Pudendal Neuralgia — What It Feels Like and What You Can Do
If sitting makes your groin, perineum, or genitals burn, sting, or feel numb, pudendal neuralgia could be the culprit. This nerve pain often hides in plain sight because people assume pelvic pain is gynecologic, urologic, or just muscle soreness. Knowing the typical signs helps you get the right care faster.
How pudendal neuralgia shows up
Common signals are sharp, electric or burning pain along the path of the pudendal nerve — from the buttock crease to the genitals and perineum. Pain usually gets worse when you sit and improves when you stand or sit on a toilet seat. You may also notice numbness, sexual dysfunction, or changes in bowel or bladder sensation. Unlike general pelvic pain, pudendal nerve pain often follows a clear nerve distribution.
Other conditions can look similar (pelvic floor muscle tension, interstitial cystitis, sciatica). That’s why a targeted exam matters: doctors check nerve sensitivity, pelvic floor muscle tone, and ask when and how the pain started.
What causes it and how it's diagnosed
Causes include nerve entrapment from scar tissue, prolonged sitting, pelvic surgery, childbirth trauma, or direct nerve injury. Sometimes no single cause shows up and the nerve seems irritated without a clear trigger.
Diagnosis starts with a detailed history and a pelvic exam. Doctors often use a pudendal nerve block (local anesthetic injected near the nerve) to confirm the source: if the pain drops after the block, that points to the pudendal nerve. Imaging like MRI can rule out structural issues but won’t always show nerve entrapment. A pain specialist or pelvic floor physiotherapist usually leads the workup.
Treatment mixes short-term pain control and longer-term fixes. Start with conservative care unless symptoms are severe.
Treatments and self-care that actually help
Medications for nerve pain — gabapentin, pregabalin, or certain antidepressants like amitriptyline — can reduce burning or electric pain. Anti-inflammatory pain relievers help some people but often aren’t enough alone. A diagnostic or therapeutic nerve block gives quick relief for many and helps plan next steps.
Physical therapy focused on the pelvic floor is central: trained therapists use manual release, biofeedback, and breathing work to ease muscle tightness that amplifies nerve pain. Lifestyle tweaks matter too — avoid long stretches of sitting, use a donut or wedge cushion, change positions often, and treat constipation to lower pelvic pressure.
If conservative steps fail and a clear entrapment is found, specialists may discuss surgical decompression. Other options in specialized clinics include Botox into tight pelvic floor muscles, nerve stimulation, or pulsed radiofrequency. Surgery isn’t a quick fix for everyone, so weigh risks and seek a team experienced in pelvic nerve disorders.
Don’t delay seeing a clinician who knows pelvic nerves if pain limits your life. With the right diagnosis and a stepwise plan, many people get meaningful relief and regain daily activities.
Baclofen and Pudendal Neuralgia: A Potential Treatment
In a recent blog post, I came across an interesting potential treatment for Pudendal Neuralgia - a condition characterized by chronic pelvic pain. This treatment involves the use of Baclofen, a muscle relaxant typically used for muscle spasms and stiffness. The theory behind this treatment is that by relaxing the pelvic muscles, it could alleviate the pressure on the pudendal nerve, thus reducing pain. Many patients have reported positive results with Baclofen, but more research is needed to confirm its effectiveness. I'll be keeping an eye on this promising development and will share any updates with you all.
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