Pudendal neuralgia is a neuropathic pain syndrome caused by entrapment of the pudendal nerve and characterised by severe perineal pain, often bilateral, aggravated by sitting. The condition affects more than 50% of patients.
Despite advances in modern medicine, pudendal neuralgia remains poorly understood and difficult to diagnose. Surgical decompression of the pinched nerve is currently the mainstay of treatment, but there is an urgent need for alternative therapies due to the complexity and limitations of existing treatments.
   The aim of this study was to evaluate the efficacy of a novel treatment approach using platelet-derived growth factor-enriched autologous plasma (PRP) for the treatment of pudendal neuralgia.

A prospective study was conducted on 20 patients diagnosed with pudendal neuralgia caused by pudendal nerve entrapment. Patients were divided into two groups: a main group receiving PRP therapy and a control group receiving glucocorticosteroid blockade.
   The study included 9 men and 11 women with a mean age of 40.4 ± 4.86 years. Exclusion criteria were organic pelvic pathology, haematopoietic diseases, herpetic neuralgia and autoimmune diseases.
   Standard neurological examination was performed, including visual analogue scale (VAS) assessment of pain intensity and assessment of pelvic muscle tone.
   Ultrasound examination of the pudendal nerve, pelvic muscles and ligaments, and assessment of pudendal artery blood flow velocity were performed. Electroneuromyography (ENMG) of the pudendal nerve was also performed.
     Ten patients received three sessions of PRP injections under local anaesthesia and ultrasound guidance, with a 14-day interval between sessions. Autologous platelet-derived growth factor-enriched plasma was injected (6 ml) under the sacrotuberous ligament at the level of the pudendal nerve.
   Control group (glucocorticosteroid blockades): ten patients underwent three glucocorticosteroid blockades with a 7-day interval between procedures.

All patients in the control group reported a reduction in pain (>50% according to VAS) within the first day after injection. However, one month after the last injection, 70% (7 out of 10) of patients had the same or slightly less pain (*p* < 0.001).
    In the main group, 30% (3 out of 10) of patients experienced a moderate increase in pain in the first 2-3 days after injection. However, pain decreased by at least 50% one week after the procedure. At the end of the PRP course, 70% (7 out of 10) of patients achieved complete resolution of pain (*p* < 0.001), while 30% (3 out of 10) experienced significant relief (>50%).
    At the six-month follow-up, 100% of patients receiving PRP therapy reported complete pain relief or at least a 50% reduction in pain intensity compared to baseline (*p* < 0.001). No adverse events were observed in either group during the study.

While glucocorticosteroid blockade provided rapid pain relief, the effect was short-lived, with pain recurring in most patients within one month. In contrast, PRP therapy showed a delayed onset of action but sustained long-term benefits, with complete resolution of pain or significant improvement in all treated patients at the six-month follow-up.
    Autologous platelet-derived growth factor-enriched plasma shows promise as a safe and effective alternative to conventional treatments for pudendal neuralgia, providing long-lasting pain relief without significant adverse effects.
    Further research is needed to optimise PRP protocols and to confirm these findings in larger randomised controlled trials.

Pudendal neuralgia is a challenging condition characterised by severe, often bilateral, perineal pain that is aggravated by sitting.
Current treatment options are limited and innovative approaches are needed to effectively manage this condition.

Continence 15S (2025) 102255
DOI: 10.1016/j.cont.2025.102255