Inguinal, Genital and Perineal Neuralgias

Ilioinguinal, Iliohypogastric, Genitofemoral, and Pudendal Neuralgias are very annoying and cause neuralgic pain in inguinal, genital and perineal areas. Nerve entrapments cause this pain. That is why, there will be burning, cramping, and electric shock-like symptoms. Let us discuss these nerve entrapments in more detail.

Ilioinguinal Neuralgia

Ilioinguinal neuralgia is a painful condition of the lower abdomen, pelvis, and inner thigh. The pain may also radiate into the genitalia. Straightening the back often worsens the pain as it leads to nerve irritation. As a result, people remain in a bent-over position to relieve pain.

Causes

Ilioinguinal neuralgia is caused by:

• Damage to the nerve due to abdominal surgery, pelvic surgery, kidney surgery, inguinal repair surgery, etc.
• Blunt trauma to the ilioinguinal nerve
• Pregnancy stretch
• Unknown causes

Symptoms

Ilioinguinal neuralgia causes tenderness, numbness, and burning or stabbing pain which has the following characteristics:

• Pain is present over the groin and inner thigh
• Burning pain is present in the lower abdomen and pelvis
• Pain radiates into the genitalia

Diagnosis

The doctor makes the diagnosis based on:

• Signs and symptoms such as pain and numbness
• Medical history such as any past traumatic injury
• Physical examination is the cornerstone of diagnosis. It is performed to check for tenderness, numbness, and pain caused by specific back movements.
• Imaging tests such as ultrasound and MRIs are performed to track the nerve entrapment and rule out other conditions.

Prognosis and Treatment

The doctor may recommend the following treatments:

• Over-the-counter painkillers such as naproxen as well as prescription medications such as opioids or other anti-neuropathies to relieve pain
• Rest and modifying activities that cause pain
• Physical therapy, massage, acupuncture, etc. to relieve pain
• Ultrasound-guided nerve block to interrupt nerve stimulation and relieve pain
• Surgery is the last resort to relieve pain. It involves cutting the nerve proximal to the damage or removing the whole nerve.

Iliohypogastric Neuralgia

Iliohypogastric neuralgia is the burning pain caused by the damage to the iliohypogastric nerve. The nerve supplies some belly muscles and the skin above the genitals and on the buttock. As a result, pain is felt over these areas of the body.

Causes

The iliohypogastric nerve originates alongside the ilioinguinal nerve. Hence, both nerves are damaged by the same types of causes which include:

• Damage or irritation due to abdominal surgery, kidney surgery, pelvic surgery, or inguinal repair surgery
• Blunt trauma or impact to the nerve such as in sports
• Pregnancy stretch (rare)

Symptoms of Iliohypogastric Neuralgia

Burning or stabbing pain in the groin, above the genitals, and buttock area is the most prominent symptom. Other symptoms include tenderness and numbness in these areas. Iliohypogastric neuralgia can weaken the abdominal muscles and lead to many complications in this area.

Diagnosis

The doctor makes the diagnosis of iliohypogastric neuralgia based on the following:

• Signs and symptoms of pain, numbness, and tenderness
• Medical history of past injury or past surgery
• Physical examination to check for tenderness and numbness
• Imaging tests such as ultrasound and MRIs to look for nerve irritation and rule out other possible conditions

Prognosis and Treatment

The prognosis of iliohypogastric neuralgia is good. The doctor may recommend the following treatments:

• Over-the-counter pain medications such as naproxen to relieve pain. If these don’t improve symptoms, the doctor may recommend strong prescription painkillers, opioids, or other anti-neuropathies.
• Rest and modifying activities that cause pain.
• Physical therapy, massage, or acupuncture may also prove helpful.
• Nerve-block with an anesthetic to relieve pain
• Surgery to cut the nerve proximal to the irritation or remove it to relieve pain

Genitofemoral Neuralgia

Genitofemoral neuralgia causes burning pain and numbness in the area supplied by the genitofemoral nerve. The nerve has two branches. The femoral branch supplies the skin of the inner and front sides of the thigh. The genital branch supplies the skin of the testicles in men and the vulva (skin of outer and inner vaginal lips and their surrounding skin) in women. 

Causes

The causes of genitofemoral neuralgia include:

• Surgeries such as abdominal, kidney, pelvic repair, etc
• Direct trauma to the nerve, such as in sports

The condition rarely occurs by itself.

Symptoms

Symptoms of genitofemoral neuralgia depend upon the location or nerve irritation. General symptoms include:

• Burning or stabbing pain on the front or medial side of the thigh
• Burning pain on the testicular skin in males or vulva in females
• Numbness and tenderness in the above-described areas

Diagnosis

The diagnosis is based on the following:

• Symptoms of pain and numbness
• Medical history or past trauma or surgery
• Physical examination to check for tenderness, numbness, and range of hip movement
• Imaging tests such as X-rays and MRIs to look for nerve entrapment or irritation and rule out other possible conditions

Treatment

The doctor may recommend the following treatments:

• Over-the-counter pain relievers such as naproxen initially. Then the doctor will prescribe strong pain relievers such as opioids and other anti-neuropathic pain drugs.
• Resting and modifying activities that cause pain
• Physical therapy and massage may also prove effective.
• Nerve block with an anesthetic and steroids to interrupt nerve stimulation
• Surgery is the last resort to relieve pain in which the nerve is cut proximal to the irritation.