[3] Pudendal nerve blocks can be used to provide pain relief to this region for about 30 days, but has been reported to last months in some patients.

[4] It can also be used during anorectal surgery, urologic surgery, diagnosing or treating chronic perineal pain (i.e. pudendal neuralgia), and other gynecologic procedures[2][4] Overall, the procedure involves injecting a local anesthetic drug (e.g. lidocaine or bupivicaine) with a 20 gauge spinal needle near the pudendal nerve in order to provide pain relief.

[1] The aim is to block the nerve as it enters the lesser sciatic foramen, which anatomically is just below the and inwards from the attachment of the sacrospinous ligament to the ischial spine of the pelvic bone.

[2] The transperineal approach more commonly requires image guidance and is used for anorectal and urologic procedures, and treatment of pudendal neuralgia.

[2] The perirectal approach requires the use of a nerve simulator that if placed in the correct position will cause the external anal sphincter to contract.

[8] It can also be used for pain relief from episiotomy or perineal lacerations[6][8] Pudendal anesthesia is used during operative vaginal delivery which includes the use of forceps.

[2] Pudendal neuralgia can arise from trauma, overuse, sports, surgery, radiation therapy, tumors, viruses (e.g.

Herpes Zoster, HIV), endometriosis, multiple sclerosis, pudendal nerve entrapment, or other medical conditions.

A pudendal nerve block provides a longer duration of pain relief versus the use of superficial local anesthetic or even spinal anesthesia.