Some of the most challenging symptomatologies encountered by the nerve surgeon are gluteal, pelvic, perineal, or genital pain. Part of the problem is the difficulty of diagnosis, and part is unfamiliarity with the anatomy of the area. These render the surgeon uncomfortable making the diagnosis or offering treatment. These patients are miserable, lose quality of life, and remain undiagnosed for years. This chapter aims at shedding light on the diagnosis and treatment of these relatively rare pathologies.