Pudendal neuralgia is a painful neuropathic condition, involving the dermatome of the pudendal nerve. In women, primary symptoms are commonly experienced in vaginal, anal, vulva, clitoral, and perineal regions. Wepresent a case of a 44 y/o female who suspected to have pudendal neuralgia. She was successfully treated by pudendal nerve block guided by combinationof ultrasound and fluoroscopy. By using dual image guiding technique, we introduced the needle precisely by visualizing anatomical landmarks such as the internal pudendal artery, nerve, the sacrospinous ligament(SSL) and sacrotuberous ligament(STL) under ultrasound guiding. Then we did hydrodissection and confirmed the injectate spread through the Alcock's canal by fluoroscopy with enhancement of the contrast. With the combination of the two skills, we can take advantage of both skills. The patient reported a reduction in pain by 60- 80% with an excellent improvement of quality of life during follow-up 8 weeks later.

Pudendal neuralgia, ultrasound, fluoroscopy