New perineal injection technique for pudendal nerve infiltration in diagnostic and therapeutic procedures

Arch Gynecol Obstet. 2016 Apr;293(4):805-13. doi: 10.1007/s00404-015-3812-0. Epub 2015 Sep 15.


Purpose: Pudendal nerve injection is used as a diagnostic procedure in the vulvar region and for therapeutic purposes, such as in vulvodynia. Here, we provide a new, easy-to-perform perineal injection technique.

Patients and methods: We analyzed 105 perineal injections into the pudendal nerve with a local anesthetic (LA), procaine in 20 patients. A 0.4 × 40 mm needle was handled using a stop-and-go technique while monitoring the patient's discomfort. The needle was placed 1-2 cm laterally to the dorsal introitus. After aspiration, a small amount of LA was applied. After subcutaneous anesthesia, the needle was further advanced step-by-step. Thus, 5 ml could be applied with little discomfort to the patient. Anesthesia in the pudendal target region was the primary endpoint of our analysis.

Results: In 93 of 105 injections (88.6 %), complete perineal anesthesia was achieved with a single injection. 12 injections were repeated. These injections were excluded from the analysis. Severity of injection pain, on visual analog scale (VAS) from 0 to 100, was 26.8 (95 % CI 7.2-46.4). Age (β = 0.33, p < 0.01) and the number of previous injections (β = 0.35, p < 0.01) inversely correlated with injection pain. Injection pain and anesthesia were not affected by BMI, the number and the side of previous injections, or order of injection. A reversible vasovagal reaction was common, but no serious adverse effects occurred.

Conclusion: Perineal pudendal injection is an effective and safe technique for anesthesia in diagnostic (vulva biopsy) and therapeutic indications (pudendal neuralgia), and regional anesthesia in perinatal settings.

Keywords: Nerve block; Neural therapy; Perineal region; Procaine; Therapeutic local anesthesia; Vulvodynia.

MeSH terms

  • Adult
  • Aged
  • Anesthesia, Conduction
  • Anesthesia, Local / adverse effects*
  • Anesthetics, Local / administration & dosage*
  • Female
  • Humans
  • Injections / instrumentation
  • Male
  • Middle Aged
  • Needles
  • Nerve Block / instrumentation*
  • Nerve Block / methods*
  • Pain Management
  • Pain Measurement
  • Perineum* / innervation
  • Pregnancy
  • Pudendal Nerve*
  • Vulva
  • Vulvodynia / diagnosis*
  • Vulvodynia / therapy*


  • Anesthetics, Local