Chronic pain in the territory innervated by the pudendal nerve and its branches poses a delicate therapeutic problem. The pudendal nerve courses through several zones where there is potential for compression. Rigorous selection after a thorough clinical and electrophysiological examination may show that some patients could benefit from pudendal nerve decompression by surgical neurolysis. The transgluteal approach permits sacro-spinal and sacro-tuberal ligament resection, obturator internus aponeurosis, incision and reduction of the falciform process of the sacro-tuberal ligament.

This film presents the clinical work-up of chronic perineal pain (cyclist's syndrome), the neuro-anatomy of the perineum, complementary exams and surgical technique of pudendal neurolysis by the transgluteal approach.