Pudendal Neuralgia: The Overlooked Cause of Chronic Pelvic Pain

Understanding a Misunderstood Condition

Burning, stabbing, aching pain in the pelvic floor. Difficulty sitting. Pain with sex or even using the bathroom. For many patients, these symptoms are real, constant, and life-altering—yet they are often dismissed or misdiagnosed.

The culprit? A little-known condition called pudendal neuralgia. Despite being responsible for some of the most debilitating pelvic pain syndromes, pudendal neuralgia is still underdiagnosed and poorly understood in many healthcare settings. Patients are often bounced between urologists, gynecologists, gastroenterologists, and mental health professionals without ever having the true cause of their pain identified. At Movability, we specialize in finding and treating conditions like this—complex, multifactorial, and deeply disruptive to people’s lives.

What Is Pudendal Neuralgia?

Pudendal neuralgia is a chronic pain condition caused by irritation, entrapment, or damage to the pudendal nerve. This nerve is responsible for sensory and motor function in the perineum, genitals, anal sphincter, and parts of the pelvic floor. When compressed or inflamed, it can create intense, localized pain that often worsens with sitting and disrupts urinary, bowel, and sexual function.

Common Symptoms

  • Burning, stabbing, or shock-like pain in the perineum or genitals

  • Pain that worsens with sitting and improves when standing or lying down

  • Sensation of a “foreign object” in the rectum or vagina

  • Pain with intercourse or ejaculation

  • Urinary urgency, frequency, or hesitancy

  • Bowel dysfunction, including constipation or pain with defecation

  • Emotional distress, anxiety, or reduced quality of life

Symptoms can be unilateral or bilateral and may fluctuate in intensity. Many patients are told their tests are normal, leading to years of frustration and unnecessary treatments.

The Anatomy and Biomechanics of the Pudendal Nerve

The pudendal nerve originates from the sacral plexus (S2–S4) and follows a complex path through the pelvis:

  • Exits the pelvis via the greater sciatic foramen, below the piriformis muscle

  • Loops around the ischial spine, between the sacrospinous and sacrotuberous ligaments

  • Re-enters the pelvis through the lesser sciatic foramen

  • Travels within Alcock’s canal, a fascial tunnel formed by the obturator internus fascia

  • Divides into three branches: the inferior rectal nerve, perineal nerve, and dorsal nerve of the penis or clitoris

Because of this anatomical course, the pudendal nerve is susceptible to entrapment at multiple points. Compression can occur due to tight ligaments, muscle hypertrophy, fascial thickening, or scar tissue from prior surgeries, trauma, or childbirth.

Postural changes, prolonged sitting, cycling, or repetitive strain can increase nerve tension. Pelvic floor dysfunction, particularly hypertonic or spasming muscles like the levator ani or obturator internus, can also trap or irritate the nerve.

Why Pudendal Neuralgia Is So Often Missed

One of the biggest challenges with pudendal neuralgia is that it mimics other pelvic conditions and often presents with nonspecific symptoms. Because the pain doesn’t always follow a classic nerve distribution, patients are often sent for gastrointestinal, gynecological, or urological evaluations—which frequently come back normal.

Additionally, the pudendal nerve is not routinely evaluated in standard imaging or physical exams unless a clinician is specifically trained to suspect and assess it. As a result, patients are often told their pain is psychosomatic or idiopathic.

Movability’s Root-Cause Approach to Pudendal Neuralgia

At Movability, we specialize in uncovering the underlying cause of chronic pain through our integrative, root-cause-focused assessment. Pudendal neuralgia requires more than symptom management—it demands a comprehensive understanding of the patient’s anatomy, biomechanics, and history.

Our Diagnostic Process Includes:

  • Detailed health history and orthopedic examination

  • Assessment of pelvic and spinal alignment

  • Internal and external myofascial and trigger point evaluation

  • Review of imaging and nerve testing when appropriate

  • Collaborative input from our pelvic floor physiotherapist

We look at the entire kinetic chain—from lumbar spine to pelvic alignment to fascial and ligamentous tension. We also assess habits that might contribute to compression (e.g., sitting posture, cycling, heavy lifting).

Our Multidisciplinary Treatment Strategy:

  • Pelvic floor physiotherapy to release internal trigger points and restore muscular balance

  • Manual therapy and nerve mobilization to reduce mechanical tension on the nerve

  • Chiropractic postural correction and movement retraining to eliminate biomechanical contributors

  • Lifestyle coaching around ergonomics, activity modification, and sleep

  • Referral for imaging, nerve blocks, or specialist interventions when needed

Most importantly, our team listens. We validate what our patients are feeling and guide them step-by-step toward resolution and recovery.

When Pelvic Pain Impacts More Than the Pelvis

Because of its location and impact on intimacy, continence, and quality of life, pudendal neuralgia can severely affect mental and emotional health. Patients often avoid sitting, withdraw from sexual activity, and lose confidence in their bodies. This pain isn’t just physical—it’s psychological, social, and relational.

That’s why our care model includes support not just for the nerve, but for the person.

Your Next Step

If you’ve been struggling with unresolved pelvic pain, unexplained symptoms, or you’ve been told “everything looks normal,” it may be time to look deeper. Pudendal neuralgia is real, treatable, and deserves expert attention.

Contact Movability today to book a comprehensive assessment and experience our results-driven approach.

Sina Yeganeh