How do I know if I have Pudendal Neuralgia or Pudendal Nerve Entrapment?

In pudendal neuralgia by Stephanie Prendergast561 Comments


Part I in the “Demystifying Pudendal Neuralgia” Series

For so many the term “pudendal neuralgia” conveys a frightening and mysterious chronic pain diagnosis. And to be sure, at one time, receiving a diagnosis of pudendal neuralgia, or “PN” as it’s commonly called, was truly terrifying, especially considering that it was against the backdrop of a medical community that didn’t have answers and an online community rife with misinformation.

However, “pudendal neuralgia” literally means “shooting, stabbing pain along the distribution of the pudendal nerve.” So in reality, pudendal neuralgia is not a dark, mysterious diagnosis, it’s simply pain anywhere along the nerve that innervates the pelvic floor.

While progress has been made in the treatment of PN over the past decade, there continues to be a tremendous amount of confusion swirling around the diagnosis, not the least of which is the massive confusion surrounding the difference between the diagnosis of PN versus the diagnosis of PNE and what is the appropriate course of treatment for each.

In this post, I’m going to tackle those two points. But, that’s not the last you’ll hear about PN on this blog. It’s a topic I’ve spent my career embroiled in, and it’s one that I’m passionate about.

So this post marks the beginning of what will be a four-part series on PN. Further posts in the series will tackle PT as a treatment for PN, and a two-part interview with Drs. Mark Conway and Michael Hibner.

A Tortuous Course

Before I get into PN versus PNE, I want to first give you a brief explanation of the physiology of the pudendal nerve and the diagnosis of PN.

The pudendal nerve is a large nerve that arises from the S2, S3, and S4 nerve roots in the sacrum, and divides into three branches—the inferior rectal nerve, the perineal branch, and the dorsal clitoral/penile branch. The nerve travels a tortuous course through the pelvis to innervate:

• the majority of the pelvic floor muscles,
• the perineum,
• the perianal area,
• the distal third of the urethra
• part of the anal canal
• the skin of the vulva, the clitoris, portions of the labia in women,
• and the penis and scrotum in men.

The pudendal nerve travels a torturous course through the pelvis.

Patients with PN can have tingling, stabbing, and/or shooting pain anywhere in the territory of the nerve. Symptoms include vulvar or penile pain, perineal pain, anal pain, clitoral pain, and pain at the ischial tuberosities as well as pain with bowel movements, urination, and orgasm.

One of the things that make the pudendal nerve so unusual is that it doesn’t just have motor and sensory fibers like other nerves that exist outside of the brain and spinal cord, it also has autonomic fibers.

Here’s the significance of this unusual quality: Motor and sensory fibers innervate somatic structures, like muscles, giving us voluntary control over them. Whereas structures innervated by autonomic fibers are not under our voluntary control. The heart, lungs, and GI tract are examples of such structures.

So it’s thanks to the autonomic fibers of the pudendal nerve that our pelvic floor muscles always maintain a degree of tone, which enables us to remain continent. But we do have the ability to override the tone in our pelvic floor muscles and further contract or relax them when we wish. So, the pudendal nerve is only partially under autonomic control.

What is the relevance of this to our discussion of PN symptoms? Well, it’s because of these autonomic fibers that patients with PN can experience disturbing feelings of sympathetic upregulation when their pain spikes. Symptoms such as:

• an increase in heart rate,
• a decrease in the mobility of the large intestines,
• a constriction of blood vessels,
• pupil dilation,
• perspiration,
• a rise in blood pressure
• goosebumps, and
• sweating, agitation, and anxiety.

I’ve had many patients that have reported these symptoms. Many have told me that they thought they were going crazy or were having an anxiety attack at those times. So it’s important that patients are aware of this feature of the nerve. They’re not crazy! And with the proper treatment, these symptoms can be stopped.

The Pudendal Nerve in Men


In order to best understand the differences between PN and PNE, you need to have a sense of the history of both diagnoses.

I began working with pelvic pain patients in 2001. Back then, nearly every patient I saw had been suffering for at least five years, often longer, had seen an average of ten other providers, and was in tremendous pain. Across the board, these patients had been dismissed, misdiagnosed, and mistreated.

However, when I came into the pelvic pain picture, a shift was happening in the medical community. It was sinking in that pelvic pain was a valid health issue that needed to be addressed. “PN,” “vulvodynia,” and “IC” were all diagnoses that had individually made their way onto the scene, but collectively they were now being handed down to patients with more frequency. So, for instance, a patient who had been told her symptoms were “all in her head” was now given a diagnosis of “PN.”

What did it mean to be diagnosed with PN back then?

Because this was a patient demographic that had been mistreated for so long, for the majority of these patients, their pain had become ingrained in their nervous systems. So as a result, the treatments that were administered, such as nerve blocks, medication and PT were not successful because they were only aimed at the periphery of the patients’ pain, not the peripheral and central nervous systems. Plus, there wasn’t the same level of understanding of the myofascial musculoskeletal component of pelvic pain or the need for a multidisciplinary approach to treatment that there is today.

Then sometime around 2003, pudendal nerve entrapment or “PNE” became the diagnosis du jour. PNE was first mentioned in 1988, but became popular as a diagnosis around 2003, most likely because of chat rooms about the condition on the Internet.

PNE is most commonly defined as a physiological entrapment of the pudendal nerve that requires surgical release. While “PNE” can certainly cause PN, it’s far from the only cause. However, one of the symptoms of PNE at the time was “pain with sitting.” Therefore, anyone who had pain with sitting, all of a sudden had nerve entrapment. Plus, the terms “PN” and “PNE” were suddenly becoming used interchangeably. So too often, as soon as there was the inkling that the pudendal nerve was involved in a patient’s pain, he or she was told entrapment was the cause and three nerve blocks and decompression surgery was the answer.

Clearly, providers were systemically over diagnosing patients with PNE. Intentions were in the right place. Providers wanted to successfully diagnose and treat their patients, and patients, for their part, wanted to get better.

PNE had emerged in the literature as a diagnosis in the 1980s when almost nothing was known about myofascial pain and chronic pain syndromes in general. Surgeons and anesthesiologists in Europe were the first ones to take an interest in PNE, and as a result the treatment methods that were developed focused on nerve blocks and decompression surgery.

Electrophysiological testing also fell within the bailiwick of this particular group of physicians, so these are the testing methods that were used to determine PN/PNE. (Remember, for a period of time the two became muddled together.) So if PN/PNE was suspected, a pudendal nerve terminal motor latency test or a “PNTMLT”, which is a nerve conduction velocity test was administered to “verify” the diagnosis. Next, patients were given three nerve blocks and medication.

For its part, A PNTMLT is a test that measures nerve conduction velocity times. The test is administered by inserting a small needle into the ventral external anal sphincter (the portion innervated by the perineal branch of the pudendal nerve). The doctor than inserts a gloved finger with an electrode into the anus and delivers a charge to the perineal branch of the pudendal nerve at the ischial spine. The recording needle electrode captures the amount of time it takes for the signal to get from the ischial spine to the sphincter. If the time is “delayed” the test is considered to be positive. This test is incredibly painful and can cause a flare that can last for weeks. Plus, at the time of testing, the secondary muscle spasm associated with the pain of the test often makes its readings unattainable.

Historically, with or without the results of a PNTMLT, the next step to treating PN/PNE was to administer nerve blocks and medications. The nerve blocks were painful and provided about four hours of relief at best, and the medication either did not help or caused side effects that were worse than the pain itself.

When that protocol failed (and it almost always did for the above mentioned reasons), the next step on the treatment train was decompression surgery. Patients were told the longer they waited to get the surgery the worse their pain would become. To further complicate matters, for a time, the only surgeons who did the surgery were in France. So patients were traveling to France en masse to have the surgery done.

Fast forward to the present day. Today there’s been a great deal of progress made in our understanding of PN and PNE.

And one of the biggest discoveries is that there is no way to know whether a patient has pudendal nerve entrapment prior to operating. I’m going to say that again because I think it bears repeating: There is no way to determine whether or not someone has pudendal nerve entrapment prior to surgery.

And in fact, the only way to know with any certainty whether there was indeed an entrapment post-surgery is a post-operative finding of pain relief. This is according to research conducted by neurosurgeon, Prof. Roger Robert, and neurologist and urologist, Dr. J.J. Labat, the team of French surgeons that developed the initial surgical technique for the PNE decompression surgery.

No Way to Know

By 2008, several groups of leading PN experts conducted studies and discredited the electrophysiological tests as diagnostic tools of PN/PNE. (A great paper that summarizes the numerous studies that led to the invalidation of the tests is “What is the Place of ENMG Studies in the Diagnosis and Management of Pudendal Neuralgia Related to an Entrapment Syndrome?” by Lefaucher, J.P., Labat, J.J., Amerenco, G., et al.)

In early days when the medical community was working to make heads or tails of a PN/PNE diagnosis, it seemed logical to apply the testing to the diagnosis. After all, it was the protocol used in other parts of the body for neuralgia and entrapment. So why wouldn’t it work for the pudendal nerve? The reason is that pudendal neuralgia and PNE is a sensory problem – pain – and this test measures the speed of motor fibers. We can not correlate the nerve conduction speeds of pain.

There are surgeons who say they believe that they can see entrapment when they open the patient up, that they can see nerves that are grey and look frayed; however, there’s not that much correlation between the levels of pain the patient has, and the doctor’s visual. Plus, surgeons are not operating on asymptomatic individuals, so we don’t know if the asymptomatic population looks the same anatomically. Therefore, it’s a big assumption to say you can see entrapment when we don’t know what “normal” is.

Today PN patients are having MRIs done. (More details on this in the fourth post in this series.) For their part, MRIs can show that there is swelling around the nerve. However, issues other than entrapment, can cause swelling, so again, this is not a appropriate diagnostic test for PNE.

So although patients continue to have these tests done and even to rely on them for proof of entrapment and PN, the fact of the matter is that all the accepted thinking in the field, even by the surgeons who perform the decompression surgery, is that the tests do not confirm either entrapment or pudendal neuralgia.

The History is the Key

The most important factor in deciding whether or not a patient has a possible entrapment is the patient’s history. In fact, this is the thinking espoused by one of the country’s leading PN physicians, Dr. Michael Hibner.

For example, if a patient who had no pelvic pain, had pelvic reconstructive surgery, and woke up from the surgery with shooting, stabbing vaginal pain, then that is likely an entrapment that probably needs to be surgically released. However, if a patient has had seven yeast infections in a row, and develops vaginal burning, it’s not reasonable to conclude that a ligament is entrapping the nerve and causing those symptoms. Connective tissue dysfunction and hypertonic muscles are more likely the cause.

So before a patient, or a surgeon for that matter, goes forward with a nerve decompression surgery, they need to be sure that the patient’s history makes sense.

Some in the medical community, myself included, believe that there are only two hard and fast situations where a nerve will likely be entrapped. One is an anatomical deviation that the patient is born with, and the other is as a result of a problematic pelvic surgery, such as a hysterectomy or a pelvic reconstructive surgery to correct a cystocele, rectocele or prolapse. If a patient has a slow, insidious onset of pain that eventually becomes burning, then that’s probably not entrapment but rather myofascial pelvic pain that is affecting the pudendal nerve.

When PN Plays a Role 

By this point, I hope that I have made it clear that the diagnoses of PN and PNE are not interchangeable and that there are no tests that can show if the pudendal nerve is entrapped or that a patient even has PN.

So then how do you know if you have PN?

Today, a diagnosis of PN is a clinical diagnosis, which means the diagnosis is based on signs, symptoms and medical history of the patient rather than on laboratory examination or medical imaging. Generally, PN symptoms are said to include burning, stabbing and/or shooting pain anywhere in the territory of the nerve.

Plus, a provider can examine the patient’s pelvic floor internally via the rectum or the vagina and upon examination test the pudendal nerve by performing a technique called a “Tinel’s Sign. A Tinel’s Sign is a way to detect irritated nerves. It is performed by lightly tapping over the nerve to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve.

As you may have already realized, many of these symptoms overlap with symptoms of other pelvic floor problems. This can make it difficult to arrive at a definitive, iron-clad diagnosis of PN.

However, at the end of the day, as is the case with most pelvic pain syndromes, not being able to have a written-in-stone diagnosis isn’t a big loss because with pelvic pain, the diagnosis doesn’t dictate a treatment protocol. In fact, there is no standard, one-size-fits-all protocol for treating PN. Not to mention the fact that more often than not, there is going to be a combination of causes. So at the end of the day, if you think about it, “pudendal neuralgia” is more of a symptom than a diagnosis, anyway.

Remember, “pudendal neuralgia” means pain along the distribution of the pudendal nerve. So saying “I have pudendal neuralgia” is analogous to saying “I have burning or stabbing clitoral, vaginal, or penile pain.”

So when it comes to pudendal neuralgia, the most important course of action is to figure out the underlying causes, and then figure out what needs to be done to treat them.

PN Treatment Today

In wrapping up this post, after having spent so much time talking about what not to do when it comes to PN, I’d like to spend some time discussing the actions I do recommend for patients when pudendal neuralgia is suspected. Thankfully, today patients have more reasonable, comprehensive treatment options. The best course of action is for them to approach their treatment with a multidisciplinary team approach in mind.


An important player in on a multidisciplinary team to treat PN is a pelvic floor physical therapist.

At the end of the day, pudendal neuralgia is a myofascial pain syndrome that affects the nerve that innervates the pelvic floor musculature and viscera, so a PT who is expert at treating the pelvic floor should be able to address why that nerve is irritated.

However, many patients are afraid that PT will further irritate their pudendal nerve. Perhaps they’ve read on an online message board that this has happened to others with similar symptoms. Here’s the deal: PTs do not learn about treating the pelvic floor in PT school let alone how to palpate the pudendal nerve. So if a patient sees a PT that does not know their way around the pudendal nerve than yes, that PT could irritate their nerve. That’s why it’s important for the patient to do his or her homework and make sure the PT has proper level of expertise to treat them. The physical therapists at the Pelvic Health and Rehabilitation Center are specifically trained to help people recover from complex pelvic pain syndromes, including pudendal neuralgia. (Our next post will delve much more deeply into PT for PN.)


There are a handful of medications that are helpful for PN. One group is SNRIs, which are aimed at calming the central nervous system, such as Cymbalta. Other anticonvulsant drugs such as Lyrica, and Neurontin are also often top choices in this group.

Another group includes tricyclic antidepressants, such as amitriptyline, nortriptyline and desiprimine.

When working with meds, patients need to realize that they must get to the proper therapeutic dose for the proper length of time before they will experience a medication’s effectiveness. In addition, just because the medication doesn’t take away all of their pain, this doesn’t mean it is not having a therapeutic effect.

Nerve Blocks

In the past, I would have said that pudendal nerve blocks are not therapeutic. However, I believe the reason they did not work for my patients in the past is that the patients that were getting them early most likely had central sensitization due to the severity and the chronicity of their pain, and therefore any treatment directed at the periphery, whether a block, medication, or PT was not going to be as effective as it could be.

However, today, patients are getting diagnosed much earlier in the game; therefore, I believe all of the treatments aimed at the periphery, such as nerve blocks, are having higher success rates.

That said, nerve blocks should never be a patient’s only course of treatment. They are not going to be a silver bullet cure-all. Much of the time, the lasting effect on the patient’s pain is very minimal. If there is a long term effect, it will be that once the anesthetic wears off, the patient will have a little less sensitivity.

So bottom line: my advice is that if a patient has access to a physician in their community who has a reputation as being an expert at administering nerve blocks, and their insurance covers the block, then they should give it a try with the expectation that at best it may help and at worst it may cause a temporary flare. However, if the patient has to travel to another state and spend thousands of dollars to get it done, the possible benefit is not likely worth the travel and expense.

Botox for PN

Botox is very good for muscle hypertonis, which is associated with PN, so if a patient (typically with the direction of their PT), is suspicious that the obturator internus is a large part of their pain/nerve irritation, then Botox may make sense.

A good test run is to have the physician first inject lidocaine into the area to see if there is a positive effect. If some or all of the patient’s pain is reduced or eliminated during the first hour after the injection it may make sense to then inject Botox. One reason for this approach is that Botox is quite expensive, so it’s a good idea to make sure it’s going to be injected into an area that is relevant.

I mention the obturator specifically because that is a muscle that is commonly involved in PN because part of the Alcock’s Canal is made up of the aponeurosis of the obturator internus and so if there is compression in that canal, decreasing the hypertonis will take some of the pressure off of the nerve in the same way that decompression surgery would. So in fact, in such a situation where the nerve is compressed, either Botox or manual therapy can serve to free it up instead of surgery.

I hope this post has fulfilled my goal of shedding light on a few areas of the PN diagnosis that continue to cause confusion. It’s a complicated diagnosis that thankfully is beginning to make more sense, but there’s still a lot of work to do. Speaking of, stay tuned for the next post in our pudendal neuralgia series, which will focus on the

role of physical therapy in treating pudendal neuralgia . Be sure and subscribe to the blog if you haven’t already.  Our book, Pelvic Pain Explained is a resource manual that helps readers understand how pelvic pain develops, it helps navigate in-clinic and at-home treatment options for men and women. Please also check out our Pudendal Neuralgia Resource List, complete with videos, blogs, and podcasts.

In the meantime, if you have any questions or comments, please leave them in the box below. I look forward to hearing from you.


Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

All my best,


About Stephanie Prendergast: Stephanie is the co-founder of the Pelvic Health and Rehabilitation Center, president of the International Pelvic Pain Society, and an organizing member of The World Congress on Abdominal and Pelvic Pain. She has written extensively on the topic of pudendal neuralgia and teaches a course titled “Demystifying Pudendal Neuralgia: A Physical Therapist’s Approach” for physical therapists.


    1. Following a second fall on my tailbone I noticed that I was habing trouble tarting my urine storm and was not emptying my bladder . Soon after I got a urinary infection which left me with burning and a feling of rawness ,I think totje urethral area . After a cystoscopy in which everything was normal I started having pelvic heaviness but much worse pain on abdominal a
      Pation wit the rebound test . Gynecology visit for possible PI D showed nothing. Now I have spasms , pain to start the flow ( it is as if there is something tightening in there). Tail bone tenderness , burning when sitting , burning to the buttocks and higher , back and front of thighs , fingertips , toes , any where ,you name it . It is driving me crazy ,can you help . Tried a bunch of medication , Marion nassy

      1. Author

        Dear Marion,

        I would recommend that you go and see a knowledgable pelvic floor PT for an evaluation. Where do you live, perhaps we can recommend one to you in your area.

        All my best,

        1. I live in alpharetta Ga. I’m cuttong in on this conversation.I had a vavinal hysterectomy and extensive repairs. They couldn’t find left fallopian tube and ovary. I had a torn cuff. I still have pain and pin sticking pin in navel pain. Sitting hurts. Would you give me the name of a good gynocologist in cumming or Atlanta GA area. rosamaryadamauney@gmail

      2. What a brilliant read up lots of things I didn’t know about, I’ve suffered with chronic pain in my pelvic area since 1996 was told to live with it.

        1. Hi Mike- thank you for leaving a comment. Chronic pain may be common, but it is not something you have to live with forever. Have you seen a pelvic floor physical therapist to assess your pain and to create a treatment plan?

          1. Hello, very informative post. Since November/December i’ve been feeling this heat/fever after sitting down for a while or when laying down my buttocks and my groins/thighs/vulva gets really really hot even my body if i prolong the sitting. I have to stand up to get relief. My PCP says it’s due to my weight but i’m not so sure because this never happened to me before and it’s only in that area, just right after having a nee sex partner which is weird, maybe a coincidence (i got tested for stds and everything came back negative). I must say i’ve always had a sedentary job/lifestyle but even more after the pandemic since we couldn’t go out and all that. Anyways i hope you could help me . Thank you

          2. Hi Cynthia,
            Thank you for reaching out for help. Sit pain is no joke and can be hard to avoid when we have to sit for work. We are going to link you to a few resources. One is about seat cushions that can help alleviate some pain while sitting. Another is a blog about tailbone/sit pain. This blog is about sitting on painful fascia (which sounds like it could be close to what you are experiencing). If you continue to have pain in your pelvic region, we always recommend seeing a pelvic floor physical therapist who can assess your state of pelvic health and see if they can help you manage the pain/alleviate the problem it stems from!

    2. Thank you so much for writing such a awesome article, and for your great work helping out others in so much pain. It’s so important to have well-written, informative articles written about such a confusing, and horrifying condition. I wish this article existed in 2006.

      Are you going to write an article about when pudendal neuralgia turns out to be pudendal nerve entrapment, and conservative treatment options fail?

      I benefited so much from surgery in Belgium with Dr. Beco, and want others to know that with true PNE, it might be a necessary step to healing.

      Thank you again,

      Jonathan Scheuer

      1. Author

        Dear Jonathan,

        Thank you so much for your kind words! Yes, we are in the process of finishing up an article collaboration with two of the top PNE surgeons in the U.S. and will be publishing it after the Thanksgiving holiday. Thank you for your comment and please subscribe to the blog so that when the article is published you will be notified.

        All my best,

        1. You have no mention of Dr. Antalok. He did surgery on me . It was a failed surgery as so many of us have been through. I have resorted to the pain pump.
          Great article. I am now seeing a pelvic floor therapist,after 8 years and 3 decompression surgeries. We are so in despair .

    3. I know what caused my injury…it was a transvaginal mesh implant, which caused infection, fatigue, urine retention, lesions on my kidney, IBS, and knee buckling; thus falling, pain and spending time in bed afraid to leave my house.
      In addition, the mesh can not be removed.
      An analogy of my condition would look like this; hold a slinky, place a goose egg on top and walk with it. There is instability…it will fall forward, backward or to the side.
      I can’t take pain meds, because I can’t urinate for my pain doc. It has ruined my quality of life. I have a suicide plan, actually 2 in place…that I made after my surgery. No, I am not going to do it tonight or in the next couple of days. I am still praying God will heal me on earth and that I don’t have to take those measures. I am tired, alone, misunderstood, and am sure those that do know me think I am an attention seeker. I will not be in a wheelchair having my daughter take care of me. It is my choice. I am on life sustaining drugs already…to make me urinate, have bowl movements, control my thyroid and depression. Really???
      Nice to have a place to vent. Thanks

      1. It isn’t uncommon to have those thoughts. Some times I have a few or several bad days in a row, and it’s tempting to think I’m going to stay that way. Then I can get very down, and my quality of life seems really bad. I’m don’t know what your pain levels are and maybe some days it feels like too much. The last time I was so down, and then had better days I asked my husband to remind me (if I’m in a bad flare) that a good day or series of days relatively) could be right around the corner. I hope that helps.
        Also, I might feel like “my God this is too hard – I’m just existing.” Then I might start to think about what I have. Well, I have my sight, wow! I can hear, some people can’t. This is not life threatening, my gosh there are people that want to live so badly, and I am living. I also think about children with painful cancer with low chances of surviving, and the thought of children suffering makes me feel like I’m not so bad.
        Hope this helps.

      2. Dawn, God is with you every minute. I know how you feel, I have the same problems, but suicide and living with the devil that caused all our pain is not an option for me. I will continue to seek help on Earth and trust God that I and you find it. God Bless!!

      3. Please try other doctors as the mesh can be removed with the skillful doctors. I did not Give up. Courage mesh-sister !

    4. I had a hysterectomy in Oct 2013 and I did not wake up with any pain at all. I do get tingly weird sensations in the vagina area and sometimes the urethra burns and sometimes it does not. I get the tingly sensations off and on even when I am walking around or sitting sometimes. There are times when I feel mostly normal. I do notice it is not getting worse so I am not sure if this is PN or PNE or not. I can have sex and it does not hurt at all.I do notice that under my urethra where the vestibule is sometimes is tender, but not really pain. I did have an instance where my urethra or clitoris was throbbing, but it went away and have not had that since. I had a scope and that was normal. My doctors do not think it is nerves, they think it is my sling that is causing problems. I do not know. What do you think?

      1. Author

        Hello Sara,

        Unfortunately it is impossible to tell based on symptom description alone. It is a good idea to get evaluated by a pelvic floor physical therapist to determine if there are musculoskeletal causes for your symptoms. It also makes sense to consult with a surgeon about a surgical revision if your PT does not think she can help you. The two doctors in the US with the most experience with this are Mark Conway and Michael Hibner. Best of luck.



      2. Slings can cause pudendal Nerve damage so I would have a special MRI to determine if that is what you have. You mentioned your not in pain so I’m more apt to say it’s not pudendal Nerve damage/entrapment.

        1. Hello,
          My name is Sneha, 23years old and I am from India. I read your post, most of the terms was difficult for me to understand but I read all and at least I got an idea so Thank you so much.

          Now coming to my problem , which I am facing since a long time say 7-8 years. This pain is not constant and doesn’t happen every day say every twice or thrice a month for a little time.
          I get a strange kind of pain as stabbing pin or needle from inside in my naval. The pain starts with my naval and extends till my clitoris hood. This is very strange and unexplainable pain, it’s more like tingling and goose bumps givining and this pain stays for say 4-5 minutes and slowly fades away. During this pain I am not able to do movements or remain relaxed I just try to form a sleeping position and hang in there for few minutes because sitting is not possible. Along with this my clitoris remains aroused, tingling sensation, my legs just tighten . This chronic strange pin pain arises once in a blue moon and the pain stays for say 5-8mints max. And then slowly fades away. During this period peeingbis also a difficult task. I don’t know what to do where to go please please please help me. please help me. And I would like to add that I haven’t bhad any kind of surgery bor something, this pain is by birth.
          Thank you.

          1. We are so sorry to hear of your trouble. You may have pelvic floor and girdle muscle dysfunction as well as involvement of a few peripheral nerves (ilioinguinal, genitofemoral, and pudendal). We suggest undergoing an evaluation with a pelvic floor physical therapist and a pain management physician that can do selective nerve blocks and provide pharmacologic management.

    5. This is an excellent article and makes all of this less scary and treatable for anyone facing this…

      I have had pelvic floor issues and never knew the name of the nerve that may cause it–now I do. I was treated for an L5S1 disc herniation and pelvic floor issues with a specialty physical therapist who is wonderful with treatment and maintenance…

      Unfortunately, I recently had a number of gynecological issues–UTI, detergent allergy, yeast infections, BV, and developed pain in this area—one doctor mentioned pudendal nerve pain–but I don’t have any of the other symptoms–no pain with urination, sex, bowel movements, etc. Im back working with the speciality PT and hoping to improve….its been a rough 3 months.

      Thank you for such comprehensive information.

      1. Author

        Hello Shannon,

        Thank you for sharing your story! Best of luck in your treatment.



        1. Don’t let up on drs! Hold them accountable if they act like they have no idea of this! Drs in other countries had to bring it here. Very good article! There is a man from England that was doing trial in Nashville! ❤️?

      2. thank you so much for this well written article. I had major reconstructive prolapse surgery 4 months ago ,my surgeon was pleased with the outcome.but it has left me with constant pain in the areas described in your article.this has given me some encouragement as I was convincing myself that the surgery must have failed in some way.I will talk to my GP.and ask for help in this area.
        kind regards
        Margaret .

    6. Thank you so much for practical but detailed perspective. I am 12 weeks post op Nichols Sacrospinous Ligament Suspension for almost complete prolapse. (history of Vag Hyst. many years ago.. ) Large enterocoele was repaired. Was doing great at 8 weeks. Now have return of vaginal itching, rectal itching and IBS symptoms, which had completely cleared up.

    7. Stephanie
      I’ve suffered from male pelvic urgency which started wen I was 25 infection which was chlamydia, I’m now 31 it has ruined my life the infection got cured, however I was left with constant chronic urgency pain based in my urethra. I’ve had cystoscopy done no problems found. Seen urologist, had lots test, they say I got nerve damage, I’m now 31 I’ve started having anal sensations feeling wet it’s horrible. Can u please help me I’m begging for a better life I have kids, and I just wanna feel better I would be so grateful if u could help I’m based down in south west England in Devon many thanks

    8. For almost a year now, I’ve felt a dull aching pain that’s hard to describe in the perineal region closest to the anus but only when sitting with pressure on the area. I have to sit on one buttocks or the other to avoid pain. If I accidentally cause pressure on the area by sitting without noticing the dull pain, when I get up and release the pressure it causes an extreme sharp shooting pain. I have no pain when I’m standing, laying down, or on a toilet. I’m male, and I’m a student with little (almost no) money. What can I do in my situation?

      1. Hi Ryan,

        It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.


    9. Hi Stephanie. I broke pelvis 20 months ago in 3 places one being 1cm separation of my pubic symphysis. I am now left with, from reading your most informative blog, PN or PNE. I am at my wits end as it restricts movement even walking is a challenge and I have been v active until I came off my push bike. I am on low dose of lyrica 150mg/day. Sitting is a real problem, I jack my upper thigh when sitting and this helps greatly. I landed hard on bitumen on right hip, pain on right side right in groin area and neuralga at rear of scrotum. Exercises and Physio of sij help but this remains chronic with levels 1 to 4 pain out of 10. Don’t know what to do. Am lying in bed on a saturday afternoon in pain. Based in Brisbane Australia. Any thoughts welcome. Cheers rob.

      1. Author Stephanie Prendergast says:

        Hi Rob,

        An interdisciplinary treatment plan that includes pelvic floor physical therapy should help you week by week. It will likely take time but your providers should be able to explain what objective impairments are changing, which are persisting, and help you come up with a plan to treat them.

    10. Hi my name is Rogelio and about 7 yrs. Ago I had an accident where I slipped and straddled a fence and the fence spikes poked my perineal with time not taking care of this I’ve been having pudendal symptoms. I live in las vegas and would like to know if there is any doctor’s that you can recommend me go see.

    11. Hi I live in Las Vegas NV . I had a accident were I was helping my father passing some boards to him. My foot slipped and landed on fence. The spikes pricked me. I was ok for a while but recently I’ve had all symptoms. Please help ! My email is [email protected]

    12. My husband has been diagnosed with demyelinating disease that ranged from calling it ADEM to now MS.
      About the same time 6 years ago he experienced a complete closing off of his urethra due to enlarged prostate. He had started complaining about pain in his penis sometime prior to that but I can’t remember when. After a TURP procedure he continued to complain of a nervy pain in his penis. Jump ahead 4 years and he still has it and states that at times it is bad. He is often squeezing it as he says pressure helps.
      To muddy the waters more is the fact that he has neuropathic pain across his chest and back that has been assumed to be from the lesions on his brain. Recently it has been discovered he at some point had a fracture at T12. No way of telling when that happened . He also has had a couple of bad falls early on one of which he fell hard on his rear end.
      No one, including his urologist, is really addressing it, just putting it down to the brain issue. Recently though a PA for a neurosurgeon office stated she didn’t think it could be related and is a separate issue.
      Any thoughts?

      1. It sounds like he may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate him in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

    13. Hi. So many doctors I have been to cannot find out what is wrong. I have been told pudundel neuropathy by one, and she wants me to try a nerve block. I also was told by a pelvic floor specialist that I am having spasms. My vagina is sooooo red and stinging on one side all day. When i pee, the redness and pain get worse throughout the day. Are these symptoms of the pudundel nerve?? Please give me any advice you have. Thank you, leah

      1. It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

    14. Thank-you!!!! Very informative, seems to explain the pain I’ve been experiencing for the last 4 or 5 years. I intend to discuss with my doctor asap.


    15. I have been diagnosed with PN and PNE by Dr. Alan Gordon in Toronto and Dr. Michael Hibner, Phoenix, AZ. I have it bilaterally and received decompression surery 2017 by Dr. Michael Hibner. I was told for the first 7 years with this unbearable pain that it was in my head by numerous Dr’s who felt psychiatry was the avenue to take Even after my surgery, which they found my pudendal nerve was wrapped in varicose veins and scar tissue to the point it caused a indentation of the nerve, my Family Dr. still did not believe and told me fresh air in the country would help. I was misdiagnosed many times and abused by the medical world until I met the above mentioned Doctors. Problem now, in order to continue to help me with this disease, I need a Dr. In Ontario that will re-refer me to Dr. Michael Hibner and Dr. Gordon is no longer practicing. When I am at mty worst pain wise, I can find no Doctor in Canada that will listen, read up on this problem and treat me, so I suffer in silence like many here. Ontario is only Province that makes us re-apply for assistance to Government so I can continue to receive treatment by Dr. Hibner and no other Dr. can help me here. It is very frustrating that many of us have to suffer in silence,. What is not said here yet is we as females due to the pain can no longer have intercourse, orgasms or get excited by our partners without increasing the pain, therefore, causing many divorces, reduced activity of any kind, pee without burning, have a bowel movement without feeling glass is passing, pelvic pain, stand for long periods, sit down, hold onto a job, walk distances, which causes some depression. It is difficult to receive any help at a hospital as in Canada our Doctors are not familiar with pelvic pain diseases, let alone PN or PNE. It has gotten worse since the opioid crisis as we were all reduced significantly or all together with our pain medication. Our quality of life has been depleted and we are made to feel that we are crazy by the same medical world that took an oath to cause no harm. We do not do the research or send any of our Doctors to France to study with Dr. Robert like the USA has.
      Since Wasser Pain Management Clinic at Mount Sinai Hospital, Toronto was closed and pain medicines removed, we have been left with no avenue for help. Many people commit suicide due to the constant pain you are in and when trying to create support group, was told talk therapy does not work. We are once again suffering in silence. We need help in Canada. Thank you for writing this article an$ I can only hope that more medical Dr’s read it. But with this, to all those that have Chronic pain, try to create those special moments with friends and family and hold onto hope to get through your days.

    16. I have been diagnosed with PN and PNE by Dr. Alan Gordon in Toronto and Dr. Michael Hibner, Phoenix, AZ. I have it bilaterally and received decompression surgery 2017 by Dr. Michael Hibner, which has reduced my pain somewhat. I was told for the first 7 years with this unbearable pain that it was in my head by numerous Dr’s who felt psychiatry was the avenue to take Even after my surgery, when they found my pudendal nerve was indeed trapped by varicose veins, scar tissue to the point the nerve was found to be indented, my Family Dr. still did not believe I was sick. My Family Doctor suggested when moving, that the fresh air of the country would help. I was misdiagnosed many times and abused by the medical world until I met the above mentioned Doctors. Problem now, in order to continue to receive help from Dr. Hibner, I require I a Dr. In Ontario to re-refer me and fill in forms for the Ontario Government as Dr. A. Gordon is no longer practicing. When I am at my worst pain, I cannot find a hospital that is familiar with PN, PNE or will listen, read up on or treat., so I continue to suffer in silence, like many others. Ontario is only Province that makes us re-apply for assistance to Government so I can continue to receive treatment by Dr. Hibner and have no other options. . What is not said yet in this article is as a female I (due to the pain) we can no longer have intercourse, orgasms or get excited by our partners without increasing the pain, therefore, causing many divorces. Our ability to be physically active as I once was has been depleted, therefore friendships are strained. Simple things like urinating has become a constant burn, bowel movements feel like glass is being passed through, pelvic pain has increased which affects our ability to stand longer than half hour, sit down, hold onto a job, walk distances without increasing pain tremendously, therefore depression. You are sent for physical therapy, in which a therapist enters your vagina, rectum with their fingers to calm down the muscles that press on this nerve. It is difficult to receive any help at a hospital as in my experience in Ontario the Doctors are not familiar with PN or PNE as they have told me, therefore no form of treatment.. It has gotten worse since the opioid crisis as we were reduced significantly or all together with our pain medication.. Our quality of life has been depleted and we are made to feel that we are crazy by the same medical world that took an oath to cause no harm. Canada is not researching or sending any of our Doctors to France to study with Dr. Robert like the USA has.
      Since Wasser Pain Management Clinic at Mount Sinai Hospital, Toronto was closed and pain medicines removed, we have been left with no avenue for help. Many people commit suicide due to the constant pain you are in and when trying to create support group, was told talk therapy does not work. We are once again suffering in silence. We need help in Canada. Thank you for writing this article and I can only hope that more medical Dr’s read it. But with this, said, to all those that have Chronic pain, try to create those special moments with friends and family to get through your days. as it does help. Hold onto hope that other Dr’s like Dr. Michael Hibner will take an interest and continue the research to find a cure for us. I highly recommend Dr. Michael Hibner, he has been my light at the end of the tunnel with his professionalism, kindness and understanding.

    17. My pain is confusing in that sometimes it starts with my toe sticking up and the pain travels all the way up to my groin. It is undescribable pain so bad I want to die. I can’t move up or down I just hang onto a chair or counter. I need to force myself to move which makes it worse but then it does start to subside. Sometimes the pain starts in my groin and then travels down the inner leg to the toe which curl up and the pain sometimes travels to the other side of my groin. Some real scary times is when I feel it travel from my toe up toy groin and then almost toy heart. It is very frightening. I sweat from the shear pain. It seems to be affected when I eat too many sweets
      I don’t know, except that I live in fear of the next cramp/spasms.

    18. Loved this article. I have been in debilitating pain for a full 2 years now. I’ve had every test possible to man at this point. I’m going through a series of 6 nerve blocks for my pudendal nerve. Yesterday, my Dr said that after my 4th block in 4 weeks with no results, we should look at releasing the nerve. Goodness, this is scary stuff. I’ve had 3 back surgeries in the past 6 years. 8 weeks after my last surgery is when all the pudendal nerve pain started. Was this a coincidence?
      Think not!

      1. Rita, you are correct in that the pains can be correlated. People with low back pain often have pelvic floor and girdle dysfunction as well and this can bring the pudendal nerve into the picture. Unfortunately pudendal nerve blocks alone are not typically sufficient for pain relief. Pelvic floor physical therapy and medical management together tend to be the most successful for patients, the treatment plans need to be coordinated and individualized. Surgical decompression of the pudendal nerve is not necessary in the majority of cases, it is more necessary when the neuralgia is directly stemming from another procedure, such as pelvic floor reconstruction or trauma from things such as childbirth.

  1. Thank you so much for this important article Stephanie. Excellent!

    I have heard and read that a fall onto the buttocks or muscle strain/rupture from say weight lifting can also cause actual entrapment too. Would you say that this would only be if an anatomical variation was existing?
    I know that you work primarily with the pelvic floor but my PN/PNE is at piriformis level and from a fall and subsequent haematoma (egg shaped lump for at least 4 months)in that muscle. I have various symptoms including PN. I can identify some of the ‘tortuous route’ of that nerve from some of my pain, which runs in the exact same lines. I also have scaitic, PCFN and inferior/mid cluneal nerve involvement too. My sciatic nerve does seem to travel though the muscle but the rest are probably caught up in scar tissue from the haematoma which does make sense given my symptoms.
    Do you find patients who may be actually entrapped due to falls or other ‘trauma’ onset apart from post op?
    Thanks Helen.

    1. Author

      Dear Helen,

      I am sorry to hear of your trouble! Your question is a good one. A fall can lead to SIJD and muscle hypertonus. These impairments, if they persist, can in turn lead to nerve irritation and compression. The fall itself rarely directly causes nerve irritation. The solution, in theory, is simple: normalize the joint and eliminate hypertonic muscles to take pressure off the nerve. Unfortunately, as I am sure you know, this is easier said than done. If the fall caused an unresolvable SI issue it is possible that it indirectly caused an entrapment. All treatments, via PT, injections, or surgery, should be directed at the impairments causing the symptoms. This can be the hard part to figure out, but it is possible with thorough evaluations to make the differential diagnosis.

      All my best,

  2. Awesome! Thanks so much for shedding light on this difficult diagnosis. I’ll be sharing this link on some forums and I look forward to the rest of the series.

    1. Gayle, saw your post on Facebook forum. Thanks to the staff here,
      I got the name of a PT in St Paul, Mn.

      1. Hello! I would love to get the name of a PT in St. Paul, MN. I have had six laparoscopies, which then caused Pelvic Floor Tension Myalgia. I went to the Mayo in Rochester, where they so kindly diagnosed me; but driving the hour+ there and back defeated any physical therapy.


        PS – Love this blog! Thanks Stephanie!

        1. Author

          Dear AMS,

          The PT we refer to in your area is:

          Stidham Beth PT St. Paul MN (651) 999-2734 [email protected] Metro Urology

          All my best, and thank you for the kind words!

  3. This is much needed information! Looking forward to more in your series. Thanks Stephanie.

  4. Thank you very much for such an informative and helpful article. I am only sad that no doctors or physiotherapists in the NHS, here in the UK have such joined up multidisciplinary thinking. However, my pain is not a stabbing or shooting pain, but more a burning and sometimes slow piercing pain. Would that still come under pudendal neuralgia as the pain is in the region of the pudendal nerve?

    Secondly, a technical issue. The diagrams you have included in this post, are too small. Is there any way you could make them bigger? The second diagram one can click on, but it does not enlarge when you do so and the first one cannot be clicked on at all.

    Thank you.

    1. Author

      Dear Reader,

      Yes, burning and piercing qualify as neuralgia. I encourage you to talk to your providers about speaking to one another. It is absolutely mandatory that the people treating you work with each other. Liz and I have made interdisciplinary communication a mandatory part of the PHRC practice. Our therapists communicate with the patient and the patient’s providers. As PTs, we get to spend more time with our patients than other disciplines are able to and therefore can act as an intermediary. Hopefully your PT sees the importance of this and can help facilitate a comprehensive treatment plan.

      All my best,

  5. Great article! One question: It was unclear to me what the relationship is of the autonomic fibers in the PN and the upregulation of other autonomic symptoms (you indicate that they are result of a spike in pain). But which comes first–the pain or more generalized autonomic aggravation. Any clarification of the interrelationship would be very appreciated!!!

    1. Author

      Dear Marion,

      Great question. It is not really a ‘chicken or egg’ conversation, rather, they occur together. Sometimes pain can lead to autonomic symptoms, in other cases the autonomic symptoms can lead to pain. It is truly remarkable that any activity that can cause the nerve to get irritated can cause sensory symptoms (pain) and autonomic symptoms (anxiety, sweating, shortness of breath, etc). I often wonder who made this set-up…..we need company-wide re-org of the pelvis!

      All my best,

  6. I just sent this to my doctor. He is trying to help, but doesn’t know much about PN. This helps tremendously. How to I sign up for your blog?

    1. Author

      Hi Mickey,

      I’m so glad you found the post helpful. Please go to our homepage at, and scroll down to where it says “Subscribe to Blog”, (which is under my photo) then enter your email address and submit. That way you will get posts sent to your email immediately after they are posted online.

      All my best,

  7. Thanks for the very good post. It’s particularly interesting about the autonomatic nerve feature of the pudendal nerve. It explains a lot of my anxiety, I believe. When you state that there are good treatments for these symptoms, what do you have in mind? I hate taking benzodiazepines but so far they are the only options my doctor is has given me. Do you mean meditation, and the like?

    Thanks again. Looking forward to the whole series!

    1. Author

      Dear Isabel,

      It is important to treat the anxiety, like you are doing, but also to treat the cause of it, which are the musculoskeletal issues that are compressing the nerve. As the pressure comes off the nerve the pain (sensory) and anxiety (autonomic) should decrease. In the meantime, pharamceuticals, nervous system quieting, meditation, etc can all be useful.

      All my best,

  8. Love the article. You mention entrapment can happen due to a hysterectomy but my surgeon states he was not near the nerve. I never woke up in pain but I did have feelings of things falling out. What are your thoughts?

    1. Author

      Dear Karen,

      Pudendal Neuralgia is associated with pain in the territory of the nerve. If you do not have pain the problem is likely not the pudendal nerve. Feelings of things ‘falling out’ can be associated with Pelvic Organ Prolapse of the lower GI, bladder, and bowel. Pelvic floor dysfunction may also be a cause. You would benefit from an evaluation from a pelvic floor physical therapist who can shed more light on the situation.

      All my best,

  9. Great article and I will be reading all your posts. I was diagnosed with PNE and the first person who gave me a diagnosis was a regular P.T. who referred me to a pelvic floor P.T. I just cried and cried when she told me I was not crazy as some drs had told me and after the first treatment I wet the bed! I am now on muscle relaxing meds; minimized exercise routine and doing stretches.

    I have had 5 steroid injections and they have helped. My dr. called me and told me I need to be thinking of PNE Decompression surgery soon since I did not respond like he was hoping.

    He said diagnosis is easy – he uses a big safety pin!

    I will be reading your posts as you make it easy to understand what all this means. You are great!

    1. Author

      Dear Shirley,

      Thank you for your kind words!

      Now for your questions: The diagnosis of PN is easy, the diagnosis of PNE is not. I am glad the injections help, however, they are never “curative”, but rarther, a management tool. I urge you not to think you have entrapment because the blocks did not “last longer” or “cure you”. If your symptoms are persisting it is likely NOT due to entrapment and more likely due to unresolved impairments – trigger points, connective tissue issues, joint dysfunction, etc. Treatment should be directed at the impairments and as they resolve you will improve. It is never a bad idea to seek a second opinion from another pelvic floor PT. Many patients do not find a pelvic floor PT who is the perfect fit on the first try. I believe the upcoming article about PT for PN will help you decide whether the PT you are seeing is the right one for you.

      All my best,

  10. Thank you so much. I had rectocele surgery and a transurethral(?) sling. I have been in constant pain since. Down to point of just coming from what feels like somewhere above the urethra, but cannot sit, bend, or stand for too long. Can I assume this is PN? Do you know where I can go for help? Buffalo, NY area. The “best” uro-gyn here has never seen this.

    1. Have you seen Dr. Howard, the head of the pelvic pain clinic in Rochester, only an hour away from you? He does know about PN and may be able to help (though he didn’t help me!).

    2. Author

      Dear Josephine,

      I’m so sorry to hear about the trouble you are having. It could possibly be associated with the PN, however, it is also possible that it is associated with the sling. You are right to seek another opinion. I recommend Fred Howard’s practice at the University of Rochester. Fred is semi-retired, however, he has excellent associates if you are not able to see him directly. If you are willing to travel further you may also want to consider consulting with Mark Conway in New Hampshire. Hang in there, they should be able to help you.

      All my best,

      1. Stephanie,
        I am a 38 yr old woman. I had a Hemorrhoidectomy do win 05. The pain started after that. Nonstop. I’ve been to all kinds of Drs. My rectal surgeon told me there was nothing that could be done but meds, ice pack and a nerve block. My pain management dr said nerve block was to risky because losing control of bowels. My med I’m taking now is Nucynta. It worked great for a few years but now not much at all. I’m so depressed. All I can do is lay in bed on an ice pack. My family suffers. My husband does everything. I want to be able to do things with my 10 yr old son. Can you help me? How do I find out if it is a nerve problem? I’m desperate. I just need a dr to help me and no one cares.

  11. Great write up. As a male physician who suffers from CPPS ( pretty much under control now), I suffered from pudendal neuralgia last year, when I was at my absolute worst. I am uncertain whether this was secondary to the tremendous pelvic muscle spasm and tension that I was having at the time,or from the internal PT as we were working on my worst and recalcitrant trigger point way back on the left, coccygeus and piriformis. While some of the symptoms of pudental neuralgia were novelties, the intimate pain was unbelievable and I now know what patients mean when they describe pain as exquisite. Your article was the first to describe the autonomic dysfunction associated with this. I had major sweats, at first only in the pelvis and would wake up in the morning soaked and wet, thinking I had wet myself in the night, and then generalized body sweats. Thanks for clarifying this. Pelvic pain is still a no man’s land for many physicians. They don’t know what to do for you and even though I’m a busy working physician, I went from being the guy who avoided doctors for myself as much as possible to the kind of patients who doctors avoid. It was because of all the information I could glean from sources such as yours, that I was able to seek and design appropriate therapy for myself. My thoughts and prayers go with all your patients.

    1. Author

      Thank you so much for your comments Dave. I know it will help other readers!

      All my best to you,

  12. I found the idea of botoxing the obturator internus interesting, sounds like it may help me. My obturator internus, among others is very painful. My doctor, after performing the trans perineal surgery on me and seeing that it failed to relieve my symptoms, is thinking I may need pudendal decompression surgery (trans gluteal) left side. I have been in pt for more than 2 years. Also, back in 2011, I took a fall down steps, resulting in severe low back pain, l4andl5 disc bulge and now sacral torsion and pelvic instability. Pain with sitting, before the fall was mostly in the perineal area, sometimes radiating to my piriformis. Now, sitting is even more unbearable, as I have the additional low back and hip pain left sided. My question is really, who would be the best to go to to get the obturator internus botoxed? I live in MD. And can it really help me avoid surgery?

    Thanks so much,

    P.s. I have been to Dr. Marvel, as well as Dr. Echenberg in PA and am now trying Dr. David Gordon, neuro urologist (Baltimore, MD).

    1. Kara,

      I had the trans gluteal decompression surgery you are talking about. The surgery was done at St. Josephs hospital in Scottsdale AZ with Dr. Hibner. It helped my nerve pain about 30%. However it left me with terrible skin sensitivity which makes it very painful to sit and wear clothing. I now wear lidocaine patches on the place on my buttock where he did his surgery. It is also by far the MOST painful and long recouping surgery I have ever had (iv had many). I’m glad I had the surgery because I am not able to function better than I I’d but in no way is it a cure all and you definitely get a different set of problems with the decompression surgery. Dr. Hibner could not have been more professional, sympathetic and skilled. He was and still is my life saver.

  13. Thank you So much for such a great article!!!! Botox was a horrible disaster for me and I know of others that have also suffered tremendously from having botox injected to their pelvic floor. Doctors and PT’s need to be made aware of this. Botox can lead to further damage and to increased pain.

    1. Author

      Dear Atara,

      Thank-you for your comments. It is important to remember that all interventions do come with associated risks and therefore the decision of how and what to do needs to be made carefully. I know everyone reading this post is struggling with these decisions daily, I want to acknowledge that I do realize this can be easier said than done. The effects of Botox on the neuromuscular junction last about 3 months. Therefore, if a patient experiences an adverse reaction from the injection it is usually temporary and does not cause lasting damage.

      All my best,

  14. Could you please explain the sudden and painful spasm of the pelvic floor muscles that sometimes occurs? Is that contraction due to an autonomic response?


    1. Author

      Dear Marion,

      That symptom can be due to numerous causes. The central nervous system, an irritated peripheral nerve, an inflammed joint or a myofascial trigger point can evoke pelvic floor muscle spasms.

      All my best,

  15. Thank you very much for this article!!

    Can you explain me what’s SIJD? I fell on my coccys, followed by bursitis in the tailbone.

  16. Dear Stephanie

    I have a very complex problem which started after my first childbirth which was prolonged and obstructed. I had a late epidural and episiotomy. My symptoms started with bladder discomfort and frequency and progressed to severe birning pain in bladder with bladder filling, distal urethra causing post urination burning and burning during urination. This has progressed to intemittent rectal shocks and pain in sit area and perimeum. I have sensory urgency, stress incontinence and reduced urine flow rate and reduced bladder pressure. I have had a release of pudendal nerve above alcocks which has reduced frequency. I am wondering whether I the perineal branch of the pudendal nerve is affected possibly from episoitomy or prolonged labour. Would this cause my symptoms? Would a Hollis Potter scan in New York confirm diagnosis?



    1. Author

      Dear Reo,

      It is possible that there is nerve involvement at the perineal branch. However, pelvic floor muscle issues can also create these symptoms. It is possible that there may be true nerve damage in cases of traumatic deliveries, in which case, multidisicplinary management is key and you likely do not need further surgery around the pudendal nerve. We do not yet have controlled, randomized clinical trials that demonstrate MRIs can confirm or rule out true entrapment, which is different than nerve damage. The MRI will likely not result in a more effective treatment plan, therefore, I would suggest using your resources on a team that would ideally consist of a urogynecologist, a pain management specialist, and a pelvic floor physical therapist. You are welcome to email me offline if you need referrals.

      All my best,

  17. Stephanie,
    I am in therapy now, going on 6 mos., dealing with most likely a PN issue of some sort. My question is, what is the difference between central sensitization pain and myofascial pain? In addition to pelvic, abdominal, and ischial area burning (which are all on and off), I also get intense, super painful burning sensations down my legs. This is mostly around the knees, inner thighs, and sometimes calves, bilaterally. This too can come and go. Sometimes it’s just a prickle sensation. Different health professionals have told me different explanations, is there a way to tell? I can’t wait to read your other blog articles on PN/PNE.

    A huge, heartfelt thank you to you and your staff for writing about this subject.


    1. Author

      Dear Debbie,

      This is a fantastic question. We have increasing evidence that central sensitization plays a large role in chronic pelvic pain states. We also know that myofascial impaiments are highly associated with pelvic pain. Most patients likely have a combination of both issues occurring if they have been in pain for a long time. Generally speaking, myofascial pain is usually specific and often time manipulation or palpation of an involved structure can reproduce symptoms. For example, if your burning was partially or completely caused by an inflamed nerve I should be able to palpate that nerve and reproduce that symptom. Pain that is more central in origin tends to be diffuse and bilateral. People with central sensitization also tend to have severe pain reactions to non-harmful stimuli. For example, if a patient sits for 15 minutes and then has severe pain causing him to lie down for three hours there is likely a central component. I need to caution our readers that these guidelines are generalized examples to help you get the picture. We use more specific guidelines, questionnaires, and criteria. Myofascial pain and central pain are both young fields. There is still a lot we do not know and I do not think the two are as separate as we would like them to be. We will be posting a blog about central sensitization soon, so stay tuned!

      All my best,

  18. If the only way to tell if someone has PNE is for them to have surgery which successfully stops their pelvic pain, does this mean that surgery is of no use to those who have PN rather than PNE?

    1. Author

      Dear Alan,

      Yes, that is correct. Surgery is not a viable option for PN.

      All my best,

  19. Hi Stephanie

    Really good article has answered some things I was unclear of. My pain began with intercourse with a new partner. Four days afterwards I developed vaginal burning and a raw feeling. I initially thought I had a std but was tested several times all clear. This cleared with antibiotics and was fine for 6 months until the same happened again with the same partner. This again cleared with antibiotics and was fine again no pain with sex. Two months later the same happened again 3 days after intercourse intense vaginal burning. This pain has stayed with me now constant for 8 months. The burning has eased but I have a stabbing deep inside my vaginal with electric shock feelings. My pain has always been right sided and at the beginning of the attacks urine infections have been present. I have seen many specialists a pain consultant thinks I have one from constipation and I should have surgery whereas the 4 physiotherapists I’ve seen think it’s because of my skeleton as I have a misalignment of my pelvis, sacrosanct illiac joint dysfunction and inward rotating hip on my right side. I also have numerous trigger points down my right side. What are your thoughts? I’m in despair with this I have lost everything job house and relationship.

    1. Author

      Dear Kate,

      I’m so sorry to hear of all the issues you are having.

      You mentioned that on two occasions your symptoms cleared with antibiotics. I am going to assume that because you were on antibiotics you actually had a culture-proven infection. Symptoms of PN and pelvic pain can mimic infections so it is always important to actually get tested to make sure you take medications when infected. It is not uncommon for the symptoms you describe to be caused by musculoskeletal issues, as your PTs mentioned. Treating your numerous trigger points and joint issues should decrease your symptoms. You did not mention any bowel symptoms so I am unsure why a surgery is being suggested. I would advise any patient with pain to proceed with caution with any surgical procedure, you want to make sure it is absolutely necessary.

      All my best,

  20. Wonderful, wonderful article.
    Can you recommend a pelvic floor therapist in the Milwaukee or Madison Wis. area? (For a woman) Keep educating …thanks.

    1. Author

      Dear DSW,

      Thank you for the kind words.

      Here is a list of PTs that we refer to in Wis.: Colleen Walz: 608 775 1851, Beth Bartelsen: 262641 5771, Linda LaBorde: 414 302 0770, Sherese Hildenbranch or Debbie Callif: 262 240 1202.

      All my best,

      1. Thank you for all of your knowledge and information. I am having pain in my pelvic, I also go into anxiety, I get confused, I have a high superior labrum tear and a impingement and a partially torn illiopsoas muscle, I went to OBGYN to ask if he would help orthopedic I find so both could work together on me with my rehab, he thinks the pelvic is misunderstood and he performs gloved fingers going inside the vaginas pressing in all different areas, some areas hurt terribly, other areas not as much, he diagnosed me with pudendal neuralgia after he had performed a internal and external ultrasound. My groin hurts bad. It is in the area of the upper area though the worst around the bony pubic, if he does go internal I do hurt, sometimes I get numb in that area, this started on the right and then went to the left, it hurt so bad I could barely walk just lay down and ice area, and still limited relief, my chiropractor told me my inguinal ligament was out and I needed to see a orthopedic. And get surgery, i told my OBGYN all of this he wanted to do a pudendal block. I got concerned that this pudendal block would maybe block what a ortho might need to figure all of what is going on, daily I have pain, it is in my back, my stomach, my hips, my groin and travels in pain, i may get constipated. I’m on opiates, neuron ton, and muscle relaxers, I didn’t show for procedure I had a rough night. Was confused , had dysentery that morning. Does any of this make sense to you , i hurt when I urinate have a bowel movement,I feel pain in my abdomen, like a bloating feeling .it hurts when I sit, I haven’t had put for pelvis floor dysfunction for years, because they found that I had tears in my high superior labrum, and a hp impingement and a partially torn illiopsoas muscle. The OBGYN wants to do a pudendal block first, before the hip gets worked on, I am diagnosed with fibromyalgia, traumatic brain injury, neck injury, lumbar spine injury, maybe thoracic, I have pain in my legs, my feet, numbness, tingling as well in NY arms, hands, corartid artery disease was found, i do not know where to start I live in scottsdale arizona, and also have family in Niles, Michigan, and elderly parents in Venice Florida, I live alone and daily now after 8 yrs of suffering from being knocked on top of the head by a bread carrier with product on many shelves I was bringing down a ramp on a double semi wheels locked up and fell on top if my head knocking me unconscious and somehow got me off of the top of the semi and I must have landed on the front rete floor if the receiving room. So can you help advise NE where to start. I’m scared. Please. Thank you

        1. I think I have PN. I have more pain in penis with sitting and more pain with jeans on. Why do you think I get more pain in penis with sitting? And how long will it take for the myeline to repair?

          1. Hello,
            Sitting can compress the pudendal nerve and therefore cause pain in this position that may not be present when standing. If a nerve is truly ‘damaged’ they can regenerate at a rate of roughly 1mm/month. In most cases people with PN have neural inflammation, not damage, and this is important to keep in mind.

  21. This is an incredibly informative article. I live in London, is there anyone in the uk with the same sort of expertise that you know of?

    I have seen several women’s health physiotherapists but I really need one that is more specialized like you.

    Please help, I have no quality of life any more and am really struggling.

    Many thanks, Elsie

    1. Author

      Dear Elsie,

      I’m so sorry to hear about the issues you are having. Yes, we do have PTs in the UK that we refer patients to: Maria Elliot and also Bill Taylor in Scotland.

      Here is Marie’s contact info:
      Maria Elliott
      Simply Women’s Health
      London Medical Centre
      144 Harley Street
      W1G 7 LE
      Tel: 07958169410

      Email: [email protected]

      and Bill’s:

      William Taylor
      Taylor Physiotherapy Sports Injury Clinic
      10 Comely Bank Avenue
      EH4 1EN
      Tel: 0131 332 8698
      Email: [email protected]

      All my best,

  22. Dear Stephanie
    I have all the symptoms of PN/PNE, I am having MRI tomorrow. The pain started 2 months ago & now I cannot sit at all & spend my days in bed. I am so depressed and anxious.
    I am studying in Perth, Australia. Do you know of any good PT for this condition in Perth?
    Thank you
    Kind regards

    1. Hello Joanne
      I am a Physiotherapist who works with people with pelvic pain (men and women) by using stoft tissue massage, ‘muscle energy techniques and exercises to release and soften overactive muscles and re-education of postural positioning and movement. I work in conjunction with Womens Health physiotherapists who do the internal work that is often necessary and frequently essential.
      You may contact me by email if you would like.

      All the best

      Annemarie McKenzie
      Reform Physiotherapy & Pilates

  23. Really informative. Would you know a PT on Long Island in New York, who you could recommend for what you do.

    1. Author

      Hi Judy,

      We don’t have anyone specifically in the Long Island area, but we do refer to Stacey Futterman, a pelvic floor PT in NYC. Her contact info is: (212) 226-2066.


  24. Do you know anything about Tarlov Cysts? I have some on my S1 and S2 measuring 1.4 x 1.5cm and right posterior S2 1.9 x 1.2cm is that big, or does size finally not matter.

    1. Author

      Hi Judy,

      We do treat patients who have had findings of Tarlov Cysts. To your second question, I’m sorry, it’s one that I can not answer for you.


        1. Author

          Specific treatment depends on the patients findings upon evaluation and symptoms, therefore there is no “usual course of treatment for Tarlov cysts”. Our blog post on good PT for pelvic pain describes our treatment philosophy in detail.

          All my best,

          1. HI I saw you mentioned you do not treat people if they have tarlov cysts? Do you feel they cause butt burning and vulva, vaginal burning? I have a small tarlov cyst on s2 that the neurosurgeion do not feel cause issues but I have had problems with si joint pain that goes into my hips and down my legs and now burning o the inner butt cheeks and now vulva, vaginal burning ? Doctor says since my cyst is small and on the right s2 I would not have any symptoms on the left side which I do. I also have fibromyalgia and myofacial pain issues for many years in my neck shoulder and jaw area? I am just wondering if you saying you don’t treat people with tarlov cysts because you feel the issue is coming from them and theres nothing that can be done at that point?

          2. Stephanie Prendergast, MPT says:

            Hi Cece,

            We do treat people with Tarlov’s Cysts but as physical therapists we do not administer treatment to the Tarlov’s Cysts directly ( injections or surgery). It sounds like you have neuromuscular pelvic issues, a pelvic floor physical therapist can help you figure out what treatments can help you.

  25. I have pudendal neuralgia but can’t find a PT on the NHS who treats it other than London and they won’t take me because I live near Birmingham. How can I find one near me? The local pt doesn’t have a clue about PN. I have one hip higher than the other due to tight muscles on one side. I have had multiple pelvic surgeries and I have piriformis pain and gluteal pain. I have SIJD too. My bladder hurts so much after sex I need help, my bladder is not infected and looks normal on cystoscopy please help thanks mel

  26. This is a very clear, concise article about very confusing topic. Unfortunately, I was eventually seen to have PNE when it is obvious to me now that I have had PN all along. And more unfortunately, I did have surgery which was unsuccessful.

    Thank you for illuminating this painful darkness.

  27. I have a long medical history. Fibromyalgia for 25+ yrs. I was very unfortunate to have pancreatitis from a bile duct blockage. I had a cololonoscopy & have beenin severe pain for over a year. It started immediately upon returning home. Entire pelvic girdle pain & collapsing. Back is very bad shape. Bulging dics, degenerative arthritis, almost no disc L1- L5.

    It’s a terrible struggle. The worst pain seems centered over bladder area. I have had total “open” hysterectomy. No one can find the “cause”, so now my PCP is talking to me about somatization disorder. (spell?). This is so very disheartening to me. I find it hurtful. I have no choice but to try to figure out why I developed this pelvic girdle pain. Between that, the Fibro, my back…Frankly, I was very “hurt”. I have seen too many doctors, but most spend an average of 15 mins. With you & they somehow believe they have made a diagnosis or push you to referrals.. I live with the pain & do not complain, but if a doctor asks me questions, I am going to give honest answers. The abdominal pain is the worst. I find it hard to “swallow” when I tell them this pelvic pain started immediately following the colonoscopy & then I developed diverticulitis within 2 wks. that followed.

    Why must women suffer by being told it is “in your head”? I cannot help that many doctors are not up-to-date, although I understand busy schedules, etc.. But, like so many other patients who are in despair, you want “help”. So, you are forced to try on you own. I went through this for 5 yrs. before my Fibro diagnosis, so I am familiar with how it always endsup being in your head when a doctor cannot diagnose you. My final comment is WHO would “want” to spend time & money you do not have. It isn’t exactly “Disney World” to those of us who suffer. My hopes are that more doctors will become more informed.

  28. Oh my goodness! Thank you so much for writing this article. It is an answer to prayer. I am at a crossroads as to which way to go next and needed this information to help me make a decision. I have had great PT over the past couple of years but only recently have begun to have my pain managed so that I can function somewhat normally. Have had seven nerve blocks over the last two years with minimal to no improvement. Maybe that’s because my pain wasn’t being managed at the time. Have never had botox to the pelvic floor but I will now seriously consider having this done. Thank you again!

  29. I would also like to mention, if I may, that my physical therapist has been wonderful and only deals with pelvic floor issues. They know their stuff and were instrumental in getting my pain down as well as helping me get to the right pain management physician. They collaborated together which made the difference. I can only speak to my experience but want to share with anyone living in the Southern California area who is looking for a well qualified pt Sarton Physical Therapy is certainly that!

  30. Appreciated your section on Autonomic involvement. I have been diagnosed with post-partum dysautonomia and also developed a stage 3 rectocele and stage 2 cystocele though pregnancy/delivery. Though I have shooting rectal pain and coccyx pain with sitting, that’s the least of my worries. the autonomic symptoms are debilitating. My standing blood pressure drops into the low 70s systolically, and my heart rate can double from sitting to standing. I’ve had 2 TIAs, Have been on various meds anyway, the point of all this is say I’m almost sure the two are related but my uro-gyn, pelvic floor PT, and cardiologist just look at me like I’m crazy when suggest this. But, it’s so marked. Initially, I would feel my prolapse fall out an know I had 2 seconds to sit down before I ended up on the floor… Anyway, I know it’s not the main point addressed her, however this is the first documentation I’ve found of anything even remotely acknowledging a link between autonomic impairment and pelvic floor anatomy and I’d be curious to know your thoughts.
    Appreciate your insight,

    1. Author

      Dear Kate,

      It is uncommon for patients to have autonomic-induced symptoms stemming from the pudendal nerve if they do not have other sensory symptoms also – such as burning or pain. It sounds like you suspect the labor and delivery caused the prolapse and you are wondering if it also caused pudendal nerve involvement and secondary dysautonomias. I think this is unlikely but anything can be plausable. If you are truly suspicious you may want to work with an MD to attempt bilteral pelvic nerve blocks to see if this helps your symptoms. Dysautonomias can exist without pudendal nerve involvement as I am sure you know. Both things are difficult to deal with and I am very sorry you are going through this. If you choose to pursue pudendal nerve blocks please let me know how it goes. I wish you the best!


  31. Hi Stephanie – Wonderful Blog Post and a
    Godsend of information! Last October, I became very ill and started having a lot of pain abdominally due to severe bowel dysfunction. This is when I first began to experience PN. Eventually, I had a complete hysterectomy and also had lots of scar tissue removed from my bowels, my bladder, etc. I am still experiencing PN and have been back to the doctor a couple of times and he says this nerve pain is because my hysterectomy was quite extensive and he had to cut deep into the muscles, etc. and give it time to heal. He did refer me to a PT (who is not a pelvic floor specialist) to help with the recovery and to help with the SIJD I have. I have been twice and both times came home in excruitiating pain! Before I went the pain was finally beginning to subside and was at a lower level than before. I would have a couple of days with almost no pain and then on the 3rd day I would have a bad day. I have been getting massages which greatly help and walking which also really helps! Should the PT be making the pain worse (which lasts for a few days afterwards) or should it be better afterwards like it is after a massage or walk? Wondering about discontinuing the PT?? Do you have any recommendations for any PT’s in Natchez, Mississippi? Thank you for your much needed work in this area and I look forward to reading your other blog posts and educating myself on PN.

    1. Author

      Dear Terry,

      You should not be experiencing an increase in your symptoms after physical therapy. You should definitely see a physical therapist that specializes in the pelvic floor, not a general orthopedic physical therapist. Here’s a few pelvic physical therapists in MS and LA:

      PhD, NPC
      [email protected]
      Women’s Specialty Center

      [email protected]
      Biloxi Regional Medical Center

      West Monroe
      [email protected]
      Melanie Massey Physical Therapy

      Baton Rouge
      [email protected]
      The Wellness PT’s

      [email protected]
      Bravo Therapy Services

      All my best,

  32. Dear Stephanie
    As a male with PN since 2007,imagine my frustration. After over 20 procedures including Ganglion and Caudal Nerve blocks, 2 Radio Frequency Ablations, 2 Botox Injections all with no relief, I was suicidal. On Christmas Day 2007 I put the right 2 words together and a whole world of info became available to me.I asked my pain center if they would try a PN block, and one very brave Anaesthesiologist agreed to try a block. I was desperate and saw him consulting his Anatomy book. About a month later I realized that my pain was slightly reduced. I lived in MD and travelled to NH to see Dr. Mark Conway. He diagnosed PN and the same day I had a 2nd block by Dr. Quesada at Eliot Hospital in Manchester,NH. Dr Conway, an OBGYN told me that he see’s many men from around the country. Dr Quesade ,when asked how many PN blocks he had done-said he did not know. Finally I knew I was not crazy. It was winter and I could not travel to see Stanly Antolak, but we spoke by phone. My frustration is that I never found a PT that would take on a man as a patient. I did however find a Radiologist in Fairfax,VA that runs a pain clinic and does do the PN block. At least I did not have to fly from MD to NH. Dr. Chrostian Muller uses a CT guided approach that proved to be more precise then a Flouro approach. I’ve had 6 PN blocks and am somewhat improved. I now live in DE, and there is no one around here(Lewes,DE) or as far as Philly that does the block. After over 20 procedures I started to experience spinal side effects-loose cracking sounds when I brush my teeth. I have held off on more blocks for now, and just deal with the pain. Being male with this condition is an impossible problem. The blocks do help, but I have now developed Sacro pain on both sides. FYI- my pain was 90% in the anal sphincter and occasionally in the tip of the penis.
    The anal pain started while in the hospital after they took my gallbladder because of Pancreaqtitis that I never had before.I also have a significant leg length difference of 3/4 inch and have worn a shoe build up for 15 years.
    Please share my story so that other men can know that they are not crazy. I saw so many Dr’s-Proctologists, Neurologist,Gastro Dr’s and no one had ever heard of this. I have an Interstim implant for bladder issues, but not one Dr or Urologist would acknowledge PN or that the bladder is a muscle innervated by nerves- specifically the Pudendal Nerve. My mother had urinary issues with Parkinsons. I failed the Urodynamics so my insurance agreed to pay for the Interstim. This was the only way to get a Neurostimulator implant, but not the one my pain Dr wanted me to get. My battery will go in about a year or so and I will have a very hard decision to make since no one in DE does the surgery or battery replacement. I’m also concerned about if the leads will need to be replaced. The Interstim has helped reduce my frequency and urge, but does nothing for the pain. The Urologist at GW told me it would not help the pain. On one of my follow ups at GW, after several PN blocks, I asked the Urologist why she would not consider the diangnosis of PN. Her reply was ” Barry we just don’t know enough about it” My sense was that since all her patients were female, that she just dismissed me as a head case. Thanks for reading this, and for by far the best article ever!

    1. Barry – Have you read the book, “A Headache in the Pelvis” by Dr. David Wise yet? This protocol is mainly from the male perspective. I attended the Wise clinic and it has been a major part of healing from my chronic pelvic pain. In the clinic they teach people how to do their own physical therapy and a relaxation meditation. I encourage you to give this a try, then you may not need to be dependent on providers for the nerve blocks if you can get your muscles and connective tissue to release as often as needed.

      1. Thank you so much for the suggestion. I will search for the book on Amazon.
        I never found a Physical Therapist that worked on men.
        I found the article: Is it PN or PNE and sent it to Australia to Soula, a truly wonderful lady.

        1. barry- there are a couple of pelvic floor PT that do see men – they arent that close nor far – to you now , but might know of someone in your area-

          stacey devine ( 5 stars the best ) please consider seeing her- lot of towners sometimes come an book a series of appts over a weeks time. ( maybe you still have family/friends in MD and can stay there reducing cost)

          she does SO MUCH more than pelvic PT ( and is a master at that- has hands of butter ! Plus, her pain theories are totally up to date – and help! @ 10 miles west of Baltimore she sees males and females equally ** recommeded highly

          and there is a male pelvic PT in Annapolis area – Jody Schmidt Jody Schmidt, PT, L.Ac. Sexologist, American College of Sexologists
          269 Peninsula Farm Road, Suite C

          Arnold, MD 21012

          Phone: 410/544-3100 
FAX: 410/255-8682 
E-mail: wifluv2jody(at)
          Specialties: Female Pelvic Pain, Female Genital Trauma, Sexual Health Recovery and Rehabilitation, Male Pelvis Pain.
          ( I didnt feel comfortable with him as a pelvic pt ;( – accupunturist YES – but that had to do w/him being male
          not his fault)

          Jennifer Ortiz at might also know of someone treating men. I do know that Dr Echenberg in Bethlehem PA sees quite a few men. His office should have PT resources in PA .

          best of luck- have you had a sacral MRI? My pain was casued by 4 tarlov cysts- I had them surgical treated by Fiegenbaum – NS in Dallas. and a number of the TCD ( tarloc Cyst Disease men I know had anal pain as their main symptom ) many times a typical lumbar/sacral MRI DOES NOT cover the sacrum- were cysts are typically – or the dude reading the MRI fails to mention tarlov cysts as they are still in the dark ages and didnt read the memo 2008 requiring them to write down what they see! and am way way better – almost back to normal 🙂 long road but was helped greatly after surgery- by both stacey devine and Jennifer Ortiz – and Dr Echenberg- 2/3 for sure see males very often .

  33. Thank you for the great article.
    I have been struggling with a burning in my perineum area for about three months. When i lay down most of the symptoms go away but i have this weird sensation the tingles from my anus toy penis. I notice muscle spasms when i sit and then get up. I have seen a Urologist and he has placed my on cipro as well as anti inflammation meds. Could this be a nerve trapped? The symptoms came on gradual and have stayed with me for awhile. I did not have any surgery or trauma. The tingle and odd shooting pain in this area is what has me concerned.

    1. One other thing i wanted to mention was that i could make the nerve sensation go away by tightening up my anal sphincter and holding it. Once i allow the muscles to relax again the nerve sensation returns. Thanks

      1. Author

        Dear Chris,

        Please see my answer to your prior question:

        Burning can be characterized under nerve pain, yes. Tingling, burning, and sharp shooting electrical like pain is thought to be neuropathic in nature. Nerves can be irritated in different scenarios, and increased muscle spasms or a “short” pelvic floor can be one of them. On the other hand, some people can experience nerve sensations when the pelvic floor muscles “bulge”. They lengthen past their normal baseline, and can exert a stretch or pull on the nerve. This is why sometimes people with nerve irritation feel more symptoms after a bowel movement, for example, because the pelvic floor bulges a little to accommodate the BM and it irritated the nerve. It sounds like you would benefit from a PT eval by a qualified pelvic floor therapist who is skilled in treating pelvic pain and possible nerve irritation. I would think that if you don’t have an infection, the Cipro may not be helping your symptoms very much. I think you are appropriate for a PT eval, to see what structures are implicated in your pain, and what needs to be worked on.


    2. Author

      Dear Chris,

      Burning can be characterized under nerve pain, yes. Tingling, burning, and sharp shooting electrical like pain is thought to be neuropathic in nature. Nerves can be irritated in different scenarios, and increased muscle spasms or a “short” pelvic floor can be one of them. On the other hand, some people can experience nerve sensations when the pelvic floor muscles “bulge”. They lengthen past their normal baseline, and can exert a stretch or pull on the nerve. This is why sometimes people with nerve irritation feel more symptoms after a bowel movement, for example, because the pelvic floor bulges a little to accommodate the BM and it irritated the nerve. It sounds like you would benefit from a PT eval by a qualified pelvic floor therapist who is skilled in treating pelvic pain and possible nerve irritation. I would think that if you don’t have an infection, the Cipro may not be helping your symptoms very much. I think you are appropriate for a PT eval, to see what structures are implicated in your pain, and what needs to be worked on.

      All my best,

  34. Hi i have what i believe is PN my symtoms started after taking a ssri frug for anxiety . my symptoms are pelvic floor spasms that feel like persistant genital arousal with burning around my clitoris and bladder urgency and restless legs. what do you know about PN and PGAD induced by a ssri drug?? Thanks kellie

    1. Author

      Dear Kellie,

      I personally do not know anything about an SSRI causing PGAD and/or PN. I’m sorry I can’t be of more help.

      All my best,

  35. I have been to several doctors I was wondering is it possible to get pn or pne from over stimulation to the Ciltoris with your hands?

    1. Author

      No, it is not possible to get PN/PNE this way; however, any time you cause pain to the pelvic floor area you can kick off a pain cycle, i.e. the muscles become tight, blood flow is reduced, nerves become irritated due to tight muscles and so on.


  36. I found this article very helpful as I have seen every type of consultant in the UK and still have no ‘definition’ of the pain which started as burning in the urethra, then became a horrible pain deep inside when it was painful to sit, walk or lift anything, followed by a loss of sensation in the vagina and perineal area. I don’t really have stabbing pains just a constant burning and some minor urinary incontineUce from time to time and chronic constipation. Cold this be PN- it came on after I became sexually active at the age of 50 after several years of abstinence? I think I may have overindulged at the time! also have a bad pain in my back and hip which an osteopath just said was probably the psoas muscle, but could that contribute to the pain in my abdomen and the impact on my bladder, bowel and vagina? Grateful for any thoughts as to what may have caused my symptoms. I have previously been told that I have myofascial pain disorder in my neck, but does this make it more likely to happen in the pelvis?

    Many Thanks

    1. Author

      Dear Jean,

      Your symptoms sound more like pelvic floor dysfunction rather than PN, and you are correct that myofascial issues elsewhere make this probable. Intercourse after a period of abstinence can be provocative if there were underlying issues that were not yet symptomatic. Do not worry, you did not ‘damage’ anything. I suggest seeing a physical therapist for a pelvic floor evaluation, you are welcome to email us offline if you need referrals. There are very qualified people in the UK that can likely help you.

      All my best,

  37. I found this informative. I am male and broke my pelvis in three places (sacrum and ramid left side panels sorry about spelling), some 18 months before the onset of severe pains which have worsened over the last year. Even though I have trapped nerve routes L4/L5, this only explained the problems with leg pain and numbness.

    But PNE answers every other symptom and I mean every other symptom. I tell the PT it can be agony doing pelvic floor exercises, and that I have a urge for a bowel movement, but they brush it off. As to say I’m putting it on or its all in my head and to carry on doing them.

    In fact you have also answered why my BP is so high, 204/162 at one point. The cardiologist is/was at a loss as to why as there is no reason (after many tests) as to why it was so high.

    Many thanks as this makes a huge difference just to know it’s not all in my head. It may not be the outcome or answer I wanted, but it makes a difference to know this is probably the answer. And just knowing is a huge relief, and again, many many thanks!

    1. Author

      Dear Reader,

      I am so glad that you found this post helpful. Please be careful, however, not to jump to the conclusion that you have PNE (pudendal nerve entrapment), recall from the article, that your symptoms may also be due to any number of/combination of myofascial musculoskeletal pelvic floor impairments. My advice to you is to seek out and visit a physical therapist who is an expert at evaluating and treating the pelvic floor.

      All my best,

      1. Thank you for all your info
        i had fascia pubo sling 4-22-13 as a result of failed burch fron 2010
        Once i was awake i had severe pain and had no control of left leg
        Dr told me the stir up repositioned during surgery
        I ended up with 2 blood transfusions a large hematoma throughout left pelvis left bladder wall and vagina
        Torn thigh muscle damaged obrutrator nerve torn abdominal muscle and unclear on the prudendal nerve
        I have NO comfortable position every symptom of prudendal nerve damage fits me to a tee except relief when i sit on toilet it makes it worse
        I have gait instability due to leg severe leg inner thigh groin vaginal anal top of pelvis and back and abdominal pain
        I feel as if i have been kicked in the crotch area by steeltoes and i am wearing and electrical tampon there feels like massive electrical needles having a war in my leg and entire pelvic area
        Now the dr of course is covering his butt so i dont sue him by trying to blow it off as it must be a pre existing condition or my back which has all been ruled out
        I have to use a cane to get outside and then a wheelchair i just cant do it
        I have two small children my husband had to take a leave to do everything for the past two months they have me on pain meds along with gabapentin which just keeps me from crying
        I just had the 4 th catheter removed due to bad bladder retention and have to cath myself 40% of the time usually at night when pain is worse
        I am looking for a new dr both urogyn and neuro because they just seem shady through this all i have even been trying to get a pt appt for a month and still no call backs
        I am so fustrated they told me within 3-4 months i should be able to walk unassisted and healed in a year
        The for has almost resolved i have no control if i have a strong urge to urinate i just go urinating is so painful anything is
        I have to change positions about every tens mins or i will throw up from the pain
        My anxiety level is off the charts i just want to cry i am useless
        Any help would be appreciated
        I am in queens ny so any dr suggestions would be great too
        Thank u for listening

        1. Author

          Dear Heather,

          I’m so sorry about all that you are going through! I recommend that you make an appointment with: Futterman Stacey PT New York NY (212) 226-2066. She is an excellent pelvic floor PT, and you will be in the best hands with her.

          All my best,

  38. I’ve been dealing with chronic intense pressure in my clitoris for almost two years now. The first time I felt it was the first time I got BV, then I had recurring BV infections and every time the feeling came back but went away once the BV was treated. Then a year ago, I got BV once again (joy!) and the feeling came back. However, the BV went away and the feeling did not. It’s been all day, everyday ever since. It feels like someone is just pressing their finger right on my clitoris at all times (and not in a pleasant way). I’ve been misdiagnosed as having IC and received painful DMSO treatments that got me nowhere. A doctor just told me last week that it could be my pudendal nerve, however the nerve block did nothing. I’m at a loss and terrified this is going to be this way for the rest of my life. I want to have a baby, but this has put my plans of hold for nearly two years. I really don’t know what to do anymore or what steps to take. Any advice is greatly appreciated. .

    1. Author

      Dear Reader,

      My advice to you is to go and get an evaluation from a qualified pelvic floor PT. We see many patients like you whose symptoms begin after repeated vaginal infections, either yeast or BV. Where are you located? Perhaps there is a PT that we could refer you to in your area.

      All my best,

  39. I have been a sufferer of this PN “symptom” for many many years. I have a long history of vaginal pain, including several pH issues after many courses of antibiotics as a child, and then for most of my life a sufferer of vaginismus, which I cured in the past few years with the help of Kegel exercises and a very kind and patient partner. Needless to say, I have had a lot of trauma associated with my pelvic area, and in the past few years I have been having these week long episodes of stop-you-in-your-tracks sharp knife-like pains in my vulva and clitoral area. After reading a lot about PN, and generally doing a lot of investigation, I have come up with a technique that seems to have GREATLY reduced the amount, length, and intensity of these episodes. I believe that over the years I have begun to “tuck my tailbone” in (like a permanent kegel) because of the trauma that I have experienced in my pelvic area – always protecting myself, worried that I might feel pain. Every moment that I catch myself doing this – during exercise, in the car, walking around at the grocery store, I have begun to repeat to myself “let your tail relax”. I have been doing this for nearly two months, and have not had a single day of pain. We’re all different, but it’s worth a try!!!

  40. It is good article which has enlightened me on PN. I am suffering from severe pain for the last 3 years. Have undergone epidural injection and ganglion impar block but no relief to the pain. Unable to sit.Only taking Tramazac 50mg (Tremedol) one A DAY WHICH GIVES ME RELIEF FROM PAIN FOR ABOUT 8 hours. Rest of the day just lay down and endure the pain.I would be glad to know if any permanent solution is there for eradicating my pain. I am now 65 yrs.Regards

    1. Author

      Dear CM,

      I would recommend that you begin by seeing a qualified pelvic floor physical therapist. Where do you live; perhaps we can refer you to one in your area. All my best, Stephanie

  41. I’m wondering if you could advise me?
    Approx 7years back I was working on a house site mixing concrete in a wheelbarrow and lifting 40kg bags of cement all day,i went home that night for a shower and to my horror I felt my left testicle had drooped significantly.Suspecting a hernia I subsequently saw my doctor,had scans etc but all came up as clear.Since that day I have had groin pain,aching and sometimes drooping left testicle and pelvic pain with pain going down my left leg and left bottom cheek.Also since that day urination has been affected,slowness and hesitancy and frequent urges in the day and at night.Sexual arousal has lessened with erectile disfunction a lot of the time and getting worse.
    My urine would get terribly discoloured and a slight stinging in in tip of penis would sometimes develop.I found Cyproflex significantly helped,but it keeps coming back.
    I always suspected my condition could have been related to some kind of muscle or nerve damage but my doctor and specialist never mentioned anything along these lines,instead saying I had benign prostatic hyperplasia or prostatis on which several different drugs have been tried without any success.
    Now I have found your article which makes me think I could have damaged my Pudental nerve that day and it has evolved into what I am suffering from now.
    Would this assumption make sense to you?
    Many thanks.

    1. Author

      Dear Mark,

      There are a number musculoskeletal pelvic floor issues that could be causing your symptoms, not just an irritated pudendal nerve. I’m not surprised that your doctors have not identified your symptoms as possibly being due to your pelvic floor as most physicians are not up-to-speed on the pelvic floor.

      What I would recommend is that you find a qualified pelvic floor PT to evaluate you. Where are you located? Perhaps we can refer you to one in your area.

      In addition, I would give this blog post about male pelvic pain a read:

      Also, take a look at the page about male pelvic pain on our website:

      All my best,

  42. Kellie, I also have PN and for years had severe like blow torch up my bladder. they treated me for IC but now with the pn it is so much worse. I get the constant pressure and orgasmic feeling which is horrific. I do not know anyone else with this..
    Please contact me at [email protected]

  43. Thank you for this wonderful article. Could you please recommend a PN educated pelvic floor PT in Minneapolis, MN? Thanks olga

    1. Author

      Dear Olga,

      The PT that we refer to in MN is in St. Paul; her info is: Stidham Beth PT St. Paul MN (651) 999-2734.

      And thank you for the kind words!

      All my best,

  44. I would like to add that professor guercini in Rome has good protocols for treatment of the pudendal nerve, his wife is a urologist for Women who choose to go.

    His website is aimed mainly at men and prostate problems but the pain of ithis leads onto pudendal nerve problems, I have had this and can say his treatments have been effective for me. it is allays a worry about treading info on the Internet but I believe his cv gives a good account of his background. I will not go into the details of my treatment as I am not a qualified doctor .

  45. Great article! My PN began a couple years after menopause, with great vaginal atrophy, with a tremendous amount of sitting at my computer every day during the day and then more at night.
    I was initially diagnosed with Vulvadynia. I was very, very sore and could no longer wear pants.
    But things got worse. Before long I couldn’t sit AT ALL. I could lay down on my back and sit on a toilet seat without pain. After that I developed constipation so severe that I deal with every day. No amount of high fiber diet, glasses of water or exercising could change it. I had to rely on Miralax. Took a trip in the car lying down on my back and condition worsened considerably. Constipation got much worse and has stayed that way. Most products don’t help anymore, even though I only used a laxative a handful of times. Did pelvic floor therapy for a year with the best of the best. She finally had to release me. Electric shock sensations in pelvis and bowel, with Pins and needles, numbness, pain, and odd sensations of things moving around, twisting, pulling, torquing. I’ve had two nerve blocks, have tried acupuncture, massage, and nutrition therapy and chiro. i am now having feelings of neuropathy in my neck, hand and feet. mGastroenterologist had to refer me to neuro gastroenterologist. My old life is gone, but I try to keep a positive attitude and count my blessings, which are many. Any thoughts on why I am not getting better? PN or PNE? Thank you.

    1. Author

      Dear Dawn,

      It sounds like many factors are involved here. First, do not give up. Second, you need to find a medical professional to help you coordinate the providers that you are going to need to straighten this out – likely a GI, PT (you should definitely try another PT. You say the PT you saw was the best of the best, but, it’s odd that she released you? Why did she release you? Did she ever relay to you what her findings were?), pain management doc, etc. Unfortunately I cannot explain why you are not improving without thoroughly evaluating you. But, please contact us offline ([email protected] or call our office!) if you would like a referral to someone we trust in your area.

      All my very best to you,

  46. PS. Can no longer have sexual intercourse or achieve climax. Also have urinary urgency and have many accidents mostly urinary (many changes of clothes per day – not making it on time, and very occasionally with a bm.). Feeling of softball up my rear. Swollen belly, severe foul gas most days many times per day, Pain and swelling after B.m. I still cannot sit without pain. Can sit for perhaps 1 – 3minutes at most. Sometimes just that little amount can cause big pain flare for the day. Also had PGAD before symptoms began.

  47. I have been experiencing pelvic nerve pain with sexual dysfunction increased sensations and was getting no answers which led me to a pelvic floor therapist who happened to help that symptom when I went for an actual treatment they worked on my back saying it could be coming from there and my symptoms got worse is this expected ?

    1. Author


      I’m sorry, but I do not understand your post. First you said the PT helped “that” symptom, then you said it make it worse. Please explain further.

      Nonetheless, a pelvic floor PT should not be working mainly on your back. Here is an article about what good pelvic floor PT is like; please read it and make sure that you are getting the right PT; not all PTs are created equal.

      All my best,

  48. Dear Stephanie,
    I am post op four mesh removal surgeries, the last one April 2013, at that time the surgeon did a partial vaginectomy as well as resecting more mesh. Right after surgery I had pelvic, vulva area, rectal area pain, pressure burning… I cannot sit for long each day, the day starts out with a low pain level and by the end of the day I am flat on the couch. I am have had one pudendal nerve block that helped for 16 hours and am starting PT. I am worried I have entrapment caused by the surgery.Is there anyone you know in Michigan, or any where for that matter who can diagnose if I have possible entrapment. I did not have any of this pain prior to the surgery. thank you for all of your help!

    1. Author

      Dear Susan,

      I’m so sorry to hear about all that you are going through. I don’t know of a doc in Michigan that is a PN specialist. Two docs that we recommend as being highly knowledgable about PN are Drs. Mark Conway in New Hampshire and Michael Hibner in Arizona. Both extremely knowledgable.

      All my best to you,

  49. Good afternoon Stephanie,

    This article was truly a miracle. I had surgery july 11,2013 for pelvic pain. I have seen many GI docs. They thought it was Diverticulitis. One GI specialist thought it could be endometrial adhesions( i had a full open abdominal hysterctomy july 2009 at the age of 27). My gyn who I have been with for 15 years performed the surgery reluctantly. Immediately after surgery I contacted my doctor and told him I was having a stabbing pain in my vaginal area. It got worse while sitting and upon standing the stabbing pain would take my breath away. Every symptom I read was verbatim what I have been describing to my doctor. I feel like I am 31 and I am going to break a hip. The pain shoots from my pelvic region to my hip. Nothing is comfortable. Sitting, standing, lying down. When I am lying in bed when I stretch my left leg out it feels as if I’m going to tear a muscle. My PCP just started me on Cymbalta yesterday. My gyn of 15 years dropped me as a patient. No warning, I just received a letter stating he was terminating our patient/doctor relationship. My PCP told me they were running into “roadblocks” with my GYN and he would personally find me a new one. I wanted to give you a litle history, but my main question is, should I request to have a decompression surgery or just see if the Cymbalta will help? I have been unable to work since April 15,2013 due to a lower GI bleed. I have had 8 procedures since then. This pain I currently am having started AFTER my surgery July 11. My employer will make me a prn employee as of Sept 15 since I have been unable to work. I feel like I am on a ticking time bomb diagnosis wise and I need to get some type of treatment ASAP. I can’t continue to live my life this way. The pain is so horrible. Thank you for writing this article and your advice would be greatly appreciated.
    Thank You,

    1. Author

      Dear Toni,

      I am so sorry to hear of your trouble. The good news is that your pCP sounds committed to helping you get your pain under control. Cymbalta sounds like a reasonable treatment option, however, your case needs to be managed with a multidisicplianry approach and at this point I would not consider you a good surgical candidate. Your treatment plan should consist of physical therapy, appropriate pharmaceuticals, and possibly medical intervention such as nerve blocks and myofascial trigger point injections, possibly botox. Your team needs to work with you to differentially diagnosis which structure are causing your pain and come up with a strategy to eradicate the problems.

      All my best,

  50. Dear Stephanie & Staff,
    I am a 65 yr old women who had a complete hysterectomy in May 2013. 4 months prior to surgery I started experiencing the feeling of something being stuck in my vagina along with a heaviness (pressure feeling). I went to my gyn doc and she said she did not fin anything on the pelvic exam but gave me an ultra sound. It was at that test that I felt a severe burning on my left side. The tech had me insert a wand so that they could get a good look at the uterus during ultra sound. That burning pain never seemed to go away from that point on. I then went to a urologist and was told that I had a prolapsed uterus and that my bladder was not emptying all the way. Had a second opinion and was told the exact same thing. Also had a very large firoid cyst in my uterus. Had robotic hysterectomy and 4 days after surgery still had the burning pain in my vagina area on one side. Surgeon tried estrogen cream, antidepressant meds and finally put some lidocaine in the suspected area. I was pain free for about 4 days and then it all came back. I have a call into the surgeon to see what the next step is to try and get rid of my pain. Sitting is very painful. I get relief sleeping but as soon as I’m on my feet for 5 min. it comes back. Standing gets painful late in the day. Still working full time as a secretary.
    Loved your PN and PNE explanation and hoping to find either a PT or someone in my area (Bucks County, Pa, outside of Philly) who is up to snuff on this.
    Thanks so much for your help,

    1. Author

      Dear Donna,

      I’m so sorry about all that you are dealing with!

      We see many patients who develop pelvic floor problems after surgery. It is quite common. I definitely think that you need to be evaluated by a knowledgable and experienced pelvic floor PT. Here are two pelvic floor PTs that we know of in your area:

      Sheth Hina PT Philadelphia PA 267-282-1301

      Rejba Amy MSN, CRNP Philadelphia PA 2158638100

      Please give this blog post a read, it describes what we consider to be a “good pelvic floor PT” session:

      Please do not hesitate to write again if you have any further questions. We also offer free 15-minute phone consults if you’d like to discuss your situation further.

      All my best,

  51. Hi
    I have had these symptoms that is explained in this article. I have seen a number of doctors with no answer. Symptoms are unknown pain in penis, anus, all kinds of electrical pain in abdominal. I have been treated for IBS. I would like to know what kind of doctor do I need to see. Im located in louisana.

    1. Author

      Dear Kevin,

      You need to find a qualified and knowledgable PT as your pain might be pelvic floor-related. Here are two PTs that we refer to in La: BravoJacqueline Lafayette LA3374060712
      MikeEmily West Monroe LA3183961969. Also there is a great urologist in New Orleans who is knowledgable about the pelvic floor (not all are); her name is Dr. Susan McSherry. Here is her contact info: 4429 Clara St, New Orleans, LA 70115; (504) 894-9102. Also there is a great yahoo online support group called Happy Pelvis that I would recommend that you join for info and support. The members are very pro-active, unlike many online groups that can be a bit depressing. You will get great advice on Happy Pelvis as the moderator, Tiff McDonald is extremely knowledgable: check it out at:

      Please read the following blog posts; one is about male pelvic pain and the other is about good pelvic floor PT:

      also check out the male pelvic pain page on our website:

      All my best,

  52. Hello,
    My PT says I have Pelvic Floor tension Myalgia and perhaps PN. My symptoms are burning in my legs and feet, muscle spasm, intense burning in the pernium and pain during intercourse. Frequent and urgent urination. It hurts if I have to hold it. My pain is minimal in the morning and gets worse at night. I have no herniated discs, diabetes or any other diseases. No Urological or prostate issues. Sometimes my body twitches slightly when I relax. It feels like I am in pain overload. The PT helps but the burning always returns. Are these typical symptoms of PN or PNE? Thank you for your time.

    1. also I CANNOT sit on hard surfaces. Sitting is horrible pain for me. I try to avoid it. Also standing for extended period of time kills me.

    2. Author

      Dear Rob,

      Don’t get stuck on the diagnosis of “PN” or “PNE”. What’s more important is for your PT to figure out what impairments are behind your symptoms. If she or he feels that your pudendal nerve is involved, then you might think about whether you want to take advantage of the list of treatments provided in this post, such as blocks, botox or medication. However, your pain could very well be muscle-driven. If this is the case than a “good pelvic floor PT” will help.

      As to your symptoms, we commonly see all of the symptoms you described in our clinics. Upon working with our patients, we can ultimately tell if their symptoms are muscle or nerve driven and from there we recommend the appropriate treatments.

      All my best,

  53. Hi
    Thank you for writing this wonderful and informative blog.
    I have urinary symtoms urge/frequency/hesitancy and later develped sit bone pain…After many intervention.(you name it!) plus nerve re-section surgery..
    I cannot tolerate sitting at all! Standing also became painful ; being on my feelt provokes the throbbing which worsens as day goes on.
    I have been basically housebound for 2 years while seeking pain relief.. I have had lots of PT with some qualfiied folks but one thing I learned from your great article is nobody explained what they were doing ,and I couldn’t tell you exactly what typeo PT was done with me.. but I can tell you that I wasn’t evaluated as thoroughly as you described…I was told by one well known PT that my CNS is too ‘revved up ‘and to give it a break from PT for awhile while I pursue pain managment.. The latter is tough as many drugs cause urinary hesitancy and ALL pain meds cause constipation.. I realize I need to get my bladder calmed down to help me tolerate the drugs…Also theres a vicious cycle in that the constipation issues probably irritate the bladder..
    BTW the my anal and perineal pain has always been a throbbing, piercing ache like the worst tootache ever… in the anal area. I DON’T have burning,numbness etc which usually are the signs of neuropathic pain…Would my pain still be considered to be be pudendal neuralgia? My practitioners (all of them) have called it neuropathic pain (with a muscular component..) The latter is surely true as it feels like there is a vise in my urethral tighening things when I pee, and my anus is tight as well. I would love to travel to see you ladies but don’t think I could handle the plane ride. (the sitting!)
    (I live in NJ…near NYC)…I would love it if one of my PTs could discuss my case and come up with a new plan that covers all of the things that you describe in your evaluation for PN.. and IC.
    I am a mom who needs to drive again to take care of my family and be part of their lives, and to live again in general
    I also would love to speak to you as you understand this brutal, life changing pain better than anyone.. Please help.
    Thanks and hope to speak with you!
    Kathy ,from NJ

    1. Author

      Dear Kathy,

      From your description of your symptoms it sounds like there are several factors contributing to your symptoms. I’m sorry to say that without evaluating you, I can not tell you whether your pain is PN, and at the end of the day, as I mentioned in the blog, it’s more about the physical findings and less about putting a label on the issue. You do bring up some important questions regarding PT. While we do offer 15-minute phone consultations, without examining you, I wouldn’t be able to consult with your local PT about your case unless he or she sought out my opinion.

      I’m so sorry about all that you are going through, but don’t give up on finding relief and I encourage you to continue to seek out options such as pain management.

      All my best,

  54. Thank you for an inspiring post. The things you said about PN being just a symptom not a cause is so logical, yet hard to come up with.

    I have suffered with a severe burning pain which started quite suddenly from the skin around my anus, then moved more to vulva and radiated to my left buttock and thighs. The pain was the worst when sitting and I even think it was triggered by long hours spent sitting in my office so now I try to avoid it. Recently I’ve developed a lot muscle spasms in my buttock and thigh and next to my rectum (in the muscle) I have noticed the kind of pain (and most probably the same place) I had after my surgery for anal fissure 3 years ago – more dull than sharp, but since than also laying on my left side or on back make feel this pain (still with burning vulva and skin around my anus). I am trying to think if there is any correlation between the old surgery and these pains now that are a lot different than back then.

    Since it all started I have noticed I cannot eat any amount of sugar – it brings awful flare up that can last even 2 weeks (after eating 1-2 small chocolates or a teaspoon of sugar). I don’t eat any sugar apart of naturally occurring sugars. My sugar level is normal.

    I had MRI scan made and it shows some bulges on lower back spine and some fatty atrophy paraspinal muscles. My doctor says it has nothing to do with the pelvic pains because it doesn’t pressure my spinal cord, but since I read your post it made me think more about causes of these pain, and not only ways to mask it with medication or nerve blocks that they’re referring me to.

    Do you have any thoughts about what can be causing me the pain?
    I am so depressed and in the age of 30 feel like no one wants to help me.

    1. Author

      Dear Meg,

      I’m so sorry about all that you are going through, but from your description of your symptoms alone it is really impossible for me to tell you what is causing your pain. I would have to complete a physical examination to make an assessment. I’m sorry I can’t be of more help. My recommendation to you would be to seek an evaluation from a skilled pelvic floor physical therapist. If you need a recommendation for a PT in your area please feel free to contact our office at: (415) 440-7600.

      All my best,

  55. On 9-17- 2013 I had rectocele surgery in Albuquerque NM,
    It included Utero Sacro Ligament Suspension and leaving the Uterus in.Also they did a pineography and used a Pudental block. I am 62 years old and had a stage 3 Rectocele.
    The operation lasted over 4 hours. When I woke up I had stabbing pain in the left buttock.a few days later, I developed hypersensitivity along the left hamstring area and on the left side of my Vulva and inner thigh. My Dr. examined me internally to see if one of the sutures, 4 temporary and 2 permanent were at fault with no decision. I am going back on 9-30.I have extreme pain all the time walking ,
    sitting and using the toilet any advice?

    1. Author

      Dear Ravelle,

      If you woke up from surgery with these symptoms likely something happened during surgery that is pulling on a nerve branch. I would ask to have the suspension taken out or revised at the very least asap. In addition, you may need to seek another opinion.

      All my best,


    2. I had the same thing Liz….1st Liz go to a Pelvic Pain Dr and ask for a MRN NOT A MRI the MRN checks all the nerves in the pelvic area and it will show Pudential Nerve Damage if you have it. I did. I could not sit ,stand or walk for more then 15 mins. Good Luck.


  56. Hello! I am having a persistent burning pain since early June. Sometimes I don’t feel it at all. Sometimes it seems to be worse after sitting. When standing it doesn’t seem to bother me as much. If I quickly twist my body a certain way or quickly pick up something heavy I feel a quick shooting/stabbing pain on the inside of my buttocks not far from the rectum. I’ve had days since June where I thought the issue vanished, to only come back a couple days later. Any ideas? Who would be a good provider to see for this? I am in the middle TN area. Thanks so much. (today I went to the chiropractor for the first time in my life, he says it could be a vertabrae pinching or compressing a nerve in my lower back which runs down to this area. He confirmed several of my vertabrae are out of alignment.) I am a male, healthy, and in my early 30’s.

    1. This is a very old post but Dr.Michael Swan,Urogynocology, Nashville TN is amazing.
      (615) 515-9180

  57. Hi,

    Great article. I am a 37 year-old female. I have suffered from worsening constipation since 2001. I have been extremely sedentary most of my life with one period of anorexia. I also suffer from Proctalgia fugax. Very little interest in sex, because I always felt burning during and afterwards. Constipation got really bad in 2012 which coincided with a weightloss program. By the end of Oct. 2012 had really bad right lower quadrant pain thought to be due to severe constipation. In Dec. 2012, I started Pilates and was doing lunges and squats as part of an exercise routine. In mid-Dec. 2012, I noticed that my external vagina felt raw. I thought it was an allergic reaction. All tests for yeast, BV and STIs negative, but treated as a yeast infection. Had an extremely itchy rectum. Also given lots of anti-fungal creams for the external vagina. Symptoms became progressively worse. Sitting was very uncomfortable and my clitoris felt like it was on fire. I felt waves of sensation through-out my vagina and all the way to my rectum. Burning in my buttocks, belly, pubic bone, thighs and feet. I had two sharp points of pain in my buttocks. By the end of Jan. 2013 the pain put me out of work. Given gabapentin and took 3 weeks off. I am now at 2400 mg gabapentin, 30 mg amatriptine, 1500 mg rebaxen and 2400 mg ibuprofen a day. Also been getting PT since April. Anesthesia seems to stop all pain for a short time. Pain levels have decreased, but lately labia and vaginal opening burning seem to be worsening. Pain is bilateral, but far worse on the right. I still work 3 days a week driving 90+ minuets a day. I was diagnosed with PN, but wondering if this could be PNE. I just don’t understand why the pain seems to be getting worse. I only sit during my commute. I get pain when standing and laying down. If I don’t stand on my right leg, pain seems to stop for a bit. Any ideas why and what my PT could do to explore this? If I have PND from the constipation or something else, can that ever heal?

    Sorry for the super long post. Just very scared and confused about all this.


    1. Forgot to add that I live in Webster, MA (central MA near Worcester). Do you know of any PTs in my area. I have been going to South County in Auburn MA.


      1. Author

        Hi Dee,

        I’m not familiar with Mass. so below is a list of all the PT in Mass that have taken our class; hopefully one is near you.

        Clarke Anne PT Braintree MA (781)348-2500
        Fonti Hannah PT Danvers MA (978) 304-8701
        Levesque Ann PT Beverly MA (978) 927-7668
        Lewis Elizabeth Burlington MA (978) 761-3149 and (781) 744-8617
        King Linda PT Brauntree MA (781) 519-4756
        Bentley Carolyn PT Amherst MA (413) 253-0413
        Barnicle Katie PT Westwood MA 7814319144
        Cole Elizabeth PT Waltham MA 7814873821
        Gillis Janet PT Dartmouth MA 5089980620
        Machugh Lalla PT Quincy MA (617) 479-8500 x 126
        Perlis Raquel PT Wellesley Hills MA (781) 237-9006
        Herman Holly PT Cambridge MA (617) 576-3204
        Wade Marie PT Framingham MA (207) 779-2256
        Cunningham Patrick Acc Arlington MA (617) 489-2381
        Lewis Elizabeth PT Gloucester MA (978) 761-3149
        Bentley Carolyn PT Northampton MA (413) 582-2113
        Berger Stacey PT Westboro MA (508) 366-7899
        Herlihy Sarah PT Wellesley MA (781) 237-9906


    2. Author

      Dear Reader,

      Before I answer your question, I have to ask you what exactly is your PT doing during treatment. Not all PTs are created equal. Below is a blog post about “good” pelvic floor PT.

      Also, if sitting is a trigger, you should try a cushion. At the bottom of this post, you will find a few cushions that we recommend:

      Also, are you doing anything to treat the constipation? Constipation will worsen pelvic pain.


      1. Hi Liz,

        Thanks for your reply and for pointing me to the article. I take Miralax twice a day for the constipation.

        I try to keep a pain diary, but I don’t always flare right away, so I have a hard time attributing pain levels and activities. I also have a hard time with reporting pain levels. I hurt 85-100% of my waking hours with varying severity.

        My physical therapist is in Auburn, MA (Patty P.). She asks me about symptoms after my last treatment. I get 10-20 minutes of heat on my hips and thighs. She usually does cranial-sacral and works on the muscles in my thighs a bit. Then we may do a little external trigger point with. We may do 5 minutes of internal vaginal trigger point work. To be honest, I’m not really sure about what feedback I should be giving with the trigger point. I have a hard time with the internal work because I get a burn at penetration that overrides almost all other feelings. It just feels weird having her finger moving around.

        I do use a cushion for sitting, but it only helps a little. The only time I sit is in the car or the bathroom.

        I live in Webster, MA near Worcester, MA. Do you know of any PTs in my area.


  58. Hello,

    my problems started 2 years ago when I woke up with burning in my anus. After week or two, burning started also in vulva and vagina, like someone pour an acid in it. Went from one doctor to another, first diagnosed I have candida issue, then I got prescribed medication. It did not help. I used so many vaginalets, it just did not help. Other STD – nothing found, went to tests.
    In July 2013, I went under operation of occult hernia. Repaired. (non mesh technique. In September 2013, went to EMG test of anal and urinar sphincter which showed both side lesions of pudendal nerve, both branches. Next step is to go to MR or MRN.
    So my symptoms are: burning in the anus after defecation, burning in the vulva and vagina during and after sexual intercourse, pain in clitoris and clitoral area after orgasm. Could I have PFD rather than PN?
    I would also like if you can give me some address and name of the PT person around my country? I am from Croatia, Europe. Thank you for your time!

    1. Author

      Dear Esthelle,

      I’m so sorry about all that you are going through. I am also sorry that without evaluating you I can’t tell you exactly what is going on with your pelvic floor. And again we do not know of any PT in your country. Is it possible for you to travel to France or the UK?

      All my best,

      1. Dear Stephanie,

        thank you for your kind reply. Do you have any address for a good PT in France and UK, or somewhere even closer to Croatia, like Italy or Slovenia? Thank you very much!

  59. I have an electrical shooting pain from my hamstring down to my heal. Chiropractors acupuncturists and PT’s have thought it was sciatica. MRI and other tests came up negative. I started doing ART (active release therapy) it wasn’t really helping. Then my therapists thought it might be a pudendal nerve issue based on all of my symptoms. Could the pudendal nerve somehow interact with the sciatic nerve? Or is it possible to have those symptoms just from the pudendal nerve? Thank you

    1. Author

      Dear RK,

      The pudendal nerve is very close to the sciatic nerve and they commonly become dysfunctional together. An MRI will not diagnose sciatica and the PN is not likely responsible for the pain down the leg. A pelvic floor physical therapist should be able to help you tell the difference.

      All my best,

  60. Dear Stephanie,
    About five years ago, my symptoms started with the feeling of a lump at the opening of my vagina, although there was no lump. It felt like there was an object there. Then a burning and aching feeling settled in. At times, the burning felt like it was as far up as my bladder. I constantly had the feeling that I had to urinate. But it actually burned worse AFTER my bladder was empty. Sitting also made it worse. I suffered horribly for a few years, and went to various doctors but could not get answers. Wonderfully, the past year has been pain free for the most part – I don’t know why. It would flair up whenever I strained during exercises such as weight lifting, but would feel better during exercise such as walking or playing volleyball. Why would that be? Unfortunately, out of the blue, my pain returned a few months ago. Even during the worst of times throughout this ordeal, I will have a day or two of NO PAIN. How can it come and go like that? Does this sound like possible PN?

    Your article gave me hope that PT could be my answer. Would you please recommend a pelvic floor PT in Colorado? I have insurance through Kaiser – do you happen to know of anyone in the Kaiser system? If not, I will go to anyone who can help me.

    Thank you so much for your article.

    1. Author

      Dear Kate,

      It’s not unusual for pelvic pain to be intermittent or to be caused by different athletic activities. It’s just the nature of the beast. After hearing your story, first I would say to be sure and rule out a bartholin’s abscess. We have had patients in the past who have had this issue but have gone undiagnosed simply b/c the abscess presented inward and not outward. Second, there are many pelvic floor impairments that could be causing your pain, not just pudendal nerve pain. So I can’t determine whether your symptoms are PN or not without evaluating you. I do recommend that you see a qualified pelvic floor PT. Below is a list of all the PTs in CO who have taken our class. Hopefully one of them can help.
      Also, read this blog post to get info on what a “good” PT session is like. All my best, Stephanie

      Hollenbeck Mary PTA Colorado Springs CO (719) 265-6601 [email protected] Orthopedic Rehab Associates
      Neujahr Hollie PT Denver CO (303) 260-5092 [email protected] Nishimota & Neujahr Physical Therapy
      Byrne Laurie PT Ft. Collins CO 9702211201 [email protected] Colorado Physical Therapy
      Gerig Nel MD Denver CO 3033889321 Denver Urology Clinic
      Brady Marie PA Denver CO 3033889321 Denver Urology Clinic
      Waliser Thomas MD Denver CO 3038301181 [email protected] Minimally Invasive Gynecologic Center of Denver
      Woodward Margaret PT Littleton CO 3037970988 [email protected] Motion On Main Street
      Nishimoto Terri PT Denver CO 7204023801 [email protected] N2 Physical Therapy
      Byrne Mary LaFayette CO [email protected] Advance PT LLC
      Eral Laura Denver CO (720) 394-9453 [email protected] Kaiser Permanente
      Fife Amy Grand Junction CO (970) 243-3061 [email protected] Western Colorado Rehab
      Fries Elizabeth Denver CO (303) 260-5092 The Pelvic Solutions Center
      Hoch Amanda Lakewood CO (303) 799-6336 [email protected] Providence Physical Therapy
      Klein Lea Denver CO (303) 333-3493 ext 1 [email protected] Cherry Creek Wellness Center
      Krum Laura Littleton CO [email protected] Providence Physical Therapy
      Larson Susan Broomfield CO [email protected] Coal Creek PT
      Mayerl Laura Colorado Springs CO (719) 365-1703 [email protected] Memorial Health System
      McIntire Veda Colorado Springs CO (719) 200-3544 [email protected] Memorial Health System
      Miller Jerri Louisville CO (303) 601-7495 [email protected] Pelvic Therapy Specialists
      Mueller Angie Denver CO (303) 799-6336 [email protected] Providence Physical Therapy
      Nangle Amie Denver CO (720) 402-3801 [email protected] N2 Physical Therapy
      Nichols Diana Denver CO (720) 493-1181 [email protected] Specialized Physical Therapy
      Raschke Kimberly Denver CO (720) 402-3801 [email protected] N2 Physical Therapy
      Ressler Mollie Fort Collins CO (970) 377-1422 [email protected] Momentum Physical Therapy
      Richardson Mary Boulder CO (303) 441-0452 [email protected] Boulder Community Hospital
      Wendt Debbie Littleton CO (303) 467-4127 [email protected] Exempla
      Wesley Michele Parker CO (303) 799-6336 [email protected] Providence Physical Therapy

  61. Fascinating article. I am a 35 year old male from the UK who has had some mechanical trauma via a poorly fitted bicycle seat during some long distance rides during the months of June-August. From the last 50 mile ride in the middle of August, I have suffered from severe pain or burning in perineum, testicles, penis, along with mild pain in lower back, pelvis & inner thighs. The tip of my penis became numb for weeks after the 50 mile ride along with constant ED but is now intermittently numb or tingly, along with some minor ED. A major concern is the cold & tingly sensation I get in my testicles & penis when sitting, lying down, or standing stationary for any short period of time. Moving around or holding the problem areas seems to get the blood flowing again, but walking around seems to then become painful in my perineum after a few hours & I cant ‘hold the problem areas’ out in public. The colour of the tip of my penis is going grey / white when cold & the skin is going a blue colour until blood flow is returned. I sweat a lot during day & night, which is unusual for me & I am so stressed out by it all & not sure how much longer I can cope after this, losing my long term relationship & my home all in this year. I am concerned that this will never be fixed as my doc keeps insisting I have CPPS & that any potential nerve problems cant be looked at for two years & by then they cant do anything about it anyway. Im also concerned that the temperature & colour changes to my penis could eventually mean my penis turning gangrenous & losing it completely! From that description, is it possible that I have PNE?

    1. Author

      Dear Andy,

      I’m so sorry about all that you are going through. First, I don’t understand what your doctor is talking about that “any potential nerve problem can’t be looked at for two years” that makes no sense to me. Unfortunately, it is impossible for me confirm or refute whether you have PNE. My suggestion is to immediately see a urologist and a neurologist. Bill Tayler is an excellent physical therapist in Edingburgh and may be able to direct you to a physician who can help. His email address is [email protected]. Also, Marie Eliot is an excellent PT in London. She may also know of a doctor for you to see. You can find her info on this website here:

      In addition, we see patients often whose pain started from bike riding. PT can often help.

      All my best,

  62. Thank You for such an informative article.
    When I think back, I have always had pelvic pains,seems as if they’re getting worse as I’m aging.
    I’m a 32yr old woman and I have 3kids
    I have been having a stabbing pain inside my vagina for a years now, the pain would be so painful it would wake me up in the middle of the night and it would dissappear as quickly as it came.
    A few months ago I started experiencing a weird sensation around my vagina and anus it was mild pain at first but now its so bad I can hardly walk when the pain hits me. Yesterday while I was sitting on a steel chair I could feel the pain starting so I sat on top of my bag which helped stop the pain from progressing.
    I’m now on painkillers(IBUPAIN;SANDOZ) to help me cope for now.
    I have discovered that a warm towel inbetween my legs sometimes help when the pain’s too much.

    PS:I’m starting to hate flying because it makes the pain worse when the plane’s taking off or landing.
    I’m in South Africa,East London. If you know of any Dr that’s in this town kindly let me know

    1. Author

      Dear Azola,

      I’m so sorry to hear about all you are going through. I would recommend that you see a pelvic floor PT. We actually have a list of PTs from South Africa who have taken our class. See below. In addition, the PT you see will likely be able to recommend a physician that might be able to help with ancillary treatments such as nerve blocks, medication, etc. All my best, Liz

      Avni Corina Cape Town South Africa [email protected]
      Berry Christy Ann Bloemfontein, Free State South Africa [email protected]
      Calvert Trish Parktown Gauteng South Africa [email protected]
      Katzman Ruth Cape Town South Africa [email protected]
      Loftus Tessa Stellenbosch (Near Cape Town) South Africa [email protected]
      Moser Bettina Parktown Gauteng South Africa [email protected]
      Raath Cecilia Pretoria (East) Silver Lakes South Africa [email protected]
      Street Patricia Edenvale Gauteng South Africa [email protected]
      Van Haweren Hester Johannesburg West South Africa [email protected]
      Van Vuuren Antoinette Jonsen Pretoria South Africa [email protected]
      Van Wyk Esta Bethlehem Eastern Free State South Africa [email protected]
      Vd Walt Ina George, Mussel Bay, Southern Cape South Africa [email protected]
      Venter Ilse Pretoria South Africa
      Verbeek Helene Pretoria South Africa
      Wilsdorf Annegret Cape Town (Northern Suburbs) South Africa [email protected]

  63. Oh Stephanie…. I am in tears reading this. That there may be hope for me, somehow, some way. I am 6 days out from rectocele, cystocele, and cervix removal. I have been having tremendous pain from the surgery that my physician (uro gyn) is acting like it is not normal. At first I thought it was just typical pain from surgery but as days go by I am realizing I am getting worse not better. I cannot sit straight down and am currently having to lay down for the most relief. But the most troubling part of this pain is when I go to have a BM. I get this shooting, stabbing pain on the left side of my perineum that shoots into my buttock. It will stop me in my tracks. Almost like a spasm. (This is consequently how I know I need to have a BM) and then the same intense pain happens every single time I am on the toilet to have a BM. Or to be honest.. On the toilet in general. When I urinate I have to lean forward with my hands on my knees in order to do it pain free. Unfortunately I don’t have the liberty of doing that with BM. I have been going through this for 6 days and I cannot imagine someone doing this for years! Do I have my urogyn fix this? A neurosurgeon? Please point me in the right direction.. I want this fixed. 🙁

    1. Author

      Dear Rachel,

      I’m so sorry about all that you are going through.

      I would recommend that you see a qualified PT. We see many patients like you who develop pain post-surgery. There are only two PTs that we refer to in GA; however, and I’m not sure if they are near you or not. If not, it would be worth it to travel to see them. Unfortunately, a lot of people are forced to travel for good PT. See below: All my best, Liz

      Howell Lone PT Auburn GA 7709955242 [email protected] Physiotherapy Associates Lawrenceville
      Hunt Jenny PT Alphretta GA 678-819-8720 [email protected] Provenance Rehabilitation of the Greater Atlanta Area

  64. Sorry.. Forgot to mention that I am in Woodstock, GA just north of Atlanta. (30188).

  65. Hi I wrote earlier about SSRI and PN. I have now been diagnosed with PN. When my PT palpates my right pudendal nerve it hurts bad and makes all the weird sensaitons I am having all the time. So she confirmed it is my pudendal nerve causing me all the trouble. I have had IC my whole life and always had urgency but it was only when I went on an SSRI for like 3 weeks did all this go crazy and I got all the PN symptoms along with my IC symptoms. My question is could the SSRI cause some type on central sensitization issue or chemical imbalance in the brain? Does anyone else on here have PN or IC that was made worse by or caused by SSRI use? Currently I take Gabapenitn with some relief. Thanks Kellie

    1. Author

      Hi Kellie,

      To my knowledge I have never known anyone to get an increase in neuropathic pain and/or more centralized pain after starting a SSRI. SSRIs have not been shown to be very effective in treating chronic pain like SNRIs or tri-cyclics have, but they should not increase pain. I hope this answers your question.



      1. i have been diagnosed with pn and pne. i have received steroid shots for symptoms. i have also been prescribred ssri’s and snri’s, both of who made symptoms worse.

        i have also been diagnosed with rls and pgad(or rgs. ssri’s and snri’s aggravate and worsen both rls and pgad.

        i wonder if there is an as yet unidentified link among these three very painful, disturbing problems and if so, is it possible that ssri’s/snri’s could also worsen pe/pne?

        just another aside: trazadone is a drug which absolutely worsens pgad. i wpuld be very careful about prescribing or taking it.

        1. Author

          The symptoms of PN and PGAD are typically caused by multiple factors, including the musculoskeletal system and a central nervous system processing dysfunction. There is not evidence to suggest that SSRIs or SSNRIs make the symptoms worse.

  66. Can you recommend any PTs that could help with a PN/PNE diagnosis in our area? We are finding little resources exist in Utah.

  67. Thank you for the article, very informative. Can you suggest a pelvic floor PT close to Everett Wa. I have been suffering with pn symptoms for two and a half years. It’s been miserable. Can they help me because I have no rectum. Taken out 23 years ago because of ulcerative colitis…Thank you Robert

    1. Author

      Dear Robert,

      Because I am not sure exactly where Everett is I’m going to send you all the PTs that we refer to in WA. See below: To your second question, I do believe a PT can help you even though you no longer have a rectum. All my best, Stephanie

      Costello Kristen PT Federal Way WA (253) 944-4026 [email protected]
      Franklin Elizabeth PT Maple Valley WA (425) 413-4425 [email protected]
      Khadduri Lucie PT Lacey WA (360) 456-3300 [email protected]
      Pazier Shannon PT Tacoma WA (253) 202-4838
      Sieber Carrie PT Seattle WA (206) 354-9590 [email protected]
      Vora Sagira PT Bellevue WA 4256885900 [email protected]
      Gerber Nathan PT Othello WA 7083013102 [email protected]
      Ferguson Carol PT Gig Harbor WA 2539852807 [email protected]
      Wallace Kathe PT Seattle WA 2065272800 [email protected]
      Gaddis Pamela PT Bothell WA 4254834270 [email protected]
      Reicher Rebecca PT Seattle WA 2069859442
      Nelson M. Quinn PT Dupont WA 2532849800
      Wheeler Claudette PT Poulsbo WA 3607793777 [email protected]
      Caples Kathleen PT Seattle WA 2064471570 [email protected]
      Allen Tina PT Seattle WA 2065982889 [email protected]
      Maas Peg PT Seattle WA 2062156596 [email protected]
      Tolcott Jane Vashon WA (206) 744-1675 [email protected]

  68. I have been struggling for nine months with pain and symptoms of PNE. What kind of doctor diagnoses this as I have seen so many and have been doing pelvic floor therapy for months. I have also had an epidural block and had some relief but it was short lived. I need to get to the right doctor in the new york area and the right therapists. Any help would be greatly appreciated!

    1. Author

      Dear Nina,

      There is a small group of pelvic floor specialists around the country, typically they are gynecologists, urologists or urogyns.

      The pelvic floor PT that we refer to in NYC is Stacey Futterman. Here contact info is below. She may be able to give you the name of a physician. All my best, Stephanie

      Futterman Stacey PT New York NY (212) 226-2066 Five Point Physical Therapy

      1. Thank you for you response. I have been doing research all day with a friend. I have also found a pain management doctor in manhattan that specializes in various pelvic floor dysfunctions. His name is Dr. Kenneth Chapman. Has anyone heard of him? I have an appointment scheduled for next week. I will also follow up with your reccomendation. If anyone else knows of any other physicians or therapists in the tri state area please let me know.

        Thanks again!

  69. Dear Admin.
    can you refer a physician and physical therapist around Lafayette La.
    I am having tons of trouble getting group coverage to understand why I would need therapy.Dr I see have written letter.They give me therapy once a month for 6 months. Or possibly send me information to present to them.

  70. My pelvic pain, burning, itching, and redness all started this past July. I was diagnosed with bacterial vaginosis twice, cervicitis, and a candida glabrata infection. All treatments did not take my external symptoms away. My last culture came back negative but still my symptoms persist. I’m now pregnant (only about 4 weeks) and am scared that there are no safe treatments for this during pregnancy. I never had a vaginal infection prior to this vicious cycle of chronic infections. I’m not sure what I did wrong or different to cause this awful mess. I cry all the time and I’m so scared that I will never get back to normal. I live in Pittsburgh.

    1. Author

      Hi Riley,

      I’m so sorry to hear about all that you are going through. I did send you the name of a pelvic floor PT in your area and I think getting an evaluation from her will be a great idea. We do treat pregnant patients, but not all PTs do. Please let us know if you need another recommendation. We do see many patients whose pelvic pain is kicked off by vaginal infections and they do very well in PT. You will get better!

      All my best,

      1. Thank you so much for responding! I scheduled an appointment with a pelvic floor physical therapist that you recommended on Monday. I’m looking forward to getting an answer and relief.

  71. Dear Admin,

    My husband has a majority of these symptoms. We have been to urologist and back specialists who are at a loss for what to do. He has a very slight bulging disc at L5-S1 in which we just had a nerve block/steroid shot for, on the outside chance it would help. It did not. We are trying to figure out what to do next. Would you know of a doctor or a physical therapist in Arkansas that would be able to help us?

    Any help would be greatly appreciated!



    1. Author

      Dear Lori,

      We do know of a PT in Arkansas. See her info below: She may know of a doctor who is knowledgable about pelvic pain.

      Gibson Mitzi PT Little Rock AR (501) 224-5454 [email protected] Advanced Physical Therapy

      Also, here are two articles that your husband might be interested in reading, one is on male pelvic pain and the other is about pelvic floor PT:

      All my best,

  72. Thank you from the bottom of my heart for putting a spotlight on pudendal neuralgia issues/pelvic floor pain issues!! I woke from pelvic floor reconstruction surgery in Oct. 2006 in unbearable and excruciating pain mainly on the left-side of my groin, rectum and the inability to lift my left leg(initially needed due to a very troublesome rectocele, but upon examination from the regional “master surgeon”, I also had a cystocele and vaginal vault prolapse). I was told it was normal, I must have a low pain tolerance, then my surgery was very involved and difficult and I needed to give my body time to heal. Some symptoms eased, but never went away especially pain with BMs, sitting “too long” (more than 10-15 mins), standing too long, walking to long(especially if there was any kind of incline), pain with intercourse and some others. Since I described a lot of rectal pain and pain between vagina and rectum, I was sent to my GI by my PCP (since the Uro/Gyn surgeon wasn’t at all helpful). After a colonoscopy, a defagram and a MRI, my GI referred me to Mayo in Jax. There I saw a colonrectal surgeon, who immediately said I needed a different MRI and to be referred to the Gyn dept. There I was told that I had a recurrence of my rectocele, but wasn’t a candidate for additional surgery though I was a good candidate for a study they were doing for trigger-point injections to relieve pelvic floor dysfunction/muscle-spasms. I was also referred to a pelvic floor pt. Though the extremely painful procedure of at least 6 trigger point injections delivered through the vaginal wall was not helpful and once I reported back to the doctor that I experienced no relief, I never, ever could get the doctor to call me to discuss the next move for my treatment…the pt was a lifesaver. She asked for my surgical notes so she could consult with a pelvic floor pt specialist she had trained with and I obliged. At my next appointment, she told me that upon consulting said specialist, that it seemed (based on her findings of her internal exam of me and reviewing my notes) they were in agreement that I should return to my original surgeon and that he should be able to release a stitch or the mesh that was pulling on my ligament that the pudendal nerve ran through. I made such an appointment and explained what I had been going through…was honest about seeing GI and the 2 doctors at Mayo…and told him that since he was familiar with my case that maybe he could help me with eliminating my pain. His response…he had no earthly idea why I was having pain and maybe I should see a colonrectal surgeon and he’d make a referral and wished me the best of luck!! I never got that referral, but based on the info the pt provided I started searching online and found Dr. John Miklos in Atlanta. He asked me why it had taken me so long to get help and I explained the road that lead to him…he was flabbergasted, but not surprised. His internal exam about sent me flying off the table because of the pain when he pressed on “a tight band” that ran along the left side of my vagina…the mesh was too tight. He did mesh removal surgery, but cautioned me that since the nerve had been compromised for over 3yrs, the nerve damage could be permanent. Sadly, I received no relief from that surgery. I’ve since had another surgery to remove most of the remaining mesh, I’ve had CT-guided nerve blocks done in my low back, PN nerve blocks done, I’ve seen a GI/Neurologist would also diagnosed rectal disinertia (not sure of spelling, but that the muscles were working against each other “making it like pooping against a brickwall”, thus an inoperable rectocele), and nerve damage to about half the nerves required to have an effective BM. I would love nothing more than to be seeing the PT I had been seeing, but can’t because I can’t drive the hour it takes to get to Savannah. But you may like to know the name of this PT, which is Cathy Ey and she works at Memorial Medical Rehab Ctr in Savannah, Ga. Also, my 3rd surgeon is Dr. Brent Parnell in Augusta, Ga and one of his offices is at what was formerly Medical College of Ga (can’t think of the new long name), but he also has pelvic floor PTs that he works with in Augusta.

    Also, Beaumont Medical Ctr in Royal Oaks, Michigan has a Dr. Kenneth Peters in the Urology Dept of their Women’s Center that is making strides in relieving pelvic pain issues with Pudendal Neuromodulation, as well as what sounds like a wonderful pelvic pain multidisciplinary team which includes pelvic floor pt and guided imagery for relaxation.

    I wish there were more medical professionals that took a sincere interest in helping others like myself, especially more that were closer to where I lived thus making it more accessible for me to get more assistance with my health issue. More professionals like yourself and your colleagues are needed in more areas of the US!!


    1. Author

      Dear Suzanne,

      I’m so sorry about all that you have been through. You are not alone. So many women have suffered similar complications due to mesh surgery. In fact, next week we will be publishing a Q&A featuring two gynecological surgeons who do many mesh repair surgeries for that very reason. I hope that you will not give up on your search for relief.

      All my best,

    2. Your story is very similar to mine. Have you had any relief in the last months? I certainly hope so and I’m glad to have “met” someone who has been through an experience like mine.

    3. Dear Suzanne, Your story is so similar to mine. I finally got some longer lasting relief. I had pudendal nerve ablations in January. It took about 2-4 weeks for relief to start to come and 6 weeks for about 50-70% pain relief. It’s May and I still feel good. I’ve been able to make better progress in physical therapy and my PT is impressed with how much it has helped. Dr Chris Russo at Javery Pain in Grand Rapids, MI is the pain doctor who I saw and will see again for this procedure. I hope that you have found some relief and don’t need this info, but if you do, it’s here. Take care! Brenda

  73. Thank you so much for this wonderful article! Very informative and extremely useful to understand this debilitating condition.

    Do you know of a doctor who performs Botox injections into the obturator internus in the northeast? I have confirmed obturaror internus muscle spasm (through a neurography) and the doctor who did these injections for me in the past retired. The pain is back and I really need to find a doctor who has experience in doing these procedures. I desperately need to find someone in MA preferably, or NH, RI, CT or even NY.

    Thank you so much for your efforts in helping all of us patients. We all appreciate it immensely.

    1. Author

      Dear Jane,

      Thank you so much for the kind words!

      I’m so sorry, but unfortunately I do not know a MD who does Botox injections in the northeast. I would recommend asking a pelvic physical therapist in your area. She would probably be your best resource. Below are two PTs that we refer to in MA; perhaps one of them can point you in the right direction. All my best, Liz

      Wade Marie PT Framingham MA (207) 779-2256

      Lewis Elizabeth PT Gloucester MA (978) 761-3149 [email protected]

  74. I think I may have a pudendal nerve issue. I have been in touch with Dr. Conway and am anxiously awaiting a telephone consultation with him. Is there anyone “out there” who can guide me – I want to see my PCP and try to get some tests ordered BEFORE seeing a gynecologist. (I found one in center city Phila (PA) and have an appointment on 1/31/2014). I feel as if I am so close to getting answers but the waiting is horrific.

    1. Author

      Dear Joy,

      I’m not sure what you really mean by “guide” you. Have you seen a pelvic PT? What type of tests are you going to get from your PCP? Have you seen your regular gyn? I’m sorry, but I don’t have very much information to go on. In any case, I’m sure Dr. Conway will call you soon.

      All my best,

  75. Hello!

    I am so happy that I came across your article! I am a young women who has been experiencing the sharp stabbing vaginal pain described here since I was a kid. The pain can occur randomly or during physical activities such as running. I also find any sort of insertion or contact unbearably painful– seriously a q-tip will leave me crying. I had a leg length descrepency of 3 inches ( even after lengthening one leg is shorter by a little over 1/2 an inch), and I also have dysautonomia which causes abnormalities within the autonomic nervous system. Do you think I could be experiencing PN, and if so could you recommend anyone in Texas?


    1. Author

      Dear Stella,

      I can not say without examining you what is behind your symptoms. But you do sound like a good candidate for PT. Where are you located in Texas?

      1. Primarily in the Austin area but I would be willing to travel to Houston or Dallas if need be.

        1. Author

          Dear Stella,

          There is actually a very good PT in the Austin area who I have shared a patient with in the past. Her info is below. All my best, Liz

          Sauder Sara PT Austin TX (512) 335-9300 [email protected] Sullivan Physical Therapy

  76. Great article!! My story. Stress fracture, sacral ala mid-August this year. Not diagnosed until Sept. Occurred on vacation alone and used towels to support butt in car as I drove for hours and days after break…maybe compressing something then. Rested some after mri in early Sept. showed break…and then limited lifting and bending. Returned to work (teaching) early Oct. standing brought on distinct and progressively prominent “poking” feeling in left rectum, which kept increasing over time. Ignored it and it kept growing. Started to bend again at waist as I grew stronger around the bone. Early Nov., started to have spreading superficial allodynia/hyperalgesia on left labia while sitting at choir (hard seats..3.5 hours) that persisted after rehearsal. Began to guard against sitting. Regardless, started to have more discomfort sitting. Appointed to new public service committees. Nov. 20th sat in evening meeting for three hours. Tried to fidget…but could feel more symptoms in “front”. Next day, all forward bending brought on “tractioning/pinching” feeling of excruciating pain in urethra/vaginal area..wall. Symptoms increased rapidly since then. Now rectal lump sensation always there but ignorable. Urethra/vaginal pain disabling and posturally crippling. Can not sit (at all) and can not drive. Tried to sit through Thanksgiving dinner and was in sheer agony and sideways. Can not get inflamed “crotch” to settle any movement and even lying down irritates it. can not sit or do any bending. Live alone and now in just a few short weeks can not work, drive, take care of house etc. or socialize. Have been reading about PNE or PN for weeks. Horrified and distressed that no solution exists. No physicians here understand it or do surgery. My question: does pelvic pt help even if you do have an entrapment as I may on that broken sacrum side? Do drugs like neurontin, Lyrica, Cymbalta help, and most important….can I do something myself (short on traveling on my back I guess to Arizona, anew Hampshire or France for surgery that I’ve yet to read helps) to “fix” my “entrapment” (which seems impossible to diagnose) or my neuralgia/neuropathy? The unrelenting pain in my urethra is literally killing me. Also and new, my legs now are weak and ache when I stand…as if the neuropathy has spread down my leg. Is there hope?? thank you!

    1. Author

      Dear Rachel,

      I’m sorry to hear about all you are going through. Yes, there is definitely hope. You need to go and see a good pelvic floor PT and also a physician who can prescribe any medication that might help you. Where are you located? Perhaps we can give you the name of a PT in your area.


  77. thank you!!! I will contact them. can’t thank you enough for this webpage and for helping us all!

  78. I have a prolapsing bladder (it is still inside) and Interstitial Cystitis. I was off my Elmiron for about a year, but my urologist thinks my new, periodic urinary urgency could be a flare up of the IC so I have restarted it. I used to take Cymbalta and Lyrica for nerve damage following an ovary removal and it worked great. I have had a few very brief episodes of clitoral pain this past year, and tonight it has lasted for seven hours. I saw in your wonderful article that Lyrica and Cymbalta have been know to work for PN. As one of the symptoms of PN is clitoral pain, is it possible that those medications could work to end or lessen my clitoral pain? I greatly appreciate your taking to time to read my questions and thank you for helping in any way you can. Also, I live in a tiny town called Yuma, in Arizona. I have seen specialists for various things in Phoenix and the San Diego area, as there is no one here who has more than a basic gynecological practice.
    Thanks again,

    1. It’s Shannon again. I also have a coccyx that continually gets misaligned, and I don’t know if it’s because of that or my nerve damage or the IC, but I’ve started having sharp pain down the inside of both my thighs, and my left labia has the same tingling pain I had after the surgery that caused the nerve damage. Thanks again.

    2. Author

      Hi Shannon,

      I’m so sorry for all that you are going through. We do know of patients who have tried those medications with success for their clitoral pain.

      All my best,

  79. Wonderful article!
    I have a question. Around year ago after some yeast infections and prolonged sitting periods I started feeling burning around my anaus/vulva. Since then the pain covered my thighs and after a few months I got a lot of muscle pain (I am sure it’s because I continued long sitting hours hours because the pain increased with sitting, every week was worse until the point I had to give up my work). It was around 2 and half months ago. Since then I am not able to sit for any amount of time. I found a pelvic floor Physiotherapist in London and she’s worked with me since then every week. She said I had shortened and tight muscles, and some fascia restrictions with a lot of trigger points. We have worked only externally. Once intravaginally made my burning extremely bad for a couple of days. also do stretching exercises – 3-4 times a day. I do some walking too. I have been diagnosed recently with both sides piriformis syndrome by some other physio. I am worried because I don’t see any improvement with my ability to tolerate sitting (after one minute I sit my pudendal burning increases so much and that worsens my piriformis syndrome very much). In the beginning of our treatment I only had problems on the left side, but the right side has been bad for some time. For most of a day I stand, but my legs are getting really weak. Worth mentioning – there are better days when my muscles are not so bad and then I don’t get almost none nerve burning pain, but whenever I have muscles pain my burning (neiropathinc pain) increases too. I had anal cryptitis and fissure surgeries a couple years ago, but MRI doesn’t show anything now apart of ovarian cysts.
    I am a bit of reluctant to take medications ( I am on baclofen and tiny dose of Lyrica, but they give me constipation and I am tapering the doses). Also I have a feeling i want to do it on my own without meds. But maybe I am not correct. I am also afraid of the nerve blocks. I am so over sensitive now. It seems like the pain is spreading. I try not to give up but even I do everything I can I don’t see much hope. Would you have any advices of what I can do?

    1. Author

      Dear Bunny,

      I’m sorry that your suffering. It’s quite difficult for me to make recommendations on what kind of treatment to pursue since I haven’t evaluated you. However, for most complex pelvic pain, I would recommend a combination of physical therapy, behavior modifications (limited sitting, or using a cushion, for example), and pain management (medications, possibly trigger point injections, possibly botox, possibly nerve blocks). These treatment options are fairly benign, meaning, they likely won’t make your symptoms worse.

      All my best,

  80. Any place I can go in Calgary, Canada for help.
    Prior to having Laproscopy surgery for Hiatial Hernia in
    Oct.2013 I have had constant pain or burning sensation around
    my Anus and Vagina. I have had seven different types of pain
    medication with none of them helping at all.
    Infection has been ruled out so I believe it is some kind of nerve damage. Before my surgery nothing like this existed.
    About a week after the surgery is when the burning began.
    Would like to hear from you ASAP as the situation is very
    Thank You

  81. Hello Stephanie.
    Thank you SO much for the work you do
    I am 62 and 5 yrs ago had surgery for a Tehered Spinal Cord
    Following this rare surgery in adults and lucky enough to be here in Louisville with a surgeon who could work with Tethered Spinal Cord, I was diagnosed with PFD, PN and Valvodinia..
    This week I learned from my dr visit that the vulvodinia is managed well using a compound medicine and other self care.
    I am looking for a new Dr in Louisville, preferably a woman who could help me with PN as the pain is in my right buttock muscle and sacrum area, with rectum spasm and constipation and I am concerned to have someone who encourages acupuncture and a personalised medivine dose.
    The nerve block seems only to irritate the nerve more
    Again, thank you for all the work you do.

    1. Author

      Dear Theresa,

      I’m sorry, but we don’t know of a doctor who specializes in pelvic pain in Louisville; I would recommend that you join the online group Happy Pelvis and pose your question there. The members are from all over the state and someone my have a recommendation for you.

      You can find HP here:

      Also, there is a PT group in Louisville that specializes in pelvic floor PT; perhaps they will have some info for you. The info is below:

      Dunn Susan PT Louisville KY (502) 899-9363 [email protected] Dunn & Associates Physical Therapy


  82. This was very interesting and informative.
    I am going to a pain clinic for chronic pain which no one seems to know what is causing it. I have pain on the right side only of the vulva area and the uretha. It hurts when i sit or stand for long periods and when i step down with my right foot. The pain is usually stabbing but know it is mixed with burning too. I have tried traditional medications but they don’t really work. I am going to have a nerve block shot, but now that i’ve read this i don’t have much hope that it will work. Does this sound like a pudenal nerve issue. If so can you recommend a doctor in the chicagoland area that deals with this. This pain is never endind and it affects my whole life.

    Christi Parra

    1. Author

      Dear Christi,

      I’m sorry about all that you are going through; however, there is some good news: you live in a city that has one of the best community of providers treating pelvic pain in the world. The two providers that I would recommend are Dr. Colleen Fitzgerald (she is amazing) and Rhonda Kotarinos, who basically developed pelvic floor PT and is also amazing. There info is below:

      As to your question about whether your symptoms could be caused by PN; I’m sorry but without evaluating you there is just no way for me to answer that question; there are many many issues that can cause pelvic pain and it’s to your medical team to pin them all down.

      All my best,

  83. I just had an MRI that shows entrapment of my nerve and my main symptom is increased sexual arousal is there hope for fixing this and if so by what method?

    1. Author

      Dear Reader,

      An MRI can not show entrapment of the pudendal nerve. I would give this blog post about PNE a read as it explains how it is diagnosed.

      In addition, I would recommend that you see a pelvic floor specialist and a pelvic floor PT; where are you located? Perhaps we can refer you to someone in your area.


  84. I have many of the symptoms listed in your blog. I have been treated for a labial inflammation and asymptomatic UTI with no relief in symptoms. I have also been prescribed Neurontin 100 mg TID. I have been treated by my PCP and my OB/GYN. PCP believes I have vulvadynia while OB/GYN feels my symptoms are all related to menopause. However, I have been menopausal for 9 years with no symptoms. Symptoms only began after the company I work for demanded I get healthy with jogging, cycling, walking,etc 12,000+ steps a day. My symptoms started after 1 week of riding an exercise bike for a couple of hours each night. I would literally get off the bike and have an absolute numb butt. I have a constant dull ache which feels better if I lay down or put pressure against the clitoris. Would PT benefit me? If so, could you recommend one in central North Carolina?


    1. Author

      Dear Kathy,

      Below are all the PTs that we refer to in NC:

      Wegmann Emily PT Raleigh NC (919) 571-9912 [email protected] Carolina Pelvic Health Center
      Blue Paige PT Southern Pines NC (910) 235-2713 [email protected] Pinehurst Physical Therapy
      Young Wilda PT Greensboro NC (336) 275-6380 [email protected]
      Casciere Michael PT Greensboro NC 3366841187 [email protected]
      Briggs Jennifer PT Raleigh NC 9195719912 C.A.W.H. Rehab


  85. I began experiencing severe pain in my left side and extreme urinary symptoms (urgency and frequency) 7months ago. I was treated for urinary infection, uretheral syndrome for 3 months, but nothing helped. At the original visit for my symptoms the urine was not cultured so the diagnosis was difficult when I went to a urologist. The symptoms got much worse after my period. My GYN decided that the uterus was prolapsed and as things “swelled” each month it was pressing on my pudendal nerve. I had a vaginal hysterectomy this past August. After I got passed the pain from the surgery these symptoms subsided. In October I developed a yeast infection and have taken 20 diflucon at this point to clear it up. Now I have begun experiencing burning in the vaginal area and some discomfort when sitting. My GYN prescribed amitriptilyn (10mg) daily. I began taking these 4days ago. My question is….could this pain be a temporary side effect of the hysterectomy? or a chronic issue?
    Thank you

    1. Author

      Dear Lisa,

      I’m sorry about all that you are going through. However, it’s impossible for me to answer your question. I will say that based on your history: surgery and a long lasting yeast infection (were you cultured for the yeast infection? Pelvic floor issues often mimic a yeast infection) you very well may have developed pelvic floor impairments, such as tight muscles and or trigger points. My best advice to you is to see a pelvic floor PT. Where are you located? Perhaps we can refer you to one in your area.


  86. I am 68 years old, was diagnosed with MS at age 35. Have had very little trouble until about 8 months ago when I developed trigeminal neuralgia. i took tegretol which helped, but began to have epigastric pain, so discontinued it. One day, after exercise in pool (leg splits in and out, and back and forward), I came in and was struck with sudden, severe, vaginal and rectal pain. It then localized to rectal pain, which I have had for 4 months. Had EUS with diagnosis of gastritis, chronic pancreatitis, H pylori.
    Gastro dr. said I would just have to suffer and take tramadol. Have found a pain management dr. and am on tramadol 100 mg twice a day and 500 mg neurontin three times a day and clonazepam .25 mg at bedtime. Colonoscopy was normal. Pain in rectum can be severe and hurts more on left side of rectum. Don’t know what to do next. I am a retired nurse, and have searched for an answer as to what my diagnosis is. Do you have any ideas? Could it be connected to MS, or did I pull something the day it started? I would appreciate your input.

    1. Author

      Dear Marion,

      I’m so sorry to hear about all you are going through.

      I’m sorry but without evaluating you I can’t tell you what is causing your pain; if you read our blog, you’ll learn that there are a myriad of issues that can cause the type of symptoms you are having. I would recommend that you visit a pelvic floor PT in your area. Where are you located; perhaps we can refer you to someone near you.

      All my best,

  87. Have stinging sensations on buttocks and thighs after period. Bruised feeling in groin at times too. Lasts a couple of days.
    Was diagnosed w/ cystocele and rectocele and am awaiting surgery. Would I benefit from PT instead? If so, I live by Salina, KS. Are the symptoms related to diagnosis?

    1. Author

      Hi Lisa,

      We recommend that patients in your sitation seek conservative forms of treatment prior to any invasive procedure. Pelvic physical therapy can help you to strengthen your muscles in order to prevent a further collapse of the organs. Additionally, there are other non surgical options such as a pessary or sling that can help keep the organs in place. However in cases where the rectocele, and cystocele are severe, surgery should be an option to consider. Below are the therapists that we recommend in KS.

      Rose Lott, PT
      Rebound Physical Therapy
      (785) 271-5533

      Heather Shire, PT
      Lawrence Memorial Hospital
      (785) 760-1850

      Lindsay Voight, PT
      Saint Luke’s Hospital South
      (913) 317-7341

      All my best,


  88. Hello, I am male and have suffered pain in the perineum for years but lately it is getting worse.It is stabbing, sharp and nasty ! My doctor takes no notice when i mention it .No idea what to do now.Cant afford to go private.

  89. Thank you for this article. I am currently researching different aspects of my pelvic pain. I have received a nerve block to three pelvic nerves- the hypogastric, ilioinguinal, and genitofemoral. This has resulted in a reduction of some of my pain. I have noticed after these blocks that I also have burning, and some sharp pain in the areas innervated by the prudendal nerve. I have not yet been diagnosed fully. I am awaiting a surgical consult to rule out endometriosis and adenomyosis. My pelvic pain gets worse with menstruation and during menstruation I am having labor like pain. I am wondering how often the prudendal nerve is implicated with endometriosis. How do you differentiate between pelvic pain caused by endo and adeno vs other reasons for pelvic neuralgia? Thank you. Your help would be appreciated.

    1. Author

      Hello Mary,

      To answer your question, I will need a bit more information. From your original post, you don’t reference receiving treatment from a pelvic floor physical therapist. Has internal manual therapy been part of your treatment?



    1. Author

      Dear Donna,

      The info for the PT that we refer to in Oak Park, IL is below. Best, Liz

      Markett Kristen PT Orland Park IL (708) 671-1971 [email protected] Flexeon Rehab

    2. Author

      Dear Donna,

      We do not know of a PT in Oak Park; however there is an amazing PT in Chicago that is worth the drive; she is one of the best in the biz!

      Her info is below:

      Kotarinos Rhonda PT Chicago IL (630) 620-0232 [email protected]


  90. Hello

    I had bilateral surgery for pne in Nantes France in 2003. This folowed a period of over a year of loss of sensation/orgasm and pain in the perineum and genital area. After surgery I got pretty much 100% better. I got on with my life and I no longer needed my thoughts in that area. However at Christmas I stupidly exercised too heavy (parallel squat) with poor form and I also lost my job. I have had some malfunction since e.g. burning in anus, ed, constipation, and a feeling of congestion in the perineum/pelvic floor. I dread to think i have got pne again. I have been very run down. Please advise.


    1. Author

      Dear Gary,

      I’m so sorry to hear about all that you are going through. Without evaluating you, however, it’s impossible for me to give you insight into what is causing your symptoms. I recommend that you see a qualified pelvic floor PT for an evaluation. Where are you located? Perhaps we can recommend one to you in your area.

      All my best,

  91. Wow, what an enlightening article. 10 weeks ago I had pelvic reconstruction surgery without any mesh or porcine grafts at all. I’m still having a lot of pain and discomfort with everything actually, especially sitting or standing. That doesn’t leave a lot of room for living. I thought I was just still healing until things seemed to be getting better and then suddenly took a turn for the worse. I don’t think it’s normal to start feel worse when you’re healing? I went to PT for the first time today. She said it was definitely pudedal nerve. She said if it was caused from the pelvic region then she could help me, but that if they hooked my nerve while tacking up an organ, then her work would not be helpful. I was hopeful until I read your article. Now I feel certain I have PNE. When I woke from surgery, I was screaming in pain. I even asked why I was the only one in the recovery room that was screaming and crying. They doubled my pain med and it dulled the pain a bit, but did not get rid of it. Seven days later, in the doctors office, when they touched my pelvic in one area that had not even been cut, I felt extreme burning pain. That area still hurts today – I found out just how much today in PT! I don’t have pain with a BM, but I do have pain afterwards. Lots of pelvic pressure and heaviness and a most certain feeling of prolapse again, although they tell me there is no prolapse.

    Does this sound like PNE to you? If so, is there any chance of recovering without surgery? Is surgery always successful? Who does this type of surgery? Is it very dangerous? Is one procedure the culprit, or could PNE be caused by any pelvic repairs (I had them all except for enterocyle).

    You mentioned respiratory problems being associated. I have had respiratory problems since surgery (stridor and gasping for breath is one symptom, and it is involuntary and happens a lot while sleeping. Shortness of breath is another symptom.) Could these really be associated with pudenal nerve?

    The plan for now is more PT and watch for improvement. Your thoughts and input would be greatly appreciated. I need all the help I can get and it’s so hard to find people that understand this problem. Thanks.

    1. Author

      Dear Marie,

      I am so sorry about all that you are going through. I understand how frustrating and scary all this can be. But, I’m sorry, there is just no way for me to speculate about the causes of your pain without evaluating you myself. That’s because there are countless impairments/issues that can cause your pain. As far as PNE and the decompression surgery goes, I recommend that you read this Q&A series that we did with the two top surgeons who treat the diagnosis; I believe these blog posts will answer all of your questions about PNE and the decompression surgery:

      All my best,

    2. Author

      Dear Marie,

      I’m so sorry about all that you are going through. I know how frustrating pelvic pain can be. I’m sorry, but even with this description of your symptoms I can not speculate about what is causing it. That’s because there are many issues and even combinations of issues that can cause the symptoms you are describing. That said, we have recently posted two blog posts about PNE/the decompression surgery by two of the top surgeons treating the diagnosis that I believe will serve to answer the questions you asked about them. Take a look at them below:

      The physicians quoted in the articles are among the best in the business, so if you’re looking for a physician consultation they are a good place to start.

      All my best,

  92. Think you for your reply Stephanie. I read the entire interview blogs while you were responding. They answered a lot of my questions. Unfortunately, there are questions that they admit there are no answers to.

    You give me a bit of hope. I felt like I had certain PNE given that my symptoms are a result of surgery and because I awoke from surgery in such pain. Sounds like you believe there is non-surgical hope for me. With PN there is a good chance of 100 % recovery, right?

    Is it abnormal to awake in the recovery room in intense pain?

    1. Author

      Dear Marie,

      With the proper treatment approach, yes, patients with PN do get better. As for waking up in the recovery room in intense pain, that’s a hard one for me to answer. I would say it depends on the surgery and the patient’s condition. But, we do see many post-surgical patients here at PHRC. Best, Stephanie

  93. Hello,

    For the past month I have been experiencing episodes of sharp pain that seem to come and go. I have seen my regular doctor twice, as well as a gynecologist, and in the midst of all the confusion, I am just hoping to receive some answers. After evaluation, the gynecologist indicated that he believed the source of my pain to be coming from my pudendal nerve. My regular doctor seemed dumbfounded by the symptoms I was presenting her with, but thought it sounded nerve-related, so she believed an MRI would be my best bet (as well as prescribing muscle relaxers). However, the MRI was later denied by my insurance company.

    I am only 22 years old, I don’t recall injuring myself, or doing any sort of activity that could have triggered this pain response from my body. I am incredibly nervous, and am looking for some help. I guess I am looking for something positive to keep my spirits up, since most posts I read regarding PN are incredibly pessimistic. Do you think since my symptoms have only been present for a month that I may have a greater chance of positively responding to treatment? I was also wondering if you knew of any doctors in the New Jersey area (I live in Northern New Jersey) or any specialized physical therapists who can help me with my pain? Any help would be greatly appreciated! Thank you so much



    1. Author


      Yes, the fact that your symptoms are only a month old and your youth are two things that are very much in your favor as far as making a complete recovery. Steer clear of the scary PN posts! First of all, PN is a symptom not a diagnosis. Second of all, there are many issues that could be causing your pelvic pain other than an irritated pudendal nerve. A good pelvic floor PT can do a complete evaluation and let you know if there are any findings that could be at the root of your pain. Below is a list of PTs who took our course in NJ. All my best, Liz

      Herzig Niva MS,PT Englewood NJ 201-568-5060 [email protected] Core Dynamics PT
      Besante Jamie PT Beachwood NJ (609) 978-3110 [email protected] Southern Ocean Medical Center
      Dela Rosa Michelle DPT Columbus NJ (609) 379-0900
      Ryan Angela MD Englewood NJ 2015672277 [email protected] Physical Medicine and Rehabilitation Center
      Ely-Maskal Nancy PTA Englewood NJ 2015672277 [email protected] Physical Medicine and Rehabilitation Center

      1. Liz,

        Thank you so much for delivering a resourceful response in such a timely manner! My gynecologist gave me a prescription to have a transvaginal ultrasound preformed, (because that is a necessary step in order to have an MRI done). Do you think this is necessary? Or do you think I should forego this step and contact Angela Ryan MD for an evaluation (as she might have better insight regarding my symptoms)? Again, thank you for the information, and support, it is greatly appreciated!



  94. As I am sending you this email, I am down on my knees in front of the computer and I have been on them several times praying for relief. My viginia burns and hurts all the time when sitting or laying or any kind of compression. I have had this ever since my first child was born. I think the nerves were damaged during childbirth. Please advise me as to where I could go for a diagnosis. I live near Jackson, MS or Hattiesburg, MS. My life is not worth living like this.
    I have been all around my area trying to find some doctor that could help me. No doctor has ever suggested for me to see any any other doctor. Please help


    1. Author

      Hello Hilda,

      I am sorry to hear about your situation. It is difficult to say whether or not your symptoms are related to nerve damage. Your nerves may have been irritated during labor, but it is also likely that impairments in your muscles, and joints are also contributing to your pain. We do not have a recommendation for therapists in either Jackson, MS or Hattiesburg, MS, but I can recommend a few therapists in nearby states.



  95. Hi….Lifesaving info…..My story is incredible….I have had 15 surgeries and even a coccygectomy trying to stop this pain….I dragged my unbearably painful butt around for 3 years playing piano for so many hospitalized and elderly people hoping to put smiles on their faces….Finally I gave in to the pain 4 months ago praying to find an answer. I just was released from Yale NH Hospital after seven days with them saying,,,you have some kind of nerve issue where the obturator internus is. This is why you have pain there and in your anus. It’s just too bad you’ll have to learn to deal with the pain as there is nothing we can do. There are no treatments for this so you’ll never walk or play piano or sports or even have sex without terrible pain ever again. Just accept it. Yes this is what they said to me today…
    You have given me hope again…especially with the article regarding the botox injections as they may work for me considering the muscle involved and the pain right across the pudendal nerve. I have constant unbearable pain in that area and in my anus…It switches….3-4 days one place 3-4 days the other.
    Pain lessens while sitting on a toilet seat….Pain is completely gone when constipated for several days. For some reason a buildup of stool removes all the pain and I run my tail off on those days…..ever hear of this?…
    My biggest problem now is finding the right DR to find the best treatment for me,,,,,I live in CT,,,,,,Do you have any leads to who I can see in this general area….I have to get better before I mentally break and I am there already.
    Thank you so much for your blog,,,,Please write back asap….Al

    1. Author

      Hello Al,

      I am sorry to hear that you are in so much pain. We do not have referrals for your area, but if you able to travel elsewhere I may be able to recommend a therapist.

      All my best,


  96. Hi

    I wrote once before. I had PN decompression surgery in France in 2003 following 2 years of constant pressure in the pelvic floor, as well as ed, sitting pain etc.

    At Christmas, I stupidly squatted with 90kg and the symptoms returned. I also got Herpes HSV1 at the same time.

    Have I just damaged the pelvic floor i.e. sent it into spasm and/or strained the area? I feel a sharp tingle in the anal area and a congestion in the perineum.. however,m unlike before I have full control of the pelvic floor muscles (I can kegel), which I couldn’t before back in 2001/2002.

    The doc who did my surgery says it may be PNE again and talks about how he has performed surgery on a couple of patients twice…

    Have I got PNE again? I am confused.. if PNE didn’t exist why did I get better for ten years following surgery? And how unlucky would I be if I got it twice? And if lifting too much weight in the gym was likely to cause this (again) then surely men all over the world would be getting this every week?

    Please help…

    1. Author

      Hi Gary,

      Thank you for your email. I apologize that we did not respond in a more timely manner. Somehow your email got lost in the shuffle.

      Hopefully by now your symptoms have resolved. I think what likely happened was the nerve became irritated with the heavy squat which maybe then made some of your pelvic floor muscles become hypertonic (tight), both of which can cause the symptoms you’ve described. I do not think you got re-entrapped. One activity/exercise/episode is not going to cause a re-entrapment. It could cause a muscle injury or neural irritation, both of which can take a long time to lessen, especially given your history.

      Again, I am sorry we didn’t answer your question earlier. I sincerely hope your symptoms have long since resolved.



  97. I have burning and pain in anal rectal area radiating to vagina. It is non-stop for two years following spinal cord surgery. I sit on donut pillow with ice 24/7. Have been to every Doctor who say nothing is wrong. I feel like I have a foreign object in my rectum. I have no life! People seem to think I am crazy! PLEASE help me if you can! I am becoming hopeless! Living in my room! In constant pain unless laying down. Don’t tolerate mentioned meds. Where do I go from here. At the end of my rope!!!

    Thank you!! Can you respond by e-mail???
    [email protected] PatJ

    1. Author

      Hello Patricia,

      Have you ever received an evaluation from a pelvic physical therapist? Pelvic PT may be able to help, however it depends on the specific details of your surgery, and overall medical history. Where are you located? I may be able to recommend a therapist in your area.

      All my best,


  98. Hello Stephanie,
    I’ve been dealing with pelvic floor dysfunction since November of 2010. I’ve seen numerous doctors (primary care,
    urologist, proctologist, osteopath, and nuerologist)with varying diagnosis’s given. I truely believe I have PN.
    Please help me locate a physical therapist in washington state, seattle area. Thank you very much, Toby

    1. Author

      Hello Toby,

      Here are the names of pelvic floor therapists in your area.

      Tina Allen, PT
      University of Washington-Roosevelt
      Seattle WA
      (206) 598-2889

      Sagira Vora, PT
      Overlake Hospital Medical Center
      Bellevue, WA

      All my best,


    1. Author

      Hello Moe,

      Yes Pamela Downey, PT is located in Miami Florida. Her contact information is below.

      Pamela Downey PT, DPT, WCS, BCB-PMB, PRPC
      (305) 666-3232



  99. I found this site while I was looking for an explanation of why I get a shooting pain in the arch of my right foot upon initial vaginal penetration. It quickly goes away in less than a minute. The pain appeared about two or years ago and since it rapidly goes away I have not worried about it. I am however, curious. What would make a pain shoot through the arch of my right foot upon initial vaginal penetration? I appreciate any information you can share, thank you.

    1. Author

      Hello Kathleen,

      Without evaluating you, it’s difficult to say why you experience shooting pain in your right foot. My guess is that this may be positional related, or there may be a superficial trigger point present in your pelvic muscles that is affected during initial penetration.



    1. Author

      Hi Michele,

      Sure thing, here are the names of two therapists in Pittsburgh, PA.

      Christine Woods, PT
      Pittsburgh, PA
      (412) 967-9229
      Fox Chapel Physical Therapy

      Janice Bryant, PT
      Pittsburgh, PA
      (412) 422-4775
      UPMC Centers for Rehab Service



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