What is Pudendal Neuralgia?

Pudendal neuralgia is a condition that causes pain, discomfort, or numbness in your pelvis or genitals. It happens when a major nerve in the lower body is damaged or irritated, and it can make it hard to use the bathroom, have sex, or sit down. The pain comes and goes.

It’s not clear exactly how many people have this condition, but experts believe it’s rare.

The pudendal nerve runs from the back of the pelvis to near the base of your penis or vagina, where it branches off into other nerves.

It sends messages to the brain from your genitals, anus, and other nearby body parts. It controls the sphincter muscles that open and close when you use the bathroom.

Causes

There are several things that can damage your pudendal nerve.

It can happen when you’re injured, have surgery, or give birth. A tumor or an infection can squeeze or irritate it. And sometimes, certain types of exercise, like spending a lot of time on a bicycle, can cause the problem.

Symptoms

You usually feel pudendal neuralgia symptoms in your lower body, genitals, or perineum (the area between your genitals and anus). These may include:

• A sharp or burning pain
• More sensitivity
• Numbness or a pins-and-needles feeling, like when your leg falls asleep
• A swollen feeling

These feelings might be worse when you sit down. Or you may have symptoms on both sides of your body, and they might go into your belly, buttocks, or legs.

You also may have problems such as:

• A sudden or frequent need to go to the bathroom
• Trouble or pain during sex
• For men, problems getting an erection

Diagnosis

If you have pelvic pain, tell your doctor. At your appointment, you’ll answer questions about your symptoms and get a physical examination. Your doctor will put a finger into your vagina or rectum and put pressure on the nerve to check on it.

You might also get an imaging test with an MRI machine. It uses powerful magnets and radio waves to take a picture of your body’s internal organs.

Your doctor may also give you a pudendal nerve block. This is a shot you get in your pelvis to numb the nerve and see if your symptoms go away.

Treatment

Most people with pudendal neuralgia get treatment with a combination of physical therapy, lifestyle changes, and medicines.

Sit up straight or stand more often to help with nerve pain. This can take pressure off the pudendal nerve.

Don’t do squats or cycle. Certain exercises can make pudendal neuralgia worse.

Go for physical therapy. It relaxes and stretches the muscles at the lower end of your pelvis, known as the pelvic floor. This can ease pressure that may irritate the pudendal nerve. If pudendal neuralgia makes it hard to control your bladder or bowels, physical therapy can help with that, too.

Try prescription medication. Muscle relaxants may help relieve symptoms of pudendal neuralgia. Drugs used to treat other conditions, like depression or epilepsy, might also help.

If these don’t work, your doctor may give you a shot of medications that numb the nerve or lower inflammation, which lessens pressure. These may take several weeks to fully take effect.

In rare cases, your doctor may recommend surgery to remove anything that presses on the nerve. You may also get a small electrical device put under your skin to stimulate the nerve and interrupt the pain signals it sends to the brain.

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