# Anatomical Variation of the Pudendal Nerve and Related Structures

## TL;DR

The pudendal nerve shows significant anatomical variation, which may explain differences in treatment outcomes and help improve diagnosis and surgical planning.

## Contribution

This scoping review systematically compiles anatomical variations of the pudendal nerve and challenges assumptions of typical anatomy.

## Key findings

- The pudendal nerve exhibits substantial anatomical diversity in roots, trunk, and branches.
- Variations may place the nerve in vulnerable positions, leading to compression or traction.
- Understanding these variations is critical for improving diagnosis and treatment of PN-related conditions.

## Abstract

Anatomical variation of the pudendal nerve is complex and clinically significant. Recognition of these variants is important for improving diagnosis, surgical planning, and treatment outcomes in conditions such as pudendal neuralgia and persistent genital arousal disorder.

The pudendal nerve (PN) typically arises from sacral roots S2–S4 and gives rise to three main branches: inferior rectal, perineal, and dorsal genital nerves. However, conditions such as pudendal neuralgia and persistent genital arousal disorder exhibit great variability in clinical course and therapeutic responses. Anatomical variation of the PN may contribute to this variability by placing the nerve or its branches in vulnerable positions that lead to compression or traction. This scoping review examined PN anatomical variations to gain a better understanding of their role in pathophysiology and clinical outcomes.

A scoping review was conducted according to the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) guidelines to answer the following research question: What are the anatomical variations of the PN and related structures along its route? Searches were conducted in the MEDLINE and EMBASE databases, with manual screening. Studies on human anatomical investigations of PN variations, regardless of method, were included.

The review revealed substantial anatomical diversity in nerve roots, trunk, branches, and related structures, for which detailed schematic illustrations were developed. Limitations include methodological heterogeneity across studies, the predominance of elderly cadaver specimens, and lack of formal quality assessment.

Anatomical variation is a key factor in the development and persistence of PN-related conditions. An understanding of this variability is critical for diagnosis, surgical planning, and effective management. This review challenges assumptions of “typical anatomy” and offers context for refinement of decompression techniques and therapeutic strategies.

Our study shows that one of the nerves in the pelvis, called the pudendal nerve, varies between individuals. This could explain why standard treatments do not work in some patients and could help doctors to better understand these conditions.