Pudendal Innervation Questioned

[Jordan Dimitrakov, MD, PhD]

Trying to be scientific - here's the first piece:

This fascinating study from a renowned researcher shows based on
dissection in humans, monkeys and rats that the PUDENDAL NERVE does
NOT innervate the levator ani muscle. So, the theory pudendal nerve
damage ---->levator ani spasticity----- does not make sense.

Am J Obstet Gynecol 2002 Jul;187(1):64-71

Innervation of the female levator ani muscles.

Barber MD, Bremer RE, Thor KB, Dolber PC, Kuehl TJ, Coates KW.

Department of Obstetrics and Gynecology, Division of Gynecologic
Specialties, Duke University Medical Center, the Durham Veterans
Administration Medical Center, NC, USA. barb...@ccf.org

OBJECTIVE: The objective of this study was to characterize the
innervation of the human female levator ani muscles. STUDY DESIGN:
Detailed dissections of the peripheral innervation of the
iliococcygeal, pubococcygeal, puborectal, and coccygeal muscles were
performed in 12 fresh-frozen female cadavers (aged, 32-100 years) with
the use of transabdominal, gluteal, and perineal approaches. Both the
pudendal nerve and the sacral nerve roots that enter the pelvis from
the cephalic side were followed from their origin at the sacral
foramina to their termination. Pelvic floor innervation was described
with reference to fixed bony landmarks, particularly the coccyx, the
ischial spine and the inferior pubis. Photographs were taken, and
nerve biopsies were performed to confirm the gross findings
histologically. Biopsy specimens were stained with Masson's trichrome.
RESULTS: In each dissection, a nerve originated from the S3 to S5
foramina (S4 alone, 30%; from S3 and S4, 40%; from S4 and S5, 30%),
crossed the superior surface of the coccygeal muscle (3.0 +/- 1.4 cm
medial to the ischial spine [range, 1.0-4.2 cm]), traveled on the
superior surface of the iliococcygeal muscle innervating it at its
approximate midpoint, and continued on to innervate both the
pubococcygeal and puborectal muscles at their approximate midpoint.
The pudendal nerve originated from the S2 to S4 foramina, exited the
pelvis through the greater sciatic foramen, traversed Alcock's canal,
and branched to innervate the external anal sphincter, the external
urethral sphincter, the perineal musculature, the clitoris, and the
skin. Despite specific attempts to locate pudendal branches to the
levator ani, none could be demonstrated. Nerve biopsy specimens that
were obtained at gross dissection were confirmed histologically.
CONCLUSION: Gross dissections suggest that the female levator ani
muscle is not innervated by the pudendal nerve but rather by
innervation that originates the sacral nerve roots (S3-S5) that
travels on the superior surface of the pelvic floor (levator ani
nerve). Because definitive studies (eg, nerve transection or
neurotracer studies) cannot be performed in humans, further studies
that will use appropriate animal models are necessary to confirm and
extend our findings.

[Federico Guercini M.D.]

I could see the problem on the contrary: chronic prostatitis>>>elevator ani
spasticity>>>pudendal nerve damage>>>pain on the pudendal nerve territory
innervation (i.e. haunches, legs etch).
Federico Guercini MD

"Jordan Dimitrakov, MD, PhD" <dimitra...@yahoo.com> ha scritto nel
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