Pudendal neuropathy involving the perforating cutaneous nerve after cystocele repair with graft

BACKGROUND: Pudendal neuropathy is a documented complication of sacrospinous ligament fixation, but it is infrequently reported with other types of gynecologic surgery. CASE: A woman developed neuropathic symptoms of the right vulva, perianal area, and gluteal fold after vaginal surgery with graft for anterior pelvic organ prolapse. Pudendal nerve entrapment with involvement of the perforating cutaneous nerve was suspected. Suture removal 1 year after the operation resulted in improved pain symptoms and sexual function. CONCLUSION: Pudendal nerve entrapment is one potential complication of anterior vaginal repair with biologic graft. Removal of sutures, even long after surgery, can result in clinically significant improvement in pain symptoms and sexual function in patients with pudendal nerve entrapment.