Pudendal neuralgia causes burning, shooting, or stabbing pain in the vulva, perineum, or anus. It results from irritation or compression of the pudendal nerve, and often worsens with sitting. Diagnosis relies on clinical criteria rather than imaging or tests, and treatment focuses on reducing nerve irritation and modifying the activities that drive symptoms. A pelvic floor physical therapist can help you find relief from pudendal nerve pain.
If you have pudendal nerve pain, the simple act of sitting can be excruciating, and even wearing tight underwear or yoga pants may cause unbearable burning or shooting pain.
Pudendal nerve pain, also called pudendal neuralgia, causes persistent, debilitating pain in and around the vulva. It occurs when there is irritation or damage to the pudendal nerve.
If you’re struggling with symptoms like these, you’re probably seeking relief…and fast. Fortunately, there are a range of treatment options that can alleviate symptoms and address the underlying issues affecting the pudendal nerve.
Understanding pudendal neuralgia is a critical first step to feeling better, so let’s get into it.
What does the pudendal nerve do?
The pudendal nerve provides essential sensation and motor function to the pelvic floor area, including the skin, parts of the vulva, the anus, and the pelvic floor muscles.
The nerve emerges from your pelvis near your sitting bones and splits into three branches: the clitoral, perineal, and rectal branches. These branches feed the front, middle, and back of your pelvic floor, respectively.
What is pudendal neuralgia?
Pudendal neuralgia is the medical term for pain, numbness, and/or tingling in the area controlled by the pudendal nerve. Pudendal neuralgia can lead to chronic pelvic pain and other frustrating symptoms that impact your bowel, bladder, and sexual function.
The term “neuralgia” refers broadly to irritation of or damage to a nerve. When any nerve is irritated or damaged, it screams out loudly, often by causing pain and muscle dysfunction. Have you ever hit your funny bone, only to feel a searing, burning, tingling pain down your arm to your wrist, pinky and ring fingers? Now imagine that pain, but in your vulva whenever you sit.
Note that pudendal neuralgia refers to any pain or irritation in the nerve. Pudendal nerve entrapment is a specific, related condition in which the nerve is physically compressed. Some people develop neuralgia due to entrapment, but others have pain and symptoms even though their nerve isn’t compressed.
There is still an alarming lack of understanding surrounding this condition. Diagnosing pudendal neuralgia often involves a lengthy and frustrating journey to relief. It may involve years of inconclusive medical examinations, consults with various specialists, and multiple failed interventions and medication trials.
Fortunately, the medical community is gradually getting better at pudendal nerve pain management. At Origin, our clinicians are highly trained experts in pelvic pain conditions, including pudendal neuralgia, and they’re here to help you find pudendal neuralgia relief.
What does pudendal nerve pain feel like?
People with pudendal nerve pain symptoms most often describe them as burning, shooting, or stabbing pain in the areas to which the pudendal nerve provides sensation. These include the perineum (the space between the genitals and anus), labia, anus, and clitoris.
You can think of pudendal neuralgia like the “sciatica of your pelvic floor”. Perhaps you’ve heard about or even experienced sciatica: an irritating, burning or aching nerve pain that runs down your butt and back of your leg (the course of the sciatic nerve). Compression or irritation of this nerve is the most common cause of sciatica.
Just like the sciatic nerve, the pudendal nerve doesn’t appreciate being irritated or compressed. It’ll let you know that it’s aggravated by causing pain and dysfunction in all of the areas it innervates.
In addition to “nervy pain” in the around your vulva and anus, symptoms of pudendal neuralgia most commonly include:
- Sympathalgia: A sensation of ”something” in your rectum or vagina
- Urinary frequency or pain when your bladder is full
- Pain during bowel movements
- Referred pain into the buttocks, pubic bone, inner thighs, and even the area of the sciatic nerve
- Pain with sex
Can pudendal nerve pain come and go?
Yep, it definitely can. Pudendal nerve pain may change as your body position changes: it can increase when pressure around the nerve increases, and decrease as that pressure goes down.
Researchers think this come-and-go pain pattern may be related to the complicated anatomy of the pudendal nerve. As it travels down to provide sensation and motor function to the pelvic floor area, the pudendal nerve twists, turns, and dives in and out of the pelvis. It passes between bones, muscles and ligaments, and it makes some pretty tight turns along the way. This “tortuous” path creates plenty of places where irritation and compression can occur.
As you change body positions, the tension on your muscles and joints also shifts. In some cases, this can increase the space around the pudendal nerve, reducing irritation and symptoms. In other situations, that space shrinks, increasing compression and pain. This may contribute to pudendal neuralgia’s intermittent pattern.
What causes pudendal neuralgia?
Any trigger that irritates or damages the pudendal nerve can cause pudendal neuralgia. Various activities or events can cause this type of irritation or damage, including:
- Chronic strain or compression of the pelvic floor, triggered by chronic constipation, repetitive squatting activities, and prolonged sitting on hard surfaces (think: long-distance cycling or horseback riding)
- Pelvic floor injury from a traumatic fall or vaginal childbirth
- Disorders of the structures surrounding the pudendal nerve. These can include pelvic tumors, bony abnormalities, and nerve anatomy abnormalities.
- Surgical or medical complications that damage the nerve. These can occur after pelvic surgery or pelvic radiation therapy.
- Complications from pelvic infections such as the herpes virus
How is pudendal neuralgia diagnosed?
The diagnosis of pudendal neuralgia usually happens through ‘clinical diagnosis’. Rather than relying on laboratory tests or imaging, a medical professional uses a person’s medical history and the signs and symptoms they report to diagnose the condition. This is because we still don’t have effective, accurate tests for pudendal nerve pain.
Pelvic pain specialists, urogynecologists, and pelvic floor physical therapists can all help to identify and treat pudendal nerve pain. Many clinicians use the Nantes Criteria to guide their diagnosis. These criteria include:
- Pain in the territory of the pudendal nerve (from the anus to the penis or clitoris)
- Pain predominantly present while sitting
- Pain that does not wake you at night
- Pain without measurable loss of sensation
- Pain that’s relieved by a diagnostic pudendal nerve block
If a pelvic floor physical therapist suspects pudendal neuralgia, they may assess the pudendal nerve during an intravaginal pelvic floor muscle exam. The pudendal nerve is fairly superficial in the pelvis, so your physical therapist can usually feel it during an internal exam.
Ordinarily, a few light taps on this nerve is pain-free. However, if the pudendal nerve is irritated or injured, tapping may reproduce your pain: this is called Tinel’s sign.
Can pelvic floor physical therapy help with pudendal nerve pain?
Pelvic floor therapy can be a powerful tool in your journey to recover from pudendal nerve pain. An Origin physical therapist can help you identify activity modifications and at-home techniques to find quick relief from pain. They’ll also help you determine and address the triggers that are driving your symptoms so the pain stays away.
If you have pudendal neuralgia or think you might have it, you deserve care with a clinician who understands your condition. Book your visit here and start your journey to pudendal neuralgia relief today.
Sources
Ahmed, Mohammed, et al. "The Diagnosis and Management of Pudendal Neuralgia." Pain and Therapy, vol. 15, no. 1, Feb. 2026, pp. 97–129, doi.org/10.1007/s40122-025-00803-w.
Labat, Jean-Jacques, et al. "Diagnostic Criteria for Pudendal Neuralgia by Pudendal Nerve Entrapment (Nantes Criteria)." Neurourology and Urodynamics, vol. 27, no. 4, 2008, pp. 306–310, pubmed.ncbi.nlm.nih.gov/17828787/.
Leslie, Stephen W., et al. "Pudendal Neuralgia." StatPearls, StatPearls Publishing, updated 12 Feb. 2024, www.ncbi.nlm.nih.gov/books/NBK562246/.
Örmeci, Burcu, et al. "A Novel Electrophysiological Method in the Diagnosis of Pudendal Neuropathy: Position-related Changes in Pudendal Sensory Evoked Potentials." Urology, vol. 99, Jan. 2017, pp. 288.E1–288.E7, www.goldjournal.net/article/S0090-4295(16)30690-2/abstract.
