Dear Doctors: I have seen my doctor and gynecologist for pain in my groin area that gets worse when I'm sitting or if I squat. It worsens at the end of the day. I'm told it could be pudendal neuralgia. I've never heard of that. Can you please explain what that is?

Dear Reader: The term “neuralgia” refers to abnormal sensations that arise in a nerve pathway. They can range from numbness, tingling or burning to pain that is described as sharp, stabbing or like an electrical shock. Some people also become hypersensitive to cold or to touch. When this occurs, something as minor as lightly brushing the skin can result in pain or discomfort.

Causes include inflammation, infection and the effects of certain chronic diseases. Physical pressure on a nerve, or on the tissues or structures adjacent to a nerve, can also cause the condition. That's the case with pudendal neuralgia.

The pudendal nerve originates in a bundle of nerves located at the lower back of the pelvic wall and runs through the pelvic region and buttocks. It is a paired nerve, which means it is present on both sides of the body. The nerve and its branches animate and provide sensation to much of the pelvic region. It is crucial to passing urine and feces, and to sexual sensation and function.

Damage or injury to the nerve can cause the pain and other sensations you have described. It can also interfere with voiding the bowels or bladder, and with sexual function.

The path and location of the pudendal nerve leaves it somewhat vulnerable to injury. This includes from prolonged sitting and activities such as cycling or horseback riding.

Childbirth, during which the nerve is repeatedly stretched, can also play a role. Typically, any symptoms related to the pudendal nerve recede within a few weeks of giving birth. But in some cases, such as during a difficult or prolonged labor, the nerve can become inflamed or even damaged.

Diagnosis of the condition begins with a physical exam, including a vaginal or rectal exam. Scans, such as an MRI, can be helpful in identifying possible points of nerve entrapment. In some instances, a nerve block may be used as a diagnostic aid. This involves disabling the nerve with an injection and then gauging if the symptoms have abated.

Treatment is a mix of behavioral changes, physical therapy and the use of medications to manage pain and inflammation. It's also important to avoid any painful stimuli. In your case, this includes sitting and squatting, and any activities that involve hip flexion. For patients whose pain arises from muscle spasms, physical therapy can be helpful.

Medications to manage nerve pain, including analgesics, muscle relaxants, antidepressants and anticonvulsants, may be prescribed. Studies show that a nerve block that includes an anesthetic plus a corticosteroid can confer pain relief that lasts for up to a month.

When nerve entrapment has been confirmed, surgical decompression may be needed. This now includes several minimally invasive laparoscopic techniques. For a diagnosis, seek out a neurologist familiar with this condition.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I am 65 years old, and I have never been to a cardiologist. I am concerned about heart disease and the possibility that I may have blocked arteries. I would like to know what screenings -- an MRI? an exercise stress test? -- I should get.

Dear Reader: As someone who has not undergone the screenings commonly used to evaluate cardiac health, it's best to start with the basics. These can be done by your regular doctor.

The appointment typically begins with a discussion of your medical history. This includes information about any diseases or conditions for which you are currently being treated, and any in your past that may have a residual effect on general health. Family history, which can suggest a genetic predisposition for certain diseases and conditions, is an important factor, as well.

Your weight, and possibly your BMI, will be recorded, and your doctor will obtain readings for heart rate and blood pressure. Testing will also include a blood lipid profile and a blood glucose level. Taken together, this information offers important insights into health risks that you may face. If the test results suggest a problem beyond the scope of your primary health care provider, such as a heart condition or heart disease, they will refer you to a cardiologist.

When visiting a cardiologist, expect them to review the test results that brought you under their care, and to explain how the results are a factor in the health of your heart. Depending on those results, you may also be asked to undergo additional tests that assess various aspects of cardiovascular health. These can include an EKG, which measures electrical activity in the heart; echocardiography, which uses ultrasound to create moving pictures of the heart; and scans that measure blood flow in the veins or that identify the presence of calcium deposits. A test known as CCTA, or coronary computed tomography angiography, produces 3D images that can help detect abnormalities in blood flow and identify possible blockages. An exercise cardiac stress test measures heart rate and rhythm, blood pressure and electrical activity of the heart as the patient performs increasingly strenuous exercise.

The cardiologist will also discuss specific aspects of your lifestyle. This includes a review of your diet, exercise habits, use of alcohol or tobacco products and your perceived level of stress. You will be asked about medications you are currently taking. It's important to provide the doctor with a complete and accurate list, and to also include any dietary supplements that you may be using. They will also want to know about any family history of heart disease.

Depending on the findings, you may be prescribed medications to manage high blood pressure or high cholesterol. You may also be advised to make lifestyle changes. These can include reaching a healthier weight, exercising more or more frequently, adjusting your diet, moderating the use of alcohol and quitting tobacco products. Your cardiologist will also schedule additional appointments to evaluate the efficacy of your treatment program. For the health of your heart, and your general well-being, it's important that you follow through.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello, dear readers, and welcome back to our monthly letters column. We're getting closer to autumn, but in much of the country, heat waves continue. Please be sure to take precautions. Drink enough water throughout the day to fuel your body's natural cooling system, which is sweating. When possible, stay indoors during the hottest hours. And, if needed, take shelter in public places in your area with air conditioning, such as malls, community centers, libraries or local cooling centers. Even a short break in a cooler environment can be helpful. And now, onward to the mail:

-- We recently wrote about spinal stenosis, which is when the spaces and hollows of the spinal column begin to narrow. The resulting pressure on the spinal cord and nerve roots causes symptoms that include pain, burning, numbness and weakness in the back, legs or feet. That prompted a question from a reader who developed these symptoms. "I had an MRI two years ago, and it showed some spinal stenosis and a mild protrusion on the disc," he wrote. "I developed numbness in my left leg and tingling in both feet, but no buttock or thigh pain. Two chiropractors and a physical therapist have offered conflicting advice, and none of their suggestions seem to work. What kind of specialist should I see?"

You would be best served by seeing a spine specialist, either a neurosurgeon or an orthopedic surgeon. A disc protrusion, if mild, can be treated with physical therapy and anti-inflammatories. It can sometimes require an epidural steroid injection. Some people with spinal stenosis are helped by a minimally invasive procedure called Vertiflex, which uses a small implant to lessen pressure within the spine to ease symptoms.

-- We recently discussed a sensitive and accurate blood test known as A1C, which measures someone's average blood sugar levels over the previous eight- or 12-week period. It is used to diagnose Type 2 diabetes. This is a condition in which the body stops responding properly to insulin, which leads to chronic high blood sugar.

A reader with high A1C results sent us a question. "I need to lower my A1C -- can diet and exercise be effective?" they asked. "How much of a reversal can you see?" The answer is, yes, A1C can be lowered by lifestyle modifications. This is achieved by minimizing added sugar in the diet, avoiding refined carbohydrates and highly processed foods, getting regular exercise and reaching a healthy weight. Each of these contribute to improving the body's response to insulin. How much you can lower your A1C with lifestyle changes depends on each person's general health, metabolism and genetics. If your doctor has outlined a treatment plan that includes medication, it's important to follow through.

Thank you, as always, for taking the time to write. It's wonderful to hear when a column has helped you, or that you simply find the information useful or instructive. We read every letter, and we will continue to try to respond to as many as possible.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)