Pudendal neuralgia is a chronic pelvic pain condition caused by irritation or injury to the pudendal nerve, which provides sensation to the pelvis, genitals, and perineum. People with pudendal neuralgia often experience burning, sharp, aching, or electric-like pain that may worsen with sitting and improve when standing or lying down. Because many pelvic conditions can cause similar symptoms, pudendal neuralgia is frequently misunderstood or mistaken for other causes of pelvic pain.
Understanding the role of the pudendal nerve—and how it can become irritated—is the first step toward finding the right treatment.
The Pudendal Nerve
The pudendal nerve travels through the pelvis and supplies sensation and function to many of the structures of the pelvic floor. While many conditions can cause pelvic pain, a diagnosis of pudendal neuralgia refers specifically to symptoms caused by irritation or injury of the pudendal nerve.
Because many pelvic pain conditions have similar symptoms, an evaluation by a pelvic floor physical therapist can help determine whether your symptoms are consistent with pudendal neuralgia or another pelvic floor condition and guide you toward the most appropriate treatment.
Pain in the territory of the pudendal nerve: from the anus to the penis or clitoris
Pain is mostly experienced while sitting
The pain does not wake the person up at night
No change or loss of sensation
Pain relieved by diagnostic pudendal nerve block
People with pudendal neuralgia can also report a variety of other symptoms. These include urinary frequency, urgency, painful ejaculation, painful vaginal penetration, painful nocturnal orgasms, and persistent sexual arousal. However, the pain cannot be labeled as pudendal neuralgia if the criteria above aren’t met.
While nerves are meant to withstand compression and stretch, they are injured when those forces are especially high and/or chronic. Due to the location of the pudendal nerve, compression from bike saddles and hard seats can also contribute.
How is pudendal neuralgia treated?
In the short term, we want to make you as comfortable as possible! Many use a special cutout cushion such as the Theraseat to better tolerate sitting.
In cases related to acute trauma or childbirth, time is a huge factor in healing. Nerves heal slowly, so improvements can occur for a year or longer.
When someone has pudendal neuralgia due to chronic constipation, it’s critical to make stool soft and regular. A pelvic PT can also teach techniques to reduce straining with bowel movements. Without addressing the underlying cause, it will be hard to make improvements in pain! See our article on constipation for places to start.
For pudendal neuralgia due to cycling, it’s important to get the bike properly fit and increase padding to the area between the sit bones. Decreasing training volume or taking a break completely may help reduce symptoms.
Medical interventions such as pudendal nerve blocks can help temporarily or permanently. Prescription nerve pain medications are also helpful.
Pelvic physical therapists are important team members in diagnosing and managing pudendal neuralgia. Your PT will work with you to determine contributing factors and a plan to address them. They will also develop an exercise program focused on the low back, pelvis, and hips. Getting the area around the nerve moving is a hugely beneficial! Finally, they provide hands-on therapy for pain relief. Our goal is to keep you moving and participating in your life as normally as possible!
Living with Pudendal Neuralgia? We’re Here to Help.
Pudendal neuralgia can make sitting, exercising, working, and even everyday activities feel overwhelming. While recovery often takes time, you don’t have to manage your symptoms alone. A pelvic floor physical therapist can help identify the factors contributing to your pain and develop a personalized treatment plan that may include manual therapy, nerve mobility exercises, movement retraining, pelvic floor muscle relaxation, activity modification, and education to help you move more comfortably and confidently.
At Agile Physical Therapy, our pelvic floor specialists provide individualized, one-on-one, 60-minute treatment sessions designed around your specific symptoms and goals. We offer pelvic floor physical therapy at our San Mateo, Palo Alto, and Los Gatos clinics. If you don’t live near one of our locations, we also provide virtual pelvic floor physical therapy for residents of California and Massachusetts. Virtual visits are an excellent option for education, exercise progression, activity modification, movement coaching, and ongoing support throughout your recovery.
