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Pudendal Neuralgia can certainly be challenging to diagnose and treat. It is probably underdaignosed.
Ideally you would want to confirm the diagnosis by seeing someone specially trained and experienced in treating this condition. Some use an ultrasound machine to see the nerves and guide a thin needle to them through the buttocks, using a local anesthetic injection to turn them off temporarily.
This is called an ultrasound-guided pudendal nerve block. Often, this treatment is sufficient to cure the problem, at least temporarily.
If the treatment doesn't hold, they might try another procedure such as low volume caudal epidural injections, pulsed radiofrequency ablation of the pudendal nerves, botox injections into the pelvic floor muscles, or spinal cord stimulation.
I would suggest you call and make an appointment to see a neurologist and/or urologist at the nearest academic medical center (i.e. one with a medical school). These are the centers that are most likely to have seen numerous cases like yours and be on the cutting edge of treatment options. If they cannot treat your condition after taking a careful history and doing a complete exam, they would know who else in the country is qualified to do so.
If you need assistance finding an appropriate facility in your area to be evaluated, let me know. I would be happy to help you in this regard.
Hi there. How's your pain today? Let me know if there is anything else I can do for you.