PMC5042193_01
Pudendal branches, mapped by clinical exam and neurostimulation.. Notes: (A) Dorsal nerve of the clitoris (continuation of pudendal nerve shown as dashed line deeper in the muscles of the urogenital diaphragm); (B) perineal branch of the pudendal nerve; (C) pudendal nerve; (D) superficial transverse perineal muscle; (E) ischiocavernosus muscle; (F) inferior pubic ramus; (G) block location. The course of the specified nerves is delineated based on quantitative sensory testing and selective nerve blocks in this patient. The arrow delineates the site of needle entry for the selective block for the perineal branch of the pudendal nerve.
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We blocked the ascending perineal branches of the perineal nerve (Figure 1). During a subsequent visit, 4 cm3 of lidocaine injected into and above the region left of the clitoris (Figure 1) resulted in an immediate relief of the patient's symptoms.