SACROTUBEROUS AND SACROSPINOUS LIGAMENTS VS. PUDENDAL NERVE ⠀ [PUDENDAL NERVE ENTRAPMENT] ⠀ The pudendal nerve is formed from the sacral plexus, a network of nerve fibres located on the posterior pelvic wall. It arises from the ventral rami (anterior divisions) of the spinal nerves S2, S3 and S4. After its formation, the pudendal nerve descends and passes between the piriformis and ischiococcygeus muscles. It leaves the pelvis through the lower part of the greater sciatic foramen. It then crosses the sacrospinous ligament (close to its insertion to the ischial spine), and then re-enters the pelvis through the lesser sciatic foramen. After re-entering the pelvis, it accompanies the internal pudendal artery and vein, coursing anterosuperiorly through the pudendal canal (also known as Alcock’s canal, a structure formed by the fascia of the obturator internus muscle). Inside the pudendal canal, the nerve divides into branches, first giving off the inferior rectal nerve, then the perineal nerve, before continuing as the dorsal nerve of the penis or clitoris. ⠀ Of clinical significance is that the pudendal nerve travels between the sacrotuberous and sacrospinous ligaments and can become entrapped. ⠀ Pudendal nerve entrapment between the sacrotuberous and sacrospinous ligaments can result in pudendal nerve neuralgia. Pudendal nerve entrapment can result in recurrent pain or numbness of the genitals, rectal pain, reduced awareness of an impending bowl movement, disturbance of normal urination (including overactive bladder), altered sensation during ejaculation and urinary or bowel incontinence. ⠀ Pudendal nerve entrapment can be profoundly life altering, but due to the intimate nature of the symptomatology, many people suffer in silence. Medical treatment for pudendal neuralgia includes pain injections, surgical decompression and drugs. ⠀ Manual/Physical teatment options include myofascial treatment of the sacrotuberous and sacrospinous ligaments as well as the pelvic floor, dry-needling and adjustments.