Postnatal sacroiliac joint dysfunction as a mechanical driver of pudendal neuralgia and dyspareunia: A case report

Pudendal neuralgia is a neuropathic perineal pain syndrome that commonly causes dyspareunia, yet sacroiliac joint dysfunction is rarely considered a primary mechanical cause in the early postnatal period. A 32-year-old woman presented 6 weeks after an elective cesarean section with a 2-week history of perineal burning that had begun 4-week postpartum and worsened on sitting. Dyspareunia was identified on a single attempted intercourse after the 40-day postpartum period, shortly before presentation. Examination showed an anterior pelvic tilt; right sacroiliac, ischial spine, obturator internus, and piriformis tenderness; and a positive sacroiliac provocation cluster. Electrophysiology showed a prolonged right pudendal nerve terminal motor latency, and four of the five Nantes criteria were fulfilled. Over twelve physiotherapy sessions across 4 weeks, she received soft-tissue and ischemic release, sacroiliac mobilization, pelvic-floor re-education, and gluteal and abdominal strengthening. Pain, dyspareunia, disability, and terminal motor latency all improved and were maintained at follow-up.