Douleurs pelvipérinéales chroniques neurogènes : diagnostic positif ou d'élimination ?

Perineal chronic pelvic pain is largely dominated at the perineal level by pudendal neuralgia. Its main aetiology is a tunnel syndrome due to an entrapment of the pudendal nerve. It can be located at three different levels: the piriformis canal, the ligamentous entrapment between the sacrospinous ligament and the sacrotubal ligament, the Alcock canal. It is diagnosed by the data of the interrogation and the perineal clinical examination. Complementary imaging by pelvic magnetic resonance will only be performed in the case of a relatively rare clinical atypia, looking for another aetiology of pudendal neuralgia: mainly searching for a mass syndrome on the path of the nerve trunk. Other entities of perineal neuralgia are rare and their diagnosis is made only on clinical grounds. The radiologist has also an important role in the diagnosis of perineal neuralgia since the infiltration, ideally under scanner control, is an essential step confirming the diagnosis.