Genitofemoral Neuropathy Symptoms, Causes, and Treatment

Pelvic nerve pain may be caused by damage or dysfunction of the genitofemoral nerve. This type of pelvic nerve pain is called genitofemoral neuralgia or genitofemoral neuropathy.

Overview

Nerve pain can be extremely uncomfortable and is often hard to describe to those who have not experienced the pain. Nerve pain is also referred to as "neuropathic pain." Neuropathic pain may occur anywhere in which a nerve is injured. With the genitofemoral nerve, this pain occurs in the pelvis.

Genitofemoral neuralgia (genitofemoral pain) is often present for some time before a diagnosis is made, adding to the frustration that goes with this type of pain. Studies have found that most women with neuropathic type chronic vulvar pain remain undiagnosed even after multiple physician visits.

To understand genitofemoral neuropathy, it's very helpful to talk about the anatomy of the nerve.

The genitofemoral nerve first leaves the spine and makes its way through the psoas muscle. The psoas muscle is the only muscle which attaches the spine to the leg. It is a large muscle that attaches to the spine on one end (it attaches to the lower thoracic spine and the lumbar spine) and attaches to the top of the hip on the other side. The body of the muscle is present in the pelvis and serves as a hip flexor (it helps you raise your upper leg towards your abdomen).

After the nerve travels through the psoas muscle, it branches into two parts; the genital and the femoral nerve (it does this just above the inguinal ligament in the pelvis). 

In women, the genital branch of the genitofemoral nerve travels to and provides sensation to the labia majora and mons pubis (parts of the vulva). In men, the genital branch provides sensation to the scrotum.

The femoral branch of the genitofemoral nerve is responsible for sensation in the outer portion of the thigh.

Causes

Damage or compression to the genitofemoral nerve, as well as conditions which damage the lining of nerves in general (peripheral neuropathy) may lead to genitofemoral nerve pain. Some causes include:

• Abdominal or pelvic surgery: The genitofemoral nerve can be damaged during certain types of surgery.
• Trauma to the abdomen and/or pelvis.
• Compression of the psoas muscle.
• Damage to the genitofemoral nerve when pelvic lymph nodes are dissected (as with ovarian, uterine, bladder, or prostate cancer surgery) or when a large pelvic mass is removed during pelvic surgery.
• Peripheral neuropathy: Conditions which cause generalized nerve damage (peripheral neuropathy) such as diabetes can result in genitofemoral nerve pain. In addition to diabetes, conditions such as multiple sclerosis, chronic alcohol abuse, some vitamin deficiencies, some metabolic and vascular diseases, and cancer chemotherapy can also cause neuropathy.
• Pregnancy: In the last trimester, the uterus can place pressure on the nerve.

Symptoms

Like many types of neuropathic pain, genitofemoral neuropathy is often described as burning, sharp, shooting or throbbing. This type of pelvic nerve pain may be felt in the abdomen, lower back or between the legs. It may come and go, or it may be more persistent. Some people report feeling this type of pelvic nerve pain more when lying down.

Treatment

Treatment for pelvic nerve pain can be difficult, and often requires trying several different modalities in order to get the best relief of pain with the fewest side effects. Treatment options may include:

• Medications, such as anticonvulsants
• Nerve blocks
• Steroid Injections
• Surgical intervention: Surgery can sometimes be helpful, but can also sometimes provoke the pain

Most cases of genitofemoral neuropathy are resolved with nerve blocks and time, though sometimes the pain may persist. Persistent pelvic nerve pain is one of the many types of chronic pelvic pain.

For pain that is persisting, other treatments may include:

• Selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) such as Cymbalta (duloxetine)
• Topical anticonvulsants (gabapentin)
• Topical lidocaine patches

There are more options not discussed here, which may be considered if your pain becomes chronic, and working with a pain specialist may be very helpful.

Coping

Neuropathic pain can be very difficult for people to describe, and even more difficult for others to understand.

If you're coping with chronic pelvic pain you may be very frustrated. Not only is the pain often chronic and unrelenting, but others in your midst, even your physicians, may not understand how much the pain limits your day to day activities.

Some people find it helpful to become involved in a support group or support community. Thankfully there are online support communities in which you can communicate with others coping with the frustration and discomfort of genitofemoral neuropathy.

Some people feel anger, not just because they are left with the pain, but because of whatever caused the pain in the first place, for example, pelvic surgery or an accident. Working with a therapist can be very helpful, not because the pain is in your head (it isn't, it's in a nerve) but because you may feel very alone as you cope with the pain. A good therapist may also be able to guide you in finding other treatment approaches such as relaxation, deep breathing, or even acupuncture to help you cope with the pain.