Pain Management

Mark Conway, MD, FACOG
OB/GYN Associates of Southern NH
30 Daniel Webster Highway, Suite 11
Merrimack, NH 03054
(603) 883-3365

Education: MD, New York Medical College, Valhalla, NY
Residency: University of Illinois College of Medicine, Chicago, IL; Michael Reese Hospital and Medical Center, Chicago, IL
Board Certified: Obstetrics & Gynecology
Special Interests: Pelvic reconstructive surgery for correction of genital prolapse, Pelvic pain disorders including endometriosis, myofascial disorders, vestibulodynia, pudendal neuralgia, and pudendal nerve decompression

Pudendal Neuralgia is a chronic pain syndrome involving pain and burning in the genital area. This can be disabling, often resulting in loss of many normal activities. The condition affects both men and women with a wide variety of symptoms. Patients will note pain and a burning sensation anywhere from the perianal/perirectal area to the clitoris or penis. Patients will note both increased and decreased skin sensitivity in the area. Also pain with arousal, orgasm, ejaculation, and erectile dysfunction can be seen. Many patients can have urgency, frequency, and urinary incontinence. Pain with bowel movements and constipation are common. Severe pain with attempted intercourse is very common. Genital pain is increased with sitting and reduced with standing or sitting on a toilet seat.

Many factors can contribute to the cause of the condition. The pudendal nerve, which supplies both sensory and motor fibers to the genital area, is susceptible to entrapment along its course. Should this occur, nerve dysfunction can cause the resultant symptoms. However, some patients will develop nerve sensitization and dysfunction because of pelvic flood dysfunction and connective tissue abnormality without entrapment. Of course, some patients develop a combination of both.

We are happy to offer comprehensive evaluation and treatment for people suffering from Pudendal Neuralgia. This is accomplished through a multidisciplinary approach with medical therapy, nerve blocks, trigger point treatment, physical therapy, and in some cases, pudendal nerve decompression surgery.

Dr. Mark Conway, MD, FACOG and Antonia Winefield, ARNP of OB/GYN Associates of Southern New Hampshire and other associated colleagues in the area have collaborated extensively with experts both in the U.S. and abroad to develop and deliver a comprehensive treatment program. Dr. Conway and Antonia Winefield traveled to France to work with the internationally known experts in Pudendal Neuralgia, Dr. Eric Bautrant and Dr. Eric de Bisschop. They have adopted protocols for preoperative EMG evaluation of the pudendal nerve and the trans-ischio rectal (TIR) approach for pudendal nerve decompression with intraoperative nerve testing. This program will offer comprehensive treatment and will be the only team offering the TIR approach in the U.S.

More information can be obtained on the internet at the Society of Pudendal Neuralgia (SPuN) at www.spuninfo.org, and www.pudendal.com. To contact Dr. Conway with questions or to schedule a consultation, please call (603) 883-3365.

1. Who Are We?

We are a collection of healthcare professionals dedicated to the comprehensive diagnosis and treatment of pudendal neuralgia and other related chronic pelvic pain issues.

Our team consists of:

Dr. Mark Conway, MD, FACOG, a gynecologist with a particular interest in pelvic reconstructive surgery and the diagnosis and treatment of pudendal neuralgia. He also offers treatment for other chronic pelvic pain issues such as vestibulodynia, vulvodynia, endometriosis and myofascial disorders.

Dr. Eduardo Quesada, MD, an anesthesiologist with a keen interest in chronic pain disorders. He provides medical therapy with pain modulating medications, as well as a variety of nerve blocking modalities.

Antonia Winefield,ARNP, who works closely with Dr. Conway in the evaluation of pudendal neuralgia patients. Her special area of practice is the EMG evaluation of the pudendal nerve.

Lynn Assad is a skilled and compassionate physical therapist with a particular interest in the treatment of pudendal neuralgia and other pelvic floor and myofascial disorders.

2. What is Pudendal Neuralgia?

Simply stated, it is a chronic pain syndrome involving the genital region in both men and women. The pudendal nerve provides both motor and sensory fibers to the genital area from the anal and perirectal area up to the clitoris or penis. Symptoms include pain (esp. burning) in the genital area. This is increased by sitting and lessened by standing or sitting on a toilet seat. Patients note a change in skin sensitivity both increased and decreased. Pain with arousal, orgasm/ejaculation and erectile dysfunction is common. Urinary incontinence, urgency or frequency, as well as pain with bowel movement and constipation can occur. Women experience pain (often severe) with attempted intercourse. The condition is often disabling and prevents many normal activities.

3. What Causes Pudendal Neuralgia?

This is a chronic pain syndrome, which may involve a variety of factors. Two major mechanisms probably account for most cases. One is nerve entrapment or compression along the course of the nerve, which causes never dysfunction and pain. The second mechanism is pelvic floor muscle dysfunction and/or connective tissue abnormalities, which causes sensitization of the nerve with the resultant pain and other symptoms.

4. What Triggers These Problems?

Again, a large variety of triggers have been noted. For nerve entrapment, most patients have an anatomical predisposition for nerve entrapment, which is exacerbated by trauma, surgery, exercise (esp. cycling), etc. Nerve sensitization can be triggered by trauma, chronic skin irritation, etc.

5. What is Involved in Diagnosis?

First, a detailed history of the patient’s condition is obtained and then a physical exam targeted for the affected areas is performed. This initial evaluation is performed in Dr. Conway’s office. Depending on the findings, an EMG evaluation of the pudendal nerve may be performed. Also, referral to Dr. Quesada for a diagnostic pudendal block and evaluation for medical treatment may be indicated.

6. What Treatments are Available?

Treatment proceeds from a multidisciplinary approach. A combination of medical therapy, physical therapy, nerve blocks, subcutaneous infiltrations, trigger point treatment and other supportive care is employed. In some cases, surgical nerve decompression is required to relieve nerve entrapment and maximize recovery. It is crucial to remember that surgery alone is usually not enough. Patients will greatly benefit from continued physical therapy after surgery.

7. What Type of Surgery is Offered?

Dr. Conway has adopted the same surgical protocol as that used by Dr. Eric Bautrant in France. This is known as the trans-ischio rectal approach (TIR). Antonia Winefield, ARNP and Dr. Conway employ the same preoperative and intraoperative nerve testing developed by Dr. Eric de Bisschop and Dr. Bautrant in France. All surgeries will be performed at St. Joseph Hospital in Nashua, New Hampshire.

8. Where Are We Located?

The members of our team are all located within an easy 15-minute drive from one another in southern New Hampshire, 34-45 miles north of Boston, Massachusetts.

Dr. Conway and Antonia Winefield, ARNP
OB/GYN Associates of Southern New Hampshire
30 Daniel Webster Highway, Suite 11
Merrimack, NH 03054
(603) 883-3365

Dr. Eduardo Quesada, MD
Pain Management Center
Elliot Hospital
One Elliot Way
Manchester, NH 03103
(603) 663-6730

Lynn Assad, Physical Therapist
Max K. Willscher Urology Center at Elliot Hospital
One Elliot Way
Manchester, NH 03103
(603) 663-4170

9. What Are Our Goals?

We want every patient to achieve the highest level of function possible. This will be achieved through a multidisciplinary approach to ensure that every patient receives the best therapy for them. In a broader sense, we also want to continue the advancement in treating this condition. We will continue our strong collaboration with other experts both here and abroad to improve care.