Understanding Pudendal Neuralgia: What It Is and How Pelvic PT Can Help
If you’ve ever experienced chronic pain in the pelvic region, perineum, or genitals, you may have wondered if something deeper is going on. One possible cause is pudendal neuralgia, a condition that is often misunderstood and misdiagnosed, but very real and treatable.
What is pudendal neuralgia?
Pudendal neuralgia (PN) is pain caused by irritation or compression of the pudendal nerve, the main nerve that supplies sensation to the genital area, perineum, and anus.
Symptoms can include:
Burning, stabbing, or sharp pain in the perineum or genitals
Pain while sitting, often relieved when standing or lying down
Numbness, tingling, or hypersensitivity in the pelvic area
Pain with bowel movements, sexual activity, or prolonged sitting
Urinary urgency or discomfort (sometimes)
The pain can be intermittent or constant, and it often worsens with prolonged sitting.
Why it happens
The pudendal nerve can be irritated or compressed due to:
Chronic pelvic floor muscle tension
Scar tissue from surgery or trauma
Prolonged sitting on hard surfaces
Pelvic instability or misalignment
Nerve entrapment from childbirth or repetitive activities
It’s important to know that PN is not psychological. The nerve is genuinely irritated, and the pain is real.
How pelvic floor physical therapy helps
Pelvic PT is often a first-line treatment for pudendal neuralgia because it addresses the root contributors, including muscle tension, posture, and movement patterns. A pelvic PT may use:
Gentle nerve gliding and mobilization techniques to relieve pressure on the pudendal nerve
Pelvic floor down-training to reduce chronic muscle tightness
Postural and ergonomic adjustments to minimize nerve compression while sitting
Breathing techniques and nervous system regulation to calm pain signals
Education on safe sexual activity, toileting, and daily movement
The goal isn’t just symptom relief. It’s restoring function and quality of life.
Living with pudendal neuralgia
PN can feel isolating and frustrating, especially when it affects everyday activities like sitting, working, or intimacy. But treatment is possible, and many people see significant improvement with a multifaceted approach:
Pelvic floor PT and nerve-specific therapy
Pain management strategies
Postural and ergonomic support
Lifestyle and activity modifications
Early recognition and intervention can prevent chronic pain patterns and improve long-term outcomes.
Takeaway
Pudendal neuralgia is real and treatable. If you notice persistent pelvic or perineal pain, especially pain that worsens with sitting, talking with a pelvic floor physical therapist can be a crucial first step. With the right guidance, you can reduce nerve irritation, regain comfort, and reclaim your daily life.
