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Pain and Spine Medicine

A Successful CT-guided Pudendal Nerve Cryoablation in a Patient with Pudendal Neuralgia and Chronic Pelvic Pain

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 4
Has Audio

    Primary Author(s)

  • Shirali Shah, MD

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Downers Grove, Illinois

    • Co-Author(s)

  • Jacqueline Dargan, MD

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

  • SH

    Sarah K. Hwang, MD

    Director of Pelvic Health Rehabilitation
    Shirley Ryan AbilityLab
    Chicago, Illinois

Disclosure(s):
Shirali Shah, MD: No financial relationships to disclose
Jacqueline Dargan, MD: No financial relationships to disclose
Case Diagnosis: Pudendal Neuralgia

Case Description or Program Description: A 50-year-old female with a history of Sjogren's syndrome, migraines, fibromyalgia, chronic interstitial cystitis, and gastroparesis presented to clinic with chronic pelvic pain whose pelvic exam demonstrated pain with palpation of the left coccygeus and piriformis that referred to the left abdomen.

Setting: Outpatient Pelvic Health Physiatry Clinic

Assessment/Results: The patient was treated by a multidisciplinary team, including pelvic floor physical therapists, a urologist, a pelvic floor physiatrist, and an interventional radiologist. She was prescribed vaginal estrogen cream, duloxetine, gabapentin, and pelvic floor physical therapy. She underwent a left pudendal nerve block with a 75% improvement in her symptoms and later had a CT-guided pudendal nerve cryoablation, which resulted in a lasting 50% improvement in her symptoms when combined with the above treatment plan.

Discussion (relevance): Pudendal neuralgia, a subtype of chronic pelvic pain which affects between 5.7-26.6% of the population, is diagnosed in 1 in 100,000 patients but remains an underdiagnosed and undertreated condition. Specifically, pudendal nerve ablations are an understudied treatment option. There have been some studies showing sustained relief (89% improvement in symptoms) at 6 months for pulsed radiofrequency ablations (pRFA) and one randomized control trial that found patients 3 months post-pRFA had 92% pain relief compared to 36% in the pudendal nerve block group. Pudendal nerve cryoablation was described in two small case series with pain improvement immediately and at one and six months post-ablation under CT guidance. An 11-patient study showed a significant decrease in pain scores at 1 day, 1.5 and 6 months post cryoablation without complications. There have been no studies comparing pRFA and pudendal cryoablation in patients with pudendal neuralgia.

Conclusions: Given the relatively low-risk profile and promising results of pRFA and cryoablation in the treatment of pudendal neuralgia, they should be considered earlier in the treatment plan, along with pelvic floor therapy and medications.