How is the pudendal nerve block performed?

The pudendal nerve block can be performed using a transvaginal approach (guided by the provider's palpating finger) or with imaging guidance (fluoroscopy or CT) for greater precision when anatomy is complex. The injection targets the pudendal nerve at the ischial spine or within Alcock's canal, the fibrous tunnel through which the nerve runs. The procedure is done in a clinical or procedural suite and typically takes 20-30 minutes including preparation.

What conditions are treated with pudendal nerve blocks?

Pudendal nerve blocks are used for pudendal neuralgia, chronic pelvic pain with a suspected nerve component, vulvodynia with pudendal distribution, clitoral pain (clitorodynia), pain worsened by sitting, perineal pain, pain after childbirth, surgery, or prolonged cycling, and Persistent Genital Arousal Disorder (PGAD) related to pudendal nerve irritation.

How long does relief from a pudendal nerve block last?

Relief duration is highly variable. A local anesthetic alone provides hours to days of relief - primarily diagnostic value. When combined with corticosteroid, relief can extend for weeks to months. Some patients experience a prolonged "reboot" effect where relief outlasts the pharmacologic duration of the medication. In patients with pudendal neuralgia, a series of blocks is typically performed, each building on the previous.

Is the pudendal nerve block painful?

The procedure involves an injection in a sensitive area, so some discomfort is expected. Dr. Toubi offers nitrous oxide (laughing gas) for all pudendal nerve block procedures to reduce anxiety and pain during the injection. Topical and local anesthetic are used before the block itself. Most patients tolerate the procedure well with these measures in place.

How many pudendal nerve blocks will I need?

This depends on the underlying condition and your response. For diagnostic purposes, typically one to two blocks. For therapeutic purposes in pudendal neuralgia, a series of three to six blocks spaced 4-6 weeks apart is common. If blocks provide meaningful relief but it doesn't last, that response guides decisions about escalating to more definitive treatments like radiofrequency ablation or surgical decompression.

Pudendal Nerve Blocks

Pudendal nerve blocks: precision pain relief that also tells you exactly what's causing your pain.

The pudendal nerve block is one of the most valuable tools in managing chronic pelvic pain - not just because it relieves pain, but because of what it reveals. When a well-placed pudendal nerve block significantly reduces your pain, that response confirms the pudendal nerve is a primary driver of your symptoms. That is diagnostic information that no imaging study can provide as directly.

A pudendal nerve block does two things at once: it tests whether the pudendal nerve is the source of your pain, and it provides real relief while you have the answer. For many patients, it's the first significant reduction in pain they've experienced after months or years of searching for an explanation.

Conditions treated with pudendal nerve blocks

Pudendal neuralgia
Chronic pelvic pain with nerve component
Vulvodynia with pudendal distribution
Clitoral pain (clitorodynia)
Pain that worsens with sitting
Perineal or rectal pain
Pain after childbirth, surgery, or cycling
PGAD related to pudendal nerve irritation

What happens during the procedure

Preparation and comfort measures

Nitrous oxide is available before and during the procedure. Topical and local anesthetic is applied to the injection site. You are positioned comfortably for the approach being used.

Precise needle placement

The pudendal nerve is targeted at the ischial spine or within Alcock's canal - the fibrous tunnel through which the nerve travels in the pelvis. Transvaginal guidance or imaging guidance (fluoroscopy or CT) is used depending on anatomy and clinical situation.

Injection of medication

Local anesthetic (bupivacaine or lidocaine), sometimes combined with corticosteroid for extended relief, is injected around the nerve. The medication spreads to the nerve and its branches.

Monitoring and recovery

You rest briefly after the injection. Temporary numbness in the perineal area is expected. Most patients can return to normal activities the same day. You record your pain level over the following hours and days to assess the diagnostic and therapeutic response.

Nitrous oxide is available for all pudendal nerve block procedures. This is not a procedure you have to dread or white-knuckle through. Comfort measures are standard - not optional.

Frequently asked questions

What is a pudendal nerve block?

A pudendal nerve block is an injection of local anesthetic - sometimes combined with corticosteroid - placed at the pudendal nerve. It serves two purposes: diagnostic (confirming the pudendal nerve is a pain source based on your response) and therapeutic (providing relief lasting from hours to months depending on the medication used and your response).

How long does relief last?

Local anesthetic alone provides hours to days of diagnostic relief. With corticosteroid, relief can extend weeks to months. Some patients experience a prolonged effect where relief outlasts the pharmacologic duration. A series of blocks is typically performed for pudendal neuralgia, with each building on the previous response.

Is the procedure painful?

Some discomfort from the injection is expected. Dr. Toubi offers nitrous oxide to reduce anxiety and pain during the procedure, and local anesthetic is applied before the block. Most patients tolerate it well with these comfort measures in place.

How many blocks will I need?

For diagnostic purposes, one to two blocks. For therapeutic management of pudendal neuralgia, a series of three to six blocks spaced 4-6 weeks apart is common. Your response to each block guides decisions about continuing, modifying, or escalating to more definitive treatments like radiofrequency ablation.

What if the nerve block doesn't help much?

A limited response is also diagnostic information - it suggests the pudendal nerve may not be the primary pain driver, or that the anatomy of nerve entrapment requires a different approach. It guides the next steps in evaluation and treatment, including consideration of other nerve targets, advanced imaging, or consultation with pain management or neurosurgery specialists.

Precision pain relief - and an answer about what's causing your pain.

Dr. Toubi's Beverly Hills practice offers pudendal nerve blocks as part of a comprehensive approach to chronic pelvic and vulvar pain. Schedule a consultation to discuss whether a nerve block is the right next step for your specific situation.

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Pudendal nerve specialistBeverly HillsNitrous oxide available

Your desire hasn't disappeared permanently. You are not broken - and there are real solutions.

Low libido is one of the most common concerns women bring to a gynecologist - and one of the most frequently dismissed. If you've been told it's "just stress" or "part of getting older," you deserve a second opinion. Hypoactive Sexual Desire Disorder (HSDD) is a recognized medical condition with effective treatments. You don't have to accept this as your new normal.

Sexual desire is influenced by hormones, brain chemistry, relationships, mental health, medications, and physical comfort. When any of these factors shift, your libido can too - and untangling which factor is driving the change is exactly what this kind of specialist evaluation is designed to do.

What could be contributing to low libido?

Multiple factors influence sexual desire, and they often work together. The most common contributors include hormonal changes (perimenopause, menopause, postpartum, or thyroid dysfunction), medications - especially SSRIs and hormonal contraceptives - stress, anxiety and depression, relationship dynamics, and pain during sex that creates avoidance over time.

Understanding which factors are at play in your specific situation is the first step to addressing them effectively.

Treatment options

Hormonal

Bioidentical testosterone & estrogen

Often the most impactful intervention - restoring hormones that directly drive desire and arousal.

FDA-Approved

Flibanserin (Addyi)

Approved for premenopausal women; works on brain neurotransmitters to support sexual desire.

FDA-Approved

Bremelanotide (Vyleesi)

A self-administered injection used on demand; approved for premenopausal women with HSDD.

Medication Review

Adjusting libido-suppressing drugs

SSRIs, antihypertensives, and hormonal contraceptives can all dampen desire - sometimes switching or adjusting resolves the issue.

Behavioral

Counseling & sex therapy

Addressing psychological factors, relationship dynamics, and patterns that contribute to low desire.

Frequently asked questions

Is low libido normal?

Low libido is extremely common - it's one of the most frequent sexual health concerns women bring to their doctors. It does not mean something is fundamentally wrong with you as a person or partner. It is a recognized medical condition called Hypoactive Sexual Desire Disorder (HSDD) when it causes distress, and it has multiple evidence-based treatments.

What causes low libido in women?

Libido is influenced by a complex mix of hormonal, psychological, relational, and medical factors. Common causes include hormonal changes from menopause, perimenopause, or postpartum; medications (especially SSRIs and hormonal contraceptives); stress, anxiety, or depression; relationship dynamics; thyroid dysfunction; and pain during sex that creates avoidance.

What treatments are available for low libido?

Treatment is tailored to the underlying cause. Options include hormone therapy (bioidentical testosterone and/or estrogen), FDA-approved medications like flibanserin (Addyi) or bremelanotide (Vyleesi), addressing medication side effects, counseling, and lifestyle modifications. Most women see meaningful improvement with the right combination approach.

Can antidepressants cause low libido?

Yes - SSRIs and other antidepressants are among the most common causes of low libido and sexual dysfunction in women. If you've noticed a change in sexual desire since starting an antidepressant, that connection is real and worth discussing with Dr. Toubi. There are strategies to address this without necessarily stopping your medication.

Will Dr. Toubi judge me for bringing up sexual concerns?

Absolutely not. Sexual health is a core part of overall health, and Dr. Toubi approaches these conversations with compassion, clinical expertise, and zero judgment. Many of her patients have never had a provider take their sexual health concerns seriously before. This practice is a safe space for those conversations.

You deserve a sex life that feels good to you.

If low libido is affecting your relationship, your confidence, or your quality of life, Dr. Toubi's Beverly Hills practice offers expert, compassionate care - with real solutions. Schedule a confidential consultation today.

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Sexual health specialistConfidential & judgment-freeBeverly Hills