If you have been living with pelvic pain that no doctor has been able to explain — if your ultrasounds are normal, your blood tests are clear, and you have been told to just manage the pain or that it might be psychological — there is a branch of medicine that was specifically created for patients like you. It is called neuropelveology, and it could be the reason you finally get a diagnosis and effective treatment.
Neuropelveology is still relatively unknown in India, which means most women suffering from nerve-related pelvic pain have never even heard of it. This article explains what neuropelveology is, what conditions it treats, how it differs from standard gynaecology, and where you can access this specialised care in India.
1. Neuropelveology Is the Study of Pelvic Nerves
Neuropelveology is a medical specialty that focuses on the diagnosis and treatment of disorders affecting the nerves within the pelvis. The word itself breaks down simply: neuro (nerves) + pelve (pelvis) + ology (study of).
The pelvis contains one of the most complex nerve networks in the human body. The sacral plexus, pudendal nerve, sciatic nerve, obturator nerve, and autonomic nerve fibres all pass through this region. These nerves control sensation in the pelvic organs, the perineum, the genitals, the bladder, the bowel, and the legs. When any of these nerves become compressed, entrapped, inflamed, or damaged, the result is chronic pain that can be debilitating.
The problem is that standard medical training — whether in gynaecology, urology, or general surgery — does not include systematic evaluation of these pelvic nerves. Gynaecologists check the uterus and ovaries. Urologists check the bladder. Gastroenterologists check the bowel. But the nerves that run between and around all these organs are examined by none of them. Neuropelveology fills this critical gap.
2. It Was Founded by Prof. Marc Possover in Switzerland
Neuropelveology was formally established as a medical discipline in 2009 by Professor Marc Possover, a German-Swiss surgeon based at the Possover International Medical Centre in Zurich, Switzerland. Prof. Possover recognised that thousands of patients with chronic pelvic pain were falling through the cracks of conventional medicine because no specialty was systematically evaluating the pelvic nerves.
He developed the LANN technique — Laparoscopic Assessment of Nerves and Navigation — a minimally invasive surgical method that allows the surgeon to directly visualise the pelvic nerve pathways during laparoscopy, identify the exact site of nerve compression or damage, and treat it with precision while preserving healthy nerve function.
Prof. Possover also founded the International School of Neuropelveology (ISON) to train doctors from around the world in this discipline. The school offers a structured Masters programme that covers pelvic neuroanatomy, clinical examination techniques, specialised imaging interpretation, and the LANN surgical technique. Graduates of this programme are among the very few doctors globally who can offer comprehensive neuropelveological care.
3. Conditions That Neuropelveology Diagnoses and Treats
Neuropelveology covers a specific set of conditions that are frequently misdiagnosed or completely missed by conventional medicine.
Pudendal neuralgia is perhaps the most common condition treated by neuropelveologists. It involves compression or irritation of the pudendal nerve, causing burning or stabbing pain in the perineum and genital area. The hallmark symptom is pain that worsens significantly with sitting and improves when standing or lying down. The average time to diagnosis for pudendal neuralgia is four to seven years — patients typically see five or more doctors before getting an accurate diagnosis.
Endometriosis of the pelvic nerves is a severe form of deep infiltrating endometriosis where the endometriotic tissue grows directly onto the sacral plexus or sciatic nerve. This causes cyclical leg pain, progressive sciatica during menstruation, and eventually permanent nerve damage if untreated. Standard endometriosis surgery frequently misses this because surgeons are looking at organs, not nerves.
Post-surgical nerve injuries can occur after hysterectomy, caesarean section, pelvic floor repair with mesh, hernia surgery, or even laparoscopic procedures. The nerve damage may not be immediately apparent — it often develops gradually over weeks to months as scar tissue forms around the injured nerve.
Pelvic nerve entrapment happens when nerves become trapped by scar tissue, ligaments, blood vessels, or tumours. The sciatic, obturator, femoral, and genitofemoral nerves can all be affected within the pelvis.
Autonomic pelvic nerve dysfunction affects the nerves controlling bladder, bowel, and sexual function. Patients may experience bladder urgency and frequency alongside pelvic pain — often misdiagnosed as interstitial cystitis — or bowel dysfunction misattributed to irritable bowel syndrome.
4. How a Neuropelveological Evaluation Differs from a Standard Check-Up
A standard gynaecological evaluation typically involves a history, a pelvic examination focused on the uterus and ovaries, blood tests, and an ultrasound. If nothing is found, an MRI or diagnostic laparoscopy may follow. This approach is designed to find organ pathology — and it is effective for that purpose.
A neuropelveological evaluation starts from a fundamentally different premise. Instead of asking “which organ is causing the pain?”, it asks “which nerve is causing the pain?” The evaluation begins with a detailed clinical history focused on the character of the pain — burning, stabbing, or electric sensations suggest nerve involvement. The relationship between pain and position — worsening with sitting, improving with standing — points to specific nerves. Radiation patterns — pain travelling to the legs, buttocks, or perineum — map to specific nerve distributions.
The clinical examination includes systematic testing of sensation across pelvic dermatomes, assessment of nerve reflexes, palpation of specific nerve pathways to identify trigger points, and evaluation of pelvic floor muscle function. This examination alone often provides a strong diagnostic direction — something that no amount of imaging can replace.
Targeted investigations follow: MRI with nerve-specific protocols (different from standard pelvic MRI), specialised pelvic ultrasound, and in some cases, nerve conduction studies or diagnostic nerve blocks. If surgical treatment is indicated, the LANN technique provides direct visualisation of the pelvic nerves during minimally invasive laparoscopy.
5. Neuropelveology in India — Where to Find a Specialist
Neuropelveology is widely practiced across Europe, particularly in Germany, Switzerland, France, and Belgium. In Asia, awareness is growing but trained specialists remain extremely rare.
In India, Dr. Juhi Dhanawat is one of the very few gynaecologists who holds a Masters in Neuropelveology from the ISON International School in Switzerland — trained directly under Prof. Marc Possover. She has also co-authored published research on pelvic nerve anatomy in the peer-reviewed journal Translational Neuroscience. This combination of formal training and academic contribution makes her uniquely qualified to offer neuropelveological evaluation and treatment in India.
Dr. Juhi Dhanawat consults at Neotia Bhagirathi Woman and Child Care Centre, Rawdon Street and New Town, and at Motherhood Hospital, Kasba, Kolkata. Her approach combines the neuropelveological clinical examination with advanced imaging to identify the exact source of pelvic nerve dysfunction — offering answers to patients who have spent years searching for a diagnosis.
If you have been living with chronic pelvic pain that standard investigations have not been able to explain, a neuropelveological evaluation may be the next step that finally provides clarity.
Frequently Asked Questions
Q: Is neuropelveology a recognised medical specialty? A: Yes. Neuropelveology was formally established in 2009 by Prof. Marc Possover and is recognised as a subspecialty within gynaecological surgery. The International School of Neuropelveology (ISON) in Switzerland provides structured training and certification. Trained specialists practice across Europe and increasingly in Asia.
Q: How do I know if I need a neuropelveologist instead of a regular gynecologist? A: If your pelvic pain has lasted more than six months, standard investigations (ultrasound, blood tests, MRI) have found no cause, and your pain has nerve-like characteristics — burning, stabbing, electric, worse with sitting, radiating to legs — a neuropelveological evaluation should be your next step. Also consider it if you developed pelvic pain after surgery.
Q: Is neuropelveology available in India? A: Yes, though very few doctors in India have formal training. Dr. Juhi Dhanawat in Kolkata holds a Masters in Neuropelveology from ISON Switzerland and offers comprehensive neuropelveological evaluation and treatment at Neotia Bhagirathi (Rawdon Street and New Town) and Motherhood Hospital (Kasba).
Q: What is the LANN technique? A: LANN stands for Laparoscopic Assessment of Nerves and Navigation. It is a minimally invasive surgical technique developed by Prof. Marc Possover that allows the surgeon to directly visualise the pelvic nerve pathways during laparoscopy, identify nerve compression or damage, and treat it precisely while preserving healthy nerve function.
Q: Can nerve-related pelvic pain be cured? A: When the specific nerve problem is correctly identified and appropriately treated — whether through conservative measures like physiotherapy and nerve blocks, or surgical decompression — most patients experience significant improvement. Early diagnosis leads to better outcomes because prolonged nerve compression can cause irreversible damage.