Pudendal neuralgia: symptoms, causes, and treatments for this pelvic nerve pain
Painful sitting could be pudendal neuralgia. Discover causes and find relief with treatments like pelvic floor physical therapy.
Table of Contents
It hurts when you sit and usually eases when you stand up or lie down. It can feel like an electric jolt shooting through your genitals, anus, and the surrounding area. You just want to know what’s causing it and how to make it go away. These symptoms could be a sign of pudendal neuralgia: a persistent, nerve-related pelvic pain condition that affects your genital and rectal areas. The pain can be intense and interfere with your daily life. But it’s not something you just have to deal with. There are treatments and steps you can try at home, like gentle stretches and lifestyle changes, to help ease the pain.
Here, learn more about what causes pudendal neuralgia, plus practical strategies to manage and treat it — including soothing pelvic exercises from Hinge Health physical therapists.
Reviewed by our clinical and medical experts
Bijal Toprani, PT, DPT
Karla Arevalo-Alas, PT, DPT
Fully Covered Pelvic Care
What is pudendal neuralgia?
Pudendal neuralgia is a type of pelvic pain that occurs when the pudendal nerve is irritated or damaged. The pudendal nerve is a major nerve in your pelvis that provides sensation to your “saddle area.” This includes the genitals, anus, and surrounding areas — essentially all the places that would touch the seat when you ride a bike.
The nerve runs through your pelvic floor, and helps control the movement of muscles involved in bladder and bowel function. When the pudendal nerve is injured or compressed (also called pudendal nerve entrapment), it can lead to stabbing, burning, or shooting pain in your pelvis.
"Pudendal neuralgia can sometimes feel isolating and limiting. It can be hard to do simple things like sit through a meal or go for a bike ride,” says Karla Arevalo-Alas, PT, DPT, a physical therapist at Hinge Health. “But with the right plan and pelvic floor physical therapy, you can get back to doing what you love — and you don't have to do it alone."
Symptoms of pudendal neuralgia
The main symptom of pudendal neuralgia is pain in the pelvic area. It can feel like a shooting, burning, or stabbing sensation, or a tingling and numbness, in the:
Vagina, vulva, and clitoris
Penis and scrotum
Anus or rectum
Perineum (the area between your genitals and anus)
Pelvis
The pain is usually most intense when you sit and improves when you stand or lie down. It typically hurts worse in the evening and often feels better in the morning.
Other symptoms of pudendal neuralgia include:
Urinary urgency, or a sudden, strong need to urinate
Urinary frequency, or urinating more often than usual
Pain with urination or bowel movements
A feeling of swelling or fullness, like there’s something in your vagina or anus
Painful sex, or dyspareunia
Pain in your buttocks, thighs, and lower back
Difficulty reaching orgasm
Erectile dysfunction in people with male anatomy
Reduced arousal or lubrication in people with female anatomy
When to see a doctor
Pudendal neuralgia often improves on its own with at-home or simple treatments. But if your pudendal neuralgia is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:
Numbness in the saddle area (genitals, anus, and surrounding areas)
Leg weakness
Bowel or bladder changes
Causes of pudendal neuralgia
Pudendal neuralgia occurs when the pudendal nerve — a main nerve in your pelvis — is damaged, irritated, or compressed. Possible causes include:
Activities that strain or put pressure on the nerve, such as cycling or horseback riding
Prolonged sitting
Chronic constipation
Trauma during childbirth
An injury or damage from pelvic surgery
Certain infections or diseases, such as genital herpes or diabetes
A growth or lesion on the nerve
Treatments for pudendal neuralgia
Treating pudendal neuralgia depends on what’s causing the pain and the severity of your symptoms. Your healthcare provider may recommend a combination of therapies, including pelvic floor physical therapy and targeted exercises, medications to help ease pain, strategies for intimacy, and in some cases, surgery. Lifestyle changes also play an important role in managing pain. Here’s a closer look at pudendal neuralgia treatments:
Pelvic floor physical therapy
Physical therapy (PT) and targeted exercises are a key treatment for pudendal neuralgia that is related to tight pelvic floor muscles. Pelvic floor muscles need to be able to tighten (contract) and fully release (relax) for proper function. When pelvic floor muscles stay contracted, spasm, or have difficulty relaxing, it can irritate the pudendal nerve and lead to pain and neuralgia symptoms, explains Dr. Arevalo-Alas.
Targeted exercises can help stretch and relax pelvic floor muscles to ease pain. A physical therapist (PT) can assess your movement patterns to customize a strengthening and stretching program that’s right for you. They can also suggest ways to modify your everyday activities to minimize symptoms and empower you with tools and tips to help manage pudendal neuralgia and other symptoms. Recommendations may include modifying activities that can aggravate the pudendal nerve or practicing healthy bathroom habits. Your PT may also recommend other techniques to help relax tight pelvic floor muscles, including soft tissue mobilization, massage using a pelvic wand, and dry needling, adds Dr. Arevalo-Alas.
You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Some exercises they may recommend can be found below.
Medications and other treatments
Your healthcare provider may recommend medications and procedures to manage pudendal neuralgia. Options include pain relievers and medications for neuropathic pain — such as antiseizure agents and certain antidepressants — as well as targeted interventions like pudendal nerve blocks. These are injections of local anesthetics to numb the pudendal nerve, often paired with steroids to reduce inflammation.
In some cases, botulinum toxin (Botox) injections or neuromodulation may be considered. Neuromodulation delivers gentle electrical pulses to nerves through a small device placed under the skin, , usually in the upper buttock or lower abdomen, helping to “turn down” pain signals.
As part of care, your provider may review current medications (including SSRIs, a type of antidepressant) and other health factors (hormonal changes, mood, vascular, or spine issues) that can affect pelvic pain and adjust your treatment accordingly.
Tips for painful sex
Pudendal neuralgia can interfere with intimacy and sex. A few simple changes can relieve nerve pressure, reduce pain triggers, and improve comfort and arousal. Use plenty of lubricant to minimize friction, choose positions that take pressure off the perineum (for example, side-lying/spooning or partner-on-top), and go slowly. Start with nonpenetrative touch and add penetration only if symptoms stay manageable.
Gentle, low-intensity external vibration can boost sensation with less pressure; avoid vibrating directly over painful spots. A certified sex therapist can help tailor positions, pacing, and communication.
Some antidepressants — especially SSRIs — can cause genital numbness, reduced arousal/lubrication, and constipation, which may aggravate pudendal nerve symptoms or sex-related pain. If you take an SSRI, ask your provider about ways to manage side effects or adjust medications and to check for interactions with nerve-pain treatments.
Surgery
Rarely, your healthcare provider may recommend surgery to ease pressure on the pudendal nerve.
Best exercises for pudendal neuralgia
Want expert care? Check if you're covered for our free program →- Reverse Kegels
- Happy baby
- Kneeling hip flexor stretch
- Pigeon pose
- Z sits
These exercises target specific muscles that can help reduce pelvic floor tension, which can help take pressure off the pudendal nerve to minimize pain and other symptoms. Reverse Kegels train you to consciously relax your pelvic floor muscles, which is especially helpful if tension or spasms are contributing to your symptoms. Happy baby and kneeling hip flexor stretch help release tightness and improve flexibility in your hips and inner thighs, while pigeon pose focuses on stretching the glutes — all areas closely connected to your pelvic floor. Z sits target both the butt and hips. Consistently practicing these exercises can help stretch and relax tense muscles to relieve pudendal neuralgia pain as well as improve bladder and bowel symptoms.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
Tips to manage pudendal neuralgia
Certain everyday habits or activities can aggravate your pudendal nerve and may make pudendal neuralgia pain worse. Simple lifestyle strategies — such as not sitting for too long, modifying activities that irritate your pudendal nerve, and practicing healthy bathroom habits — can help. Here’s more:
Avoid prolonged sitting. Sitting for extended periods can put pressure on the pudendal nerve. Try to stand up regularly and move around. If sitting is painful, try using a specialized cushion — like a U-shaped or donut pillow — to take pressure off your pelvic floor muscles and perineum.
Modify certain activities. Some movements — such as cycling, running, horseback riding, and squatting with weights — may irritate the pudendal nerve and aggravate symptoms. A physical therapist can help you modify these activities or suggest alternatives.
Don’t strain. Straining while urinating or during bowel movements puts stress on your pelvic floor, which may contribute to pudendal neuralgia symptoms. Stay hydrated and maintain a balanced diet to help prevent constipation, which can reduce pelvic floor strain.
What conditions can be mistaken for pudendal neuralgia?
Pudendal neuralgia is often misdiagnosed or mistaken for other conditions with similar symptoms, such as pelvic pain and bladder control problems. Your healthcare provider may run tests or ask questions to help rule out other issues. Some of these other conditions include:
Pelvic floor dysfunction, a condition that can lead to symptoms such as pelvic pain, bladder and bowel issues and pain during sex
Interstitial cystitis, a condition that causes pain or pressure in the bladder and pelvic area
Vulvodynia, a general term for pain in your vulva
Vaginismus, which is pain with penetration due to tight pelvic floor muscles
Coccygodynia, or tailbone pain
Sacroiliac joint dysfunction, a condition that cause butt and low back pain
Endometriosis, a condition where tissue that normally lines the inside of your uterus grows outside of the uterus, and can cause pelvic pain
Prostatitis, which is(inflammation of the prostate gland
PT tip: Tweak your sitting position
“Experiment with your sitting posture — sometimes something as simple as shifting your weight slightly can make a big difference in comfort," says Dr. Arevalo-Alas. Many people are surprised to learn how much daily habits, like how you sit or move, impact nerve pain, she explains. “Even changing your bathroom position — like placing your feet on a small stool — can help ease pelvic floor tension and symptoms.”
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
Looking for pain relief? Check if your employer or health plan covers our program
References
Desrosiers, L., & Knoepp, L. R. (2020). Botulinum Toxin A: A Review of Potential Uses in Treatment of Female Urogenital and Pelvic Floor Disorders. Ochsner journal, 20(4), 400–409. doi:10.31486/toj.19.0076
Kaur, J., & Singh, P. (2020). Pudendal Nerve Entrapment Syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544272/
Kinter, K. J., & Newton, B. W. (2021). Anatomy, Abdomen and Pelvis, Pudendal Nerve. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554736/
Kovacevic, N., Sirls, L., Gilleran, J., & Peters, K. (2023). Peripheral nerve stimulation for pudendal neuralgia and other pelvic pain disorders: current advances. Frontiers in urology, 3, 1323444. doi:10.3389/fruro.2023.1323444
Pudendal neuralgia. (2017, October 19). Nhs.uk. https://www.nhs.uk/conditions/pudendal-neuralgia/
Pudendal neuralgia | About the Disease | GARD. (2025). Nih.gov. https://rarediseases.info.nih.gov/diseases/10713/pudendal-neuralgia
Soon-Sutton, T. L., Feloney, M. P., & Antolak, S. (2020). Pudendal Neuralgia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562246/