Treatment of Pudendal Neuropathy to Restore Orgasmic Function

First-Line Conservative Management

• The National Comprehensive Cancer Network recommends PDE5 inhibitors, such as sildenafil, vardenafil, and tadalafil, to improve orgasm problems, including decreased intensity and difficulty achieving climax, in patients with pudendal neuropathy 1, 2
• Testosterone replacement therapy may relieve orgasm problems in patients with morning testosterone levels less than 300 ng/dL, as suggested by the National Comprehensive Cancer Network 2, 4
• Pelvic floor physical therapy may improve sexual function in patients with pudendal neuropathy, although evidence is primarily from prostate cancer populations 2, 4
• Vibratory therapy may reduce orgasm problems in patients with pudendal neuropathy, according to the National Comprehensive Cancer Network 5

Critical Clinical Considerations

• The American Diabetes Association and other organizations suggest screening for coexisting erectile dysfunction, which commonly accompanies pudendal neuropathy, and managing it concurrently with PDE5 inhibitors 6