Pudendal Nerve

The pudendal nerve is a major peripheral nerve in your pelvis. It sends movement and sensory signals to and from your genitals and the holes you use to pee and poop. You have two pudendal nerves — one on each side of your body.

All peripheral nerves are like cables that carry electrical impulses between your brain and the rest of your body. These impulses help you feel sensations and move your muscles.

What does it do?

The pudendal nerve is crucial for sensation and function in your pelvic region.

It controls the movement of your:

• Anal sphincter muscles, which help you hold in or release poop
• Urethral sphincter muscles, which help you hold in or release pee
• Penis (during erection and ejaculation)

It provides sensory information about touch, pleasure, pain and temperature in your:

• Penis and scrotum
• Clitoris, labia and vagina
• Anal canal and anus
• Perineum, which is the skin between your anus and your vagina or penis

Where is it located?

Your pudendal nerves are in your pelvis around your genitals. They arise from the sacral plexus, a network of nerves in the lowest part of your spine.

The pudendal nerve:

• Begins from the S2 through S4 sacral spinal nerve roots in the sacral plexus
• Runs through your pelvis near the top of your thighbone (femur) and sit bone
• Travels alongside the pudendal artery and vein into the pudendal canal, which is a narrow, tunnel-like opening in your pelvis
• Divides into smaller nerve branches

After entering the pudendal canal, your pudendal nerve branches into the:

• Inferior rectal nerve: This nerve controls your anal sphincter muscle and sends sensory information to your anal sphincter and anal canal.
• Perineal nerve: This nerve controls your pelvic floor muscles and your urethral sphincter. It provides sensory information to the perineum and the labia (the “lips” outside your vaginal opening) or scrotum (the sac that holds your testicles).
• Dorsal nerve: This nerve sends sensory information (touch, pleasure, pain) to the skin of your penis or clitoris. It allows for sexual pleasure and assists in erections.

What conditions and disorders affect the pudendal nerve?

Certain conditions and problems can cause a pudendal nerve injury.

Injury typically happens when there’s excess pressure on the nerve, causing a pinched nerve. Direct nerve damage or irritation can cause problems, too. Damage can lead to pudendal neuralgia, which causes long-term (chronic) pelvic pain.

Causes of pudendal nerve damage include:

• Tight pelvic floor muscles
• Difficult labor and delivery, or birth injury
• Prolonged pressure on the nerve from certain activities, like cycling
• Accidents and trauma
• Complications from pelvic surgeries, like a prostatectomy or a surgery to correct pelvic organ prolapse
• Diabetes (diabetes-related neuropathy)
• Radiation therapy
• Tumors or cysts

Signs and symptoms that something’s wrong

The biggest symptom of pudendal nerve damage is a burning pain. You may feel pain in your clitoris, labia, vagina, penis, scrotum, anus or rectum. It may hurt the most when you sit and get better when you stand or lie down.

Other symptoms include:

• Feeling a frequent or urgent need to pee
• Painful bowel movements
• Painful sex or pain after sex
• Trouble reaching orgasm or painful arousal
• Erectile dysfunction

What is the role of pudendal nerve blocks during childbirth?

Healthcare providers sometimes use pudendal nerve blocks to provide pain relief during childbirth.

Your provider may suggest the nerve block if you can’t have or don’t want an epidural (spinal anesthesia). You may also need it during repair of a vaginal tear or episiotomy.