Pudendal neuralgia is a neuropathic pain condition estimated to affect approximately 1/100,000 people, yet some believe that number to be much higher due to the lack of informed medical providers. Along with other medical specialists, pelvic floor physical therapists play an integral role in the successful treatment of pudendal neuralgia.

Pudendal neuralgia is a neuropathic pain condition estimated to affect approximately 1/100,000 people, yet some believe that number to be much higher due to the lack of informed medical providers. Along with other medical specialists, pelvic floor physical therapists play an integral role in the successful treatment of pudendal neuralgia.

  • The pain is described as burning, shooting, stabbing, and/or lancinating.
  • The pain is only in the distribution of the pudendal nerve, or the areas of the pelvis the nerve supplies. The pain can occur in any or all of the following areas: vagina, vulva, urethra, penis, scrotum, perineum, peri-anus, anus, and/or rectum.
  • Pudendal neuralgia can cause urinary dysfunction, such as pain with urinating (dysuria), urinary frequency, and/or urinary urgency.
  • Pudendal neuralgia can cause bowel dysfunction, such as pain with bowel movements or difficulty evacuating stool.
  • Pudendal neuralgia can cause sexual dysfunction, such as pain with arousal, pain during intercourse or genital stimulation, or during or post-orgasm. It can also cause difficulty getting and/or maintaining an erection.
  • Symptoms are usually aggravated by sitting, particularly on a hard surface, and relieved when sitting on a toilet or a cushion with a cut-out.
  • Symptoms can be aggravated by activity, such as deep squatting or climbing stairs, or walking up a steep incline.
  • Symptoms can be constant or intermittent.
  • Pudendal Neuralgia symptoms tend to be minimal during sleeping and first thing in the morning but increase as the day progresses.
  • The pain is described as burning, shooting, stabbing, and/or lancinating.
  • The pain is only in the distribution of the pudendal nerve, or the areas of the pelvis the nerve supplies. The pain can occur in any or all of the following areas: vagina, vulva, urethra, penis, scrotum, perineum, peri-anus, anus, and/or rectum.
  • Pudendal neuralgia can cause urinary dysfunction, such as pain with urinating (dysuria), urinary frequency, and/or urinary urgency.
  • Pudendal neuralgia can cause bowel dysfunction, such as pain with bowel movements or difficulty evacuating stool.
  • Pudendal neuralgia can cause sexual dysfunction, such as pain with arousal, pain during intercourse or genital stimulation, or during or post-orgasm. It can also cause difficulty getting and/or maintaining an erection.
  • Symptoms are usually aggravated by sitting, particularly on a hard surface, and relieved when sitting on a toilet or a cushion with a cut-out.
  • Symptoms can be aggravated by activity, such as deep squatting or climbing stairs, or walking up a steep incline.
  • Symptoms can be constant or intermittent.
  • Pudendal Neuralgia symptoms tend to be minimal during sleeping and first thing in the morning but increase as the day progresses.

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Associated Diagnoses

  • Myofascial Pelvic Pain Syndrome
  • CPPS (Chronic Pelvic Pain Syndrome or Male Pelvic Pain Syndrome)
  • Endometriosis
  • Vestibulodynia
  • Pudendal Nerve Entrapment
  • “Cyclist’s Syndrome”
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Pudendal Neuralgia Causes

  • Chronic constipation
  • Prolonged vaginal childbirth
  • Activity related, such as long-distance cycling or heavy weight lifting that involves repetitive squatting
  • Sitting for long periods of time for work, commuting, and/or school
  • Surgical trauma, such as during pelvic organ prolapse surgical repairs that utilize mesh products
  • Repetitive falls on your buttocks, such as with a snow sport
  • Repetitive vaginal infections, such as bacterial vaginosis or vaginal candidiasis (yeast infection)
  • Chronic pelvic floor hypertonus

Pudendal Neuralgia Causes

  • Chronic constipation
  • Prolonged vaginal childbirth
  • Activity related, such as long-distance cycling or heavy weight lifting that involves repetitive squatting
  • Sitting for long periods of time for work, commuting, and/or school
  • Surgical trauma, such as during pelvic organ prolapse surgical repairs that utilize mesh products
  • Repetitive falls on your buttocks, such as with a snow sport
  • Repetitive vaginal infections, such as bacterial vaginosis or vaginal candidiasis (yeast infection)
  • Chronic pelvic floor hypertonus
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Diagnostic Challenges

Pudendal neuralgia is not a common nor well understood neuropathic pain condition for the majority of medical providers; therefore, many medical providers are unfamiliar with the diagnosis, let alone comfortable recommending treatment. Unfortunately many people suffering often diagnose themselves through online research and resources. For example, many people that have pain while sitting will think they have pudendal neuralgia because that’s what they read on the internet.

The truth is that pelvic pain while sitting, nerve pain in the vagina, and nerve pain in the pelvis can be due to several factors, none of which may be pudendal neuralgia. Additionally, there are several nerves that supply the pelvis, so not all nerve pain is necessarily due to the pudendal nerve.

Another diagnostic challenge is differentiating pudendal neuralgia from the signs and symptoms of pudendal nerve entrapment. Pudendal nerve entrapment is when the nerve is fixated somewhere along its path within the pelvis. Unfortunately, it is impossible to confidently diagnose pudendal nerve entrapment and any associated pudendal nerve entrapment symptoms with our current medical technology. The only way to definitively diagnose pudendal nerve entrapment is during a pudendal nerve surgical decompression. Although not near enough, thankfully, there are more and more medical specialists who are able to confidently diagnose pudendal neuralgia and provide helpful guidance for successful treatment.

Diagnostic Challenges

Pudendal neuralgia is not a common nor well understood neuropathic pain condition for the majority of medical providers; therefore, many medical providers are unfamiliar with the diagnosis, let alone comfortable recommending treatment. Unfortunately many people suffering often diagnose themselves through online research and resources. For example, many people that have pain while sitting will think they have pudendal neuralgia because that’s what they read on the internet.

The truth is that pelvic pain while sitting, nerve pain in the vagina, and nerve pain in the pelvis can be due to several factors, none of which may be pudendal neuralgia. Additionally, there are several nerves that supply the pelvis, so not all nerve pain is necessarily due to the pudendal nerve.

Another diagnostic challenge is differentiating pudendal neuralgia from the signs and symptoms of pudendal nerve entrapment. Pudendal nerve entrapment is when the nerve is fixated somewhere along its path within the pelvis. Unfortunately, it is impossible to confidently diagnose pudendal nerve entrapment and any associated pudendal nerve entrapment symptoms with our current medical technology. The only way to definitively diagnose pudendal nerve entrapment is during a pudendal nerve surgical decompression. Although not near enough, thankfully, there are more and more medical specialists who are able to confidently diagnose pudendal neuralgia and provide helpful guidance for successful treatment.

Treatment:

Pudendal Neuralgia Treatment: How We Can Help You

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People experiencing pelvic pain due to pudendal neuralgia can benefit from an evaluation with a pelvic floor physical therapist specializing in pelvic pain. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone, and how effective (or not effective) these treatments have been. Most importantly, we understand what you have been going through and that most people are frustrated by the time they see us.

During the physical examination, the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once your physical therapist completes the examination they review your findings with you. The physical therapist creates an assessment that explains how you developed pudendal neuralgia and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to complement your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life!

Want to learn more about our pudendal neuralgia treatment offerings?

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Treatment:

Pudendal Neuralgia Treatment: How We Can Help You

People experiencing pelvic pain due to pudendal neuralgia can benefit from an evaluation with a pelvic floor physical therapist specializing in pelvic pain. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone, and how effective (or not effective) these treatments have been. Most importantly, we understand what you have been going through and that most people are frustrated by the time they see us.

During the physical examination, the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once your physical therapist completes the examination they review your findings with you. The physical therapist creates an assessment that explains how you developed pudendal neuralgia and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to complement your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life!

Want to learn more about our pudendal neuralgia treatment offerings?

How Can We Help You?

Please use the form below to send us any questions or comments. You must include your e-mail address in order for us to send a response. Please be assured that all of your information will be kept confidential.

How Can We Help You?

Please use the form below to send us any questions or comments. You must include your e-mail address in order for us to send a response. Please be assured that all of your information will be kept confidential.

Join The Newsletter. Win a copy of our book, “Pelvic Pain Explained!”

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pelvic pain explained

At its heart, Pelvic Pain Explained is the story of how patients develop pelvic pain, the challenges patients and providers face throughout the diagnosis and treatment process, the difficult task of sifting through the different available treatment options, and the impact that an “invisible” condition has on a patient’s life and relationships, and much more.

Join The Newsletter. Win a copy of our book, “Pelvic Pain Explained!”

We love getting to know our website visitors. Please tell us a little bit about yourself and get the latest info via PHRC e-newsletter!
*Subscribers automatically eligible to win our book, “Pelvic Pain Explained.”

At its heart, Pelvic Pain Explained is the story of how patients develop pelvic pain, the challenges patients and providers face throughout the diagnosis and treatment process, the difficult task of sifting through the different available treatment options, and the impact that an “invisible” condition has on a patient’s life and relationships, and much more.