trial design Participants Interventions Outcomes Sample size Randomization and blinding Statistical methods

Results

| Demographics & Comorbidities | Treatment (N = 22) | Placebo (N = 12) | Total (N = 34) | |---|---|---|---| | Age (mean, range) (p = 0.975) | 46 (22–66) | 47 (28–69) | 46 (22–69) | | Race/ethnicity (p = 0.5) | ||| | Caucasian | 17 (77%) | 8 (67%) | 25 (73%) | | Black | 2 (9%) | 1 (8%) | 3 (9%) | | Hispanic | 2 (9%) | 2 (17%) | 4 (12%) | | Asian | 1 (5%) | 1 (8%) | 2 (6%) | | Primary pelvic pain etiology | ||| | Genitourinary | 3 (14%) | 1 (8%) | 4 (12%) | | Inflammatory | 7 (32%) | 3 (25%) | 10 (29%) | | Neurologic | 2 (9%) | 1 (8%) | 3 (9%) | | Levator ani spasms | 4 (18%) | 2 (17%) | 6 (18%) | | Trauma | 2 (9%) | 2 (17%) | 4 (12%) | | Vulvodynia | 3 (14%) | 2 (17%) | 5 (15%) | | Unidentified | 1 (5%) | 1 (8%) | 2 (6%) | | Prior pelvic surgery | 15 (68%) | 7 (58%) | 22 (64%) | | Pain Questionnaires | Pudendal block | Placebo | p-Value | |||| |---|---|---|---|---|---|---|---| | Baseline | Week 8 | Baseline | Week 8 | Treatment | Time | Time × treatment | | | VAS | 7.1 ± 0.6 | 3.7 ± 0.8 | 6.4 ± 0.8 | 3.6 ± 1.1 | 0.70 | <0.001 | 0.73 | | Tenderness score | 3.5 ± 0.1 | 2.7 ± 0.2 | 3.2 ± 0.2 | 2.3 ± 16 | 0.15 | 0.003 | 0.83 | | Vaginal EMG | Pudendal block | Placebo | p-Value | |||| |---|---|---|---|---|---|---|---| | Baseline | Week 8 | Baseline | Week 8 | Treatment | Time | Time × treatment | | | EMG-rest (uV) | 2.2 ± 0.5 | 2.3 ± 0.5 | 2.5 ± 0.7 | 2.5 ± 0.7 | 0.76 | 0.90 | 0.86 | | EMG-short (uV) | 13.7 ± 1.8 | 18.6 ± 2.5 | 13.8 ± 0.2 | 14.9 ± 3.5 | 0.62 | 0.04 | 0.18 | | Oxford | 2.8 ± 0.3 | 3.5 ± 0.2 | 3.0 ± 0.4 | 3.6 ± 0.2 | 0.76 | 0.003 | 0.81 | | Questionnaires | Pudendal block | Placebo | p-Value | |||| |---|---|---|---|---|---|---|---| | Baseline | Week 8 | Baseline | Week 8 | Treatment | Time | Time × treatment | | | PFDI | 87 ± 16 | 79 ± 17 | 100 ± 18 | 77 ± 20 | 0.82 | 0.04 | 0.26 | | PFIQ | 86 ± 20 | 69 ± 14 | 100 ± 23 | 68 ± 16 | 0.80 | 0.02 | 0.44 | | PCS | 39 ± 3 | 40 ± 3 | 41 ± 4 | 42 ± 4 | 0.67 | 0.35 | 0.99 | | MCS | 36 ± 3 | 42 ± 3 | 35 ± 4 | 45 ± 4 | 0.79 | <0.001 | 0.24 | | FSFI | 14 ± 3 | 14 ± 3 | 10 ± 4 | 13 ± 4 | 0.54 | 0.29 | 0.33 |

Discussion

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chronic_pelvic_pain

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