Testing for Pudendal Neuropathy

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Below is a description of testing done for a

possible compression of the pudendal nerve.

A PNMLT is an electrophysiological

procedure, similar to an EMG

(electromyogram), which measures the speed of nerve conduction. This exam is done

by a neurologist. Not all neurologists have the necessary equipment to do this

type of examination. During this exam, the pudendal nerve is stimulated

electrically inside the rectum (or vagina) at the ischial spine with electrodes

on the tip of a special glove. The speed of the nerve conduction is recorded by

a small needle inserted in the perineum. If the nerve responds slower than

normal, this gives an indication that the nerve may be entrapped or damaged.

The PNMLT examines only the motor function of

the nerve. There is no way to test for the sensory fibers of the nerve which

transmit pain. The reason for the test is based on the assertion that an

abnormal motor function will most likely conceal a sensory affection as well.

So, an abnormal PNMLT indicates that the pudendal nerve is affected but a

normal reading does not rule out PNE. In this case an entrapment could exist

even if the motor fiber of the nerve has not been affected yet. This is more

common with people who have had PNE only for a short period of time.

Nevertheless, the PNMLT is the most accurate neurological examination for the

pudendal nerve.

The neurological examination can be

completed by the measurement of the anal reflex latency, measurements of the

bulbocavernosus reflex latencies (BCRLs), somatosensory evoked potentials of

the pudendal nerve (SEPPNs) and the sensory conduction velocity of the dorsal

nerve of the penis (SCVDNP). Those exams can give further information about the

condition of the nerve or the origin of the pain.

The EMG

tests the entire length of the pudendal nerve. I had electrodes in my forehead

and they shocked other areas of my body to look for nerve conductuity in the

spine, to make sure there are no issues with spinal conductivity.

My understanding, (reports I have heard

from other doctors), is that the PNMLT is more reliable than the EMG. Every doctor though has their own opinion

and the PNMLT is sometimes not a great indicator of entrapment or not.

nne