Pudendal neuralgia is chronic pelvic pain caused by an irritated or damaged pudendal nerve. Your pudendal nerve runs from the back of your pelvis to all the muscles and skin in your genital area, including your anus, vagina and penis. Treatment options include medication, physical therapy, lifestyle changes or surgery.
Pudendal neuralgia (or pudendal nerve entrapment) is when you experience chronic pelvic pain from damage or irritation to your pudendal nerve. If you have pudendal neuralgia, this nerve is injured or compressed and causes stabbing, burning or shooting pain. The pain can be felt in your buttocks, perineum and genital region, and is more severe when sitting.
The pudendal nerve runs from the back of your pelvis to all the muscles and skin between your legs. Think of all the areas that touch the seat while riding a bike. That entire area may be affected by pudendal nerve damage. Your pudendal nerve controls movement and feeling in your genitals and anus. It also controls the sphincter muscles that help you pee and poop.
The pudendal nerve provides sensory information about touch, pleasure, pain and temperature to your:
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Pudendal neuralgia is rare, but anyone can get it. An estimated 30,000 to 200,000 people have pudendal neuralgia in the United States. It’s most common in adults older than 19.
The biggest symptom of pudendal neuralgia is pain. Any organs or muscles served by the pudendal nerve can be affected. You may feel pudendal nerve pain in your clitoris, labia, vagina, penis, scrotum, anus or rectum.
Some people describe the pain as:
Other symptoms include:
There are three branches of your pudendal nerve: a rectal branch, a perineal branch and a clitoral/penile branch. Your symptoms will vary depending on which branches and nerves are affected.
Pudendal neuralgia can occur when the pudendal nerve is damaged (by pressure or other irritation) or compressed, often by surrounding tissues or muscles. Some causes include:
Healthcare providers diagnose pudendal neuralgia with a physical exam and other tests. They’ll ask you to describe your symptoms and the location of your pain. Often, they’ll rule out other conditions that cause similar pain first.
Some of the tests providers use include:
Pudendal neuralgia and many other conditions have similar symptoms, such as pain and incontinence. Your provider may run tests or ask questions to rule out other issues. Some of these other conditions are:
Physical therapy, medication, lifestyle changes or surgery are possible treatments for pudendal neuralgia. Providers may combine treatments for quicker relief from symptoms.
A physical therapist can teach you exercises to relax or stretch the muscles causing your pudendal nerve pain. They may also recommend using a TENS (transcutaneous electrical nerve stimulation) machine to reduce nerve pain.
Certain things make pudendal nerve pain worse. Avoiding or modifying these activities can be beneficial. Some examples include:
Using a donut or U-shaped pillow when you sit. These pillows have a hole in the center and take pressure off your pelvic floor muscles and perineum. If you find yourself chronically constipated, try increasing your fiber intake or using a stool softener, so you’re able to poop without straining.
Some people find pain relief through medications like painkillers or steroids. Specific medications for pudendal neuralgia include:
Surgery is usually the last treatment option. Pudendal nerve decompression is a surgery that removes muscle or tissues away from your pudendal nerve. Surgeons make an incision in your gluteal muscles (buttocks) or perineal muscles to access your pudendal nerve. Pain relief from decompression surgery may take months or years and isn’t instantaneous relief.
Massage therapy isn’t one of the recognized treatments for pudendal neuralgia. Some healthcare providers recommend massaging the muscle tissue around your pudendal nerve to release tension and tightness. This can offer temporary relief to a compressed or trapped pudendal nerve.
It may be hard to reduce your risk of pudendal neuralgia if the cause is due to childbirth, trauma or surgery. However, certain activities can aggravate your pudendal nerve.
Some of the things you can do to help reduce your risk of pudendal nerve pain include:
No, there isn’t a cure. The goal of treatment is to minimize symptoms, but symptoms may never go away entirely.
Chronic nerve pain can interfere with your daily life. It affects your relationships, activities and general wellness. Seek help from a healthcare provider if you have pelvic pain or experience sexual dysfunction, incontinence or depressive thoughts. They can help you find relief for your pain and determine if your pudendal nerve is the cause.
Contact a healthcare provider if you have pain in your pelvic or genital region. When left untreated, your pain may intensify and limit your activities. Some symptoms you should watch for include:
A note from Cleveland Clinic
If you have chronic pelvic pain and a possible diagnosis of pudendal neuralgia, you’re not alone. While relatively rare, pudendal nerve pain can be debilitating and affect your lifestyle, relationships and daily activities. Discuss your symptoms with your healthcare provider. They can determine which type of treatment will be best based on the severity and location of your pain. Remember, pain relief is available and within your reach if you seek help from your provider.
Last reviewed by a Cleveland Clinic medical professional on 11/11/2022.
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