Pudendal Neuralgia: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 2, 2026.
What kind of doctor treats Pudendal Neuralgia?
A primary care doctor is a good place to start. This doctor can check for common causes, suggest sitting changes and cushions, and prescribe nerve pain medicines. If the pain continues, they will likely refer you to a specialist, such as a pelvic pain doctor or pelvic floor physical therapist. A direct primary care or concierge doctor can also be a good first stop.
What it is
Pudendal neuralgia is long-term pain caused by irritation or damage to the pudendal nerve. The nerve runs from the lower spine into the pelvis and carries feeling to the area between the legs, including the genitals and anus. When the nerve is irritated, people often feel burning, stinging, or aching that may get worse when sitting.
Symptoms
The most common symptom is pain in the pelvic area, especially when sitting, that often feels better when standing or lying down. Other symptoms can include numbness or tingling in the genital area, pain during sex, and discomfort when going to the bathroom. Symptoms may affect one side or both.
Causes and who gets it
Pudendal neuralgia happens when the pudendal nerve gets squeezed, stretched, or injured. Common causes include long hours of sitting, long-distance cycling, childbirth, and pelvic surgery or injury. In some cases, doctors cannot find a clear cause. The condition can affect anyone but appears more often in adults.
How doctors diagnose it
There is no single test for pudendal neuralgia. Doctors usually start by asking about symptoms and doing a physical exam. An MRI can rule out other problems. A nerve block can help confirm the diagnosis: numbing medicine is injected near the nerve, and the diagnosis is more likely if the pain briefly goes away.
Treatment
Treatment usually starts with simple steps, such as avoiding long periods of sitting and using a cushion with a hole in the middle. Physical therapy often helps relax tight pelvic muscles. Doctors sometimes prescribe medicines that calm nerve pain, and some people get a nerve block injection. In rare cases, surgery may free a squeezed nerve.
When to see a doctor
See a doctor if you have pelvic pain that lasts more than a few weeks or keeps coming back. Pain during sex, numbness in the genital area, or trouble with urination also deserve a visit. If pain is sudden and severe, or you lose control of your bladder or bowels, seek care right away.
Common questions
Is pudendal neuralgia permanent?
Not always. Some people improve with rest, physical therapy, and medicine over months. Others have pain that lasts longer, and results differ from person to person.
Can cycling cause it?
Long or frequent cycling can put pressure on the nerve and may contribute to the problem. Adjusting the saddle, taking breaks, and using padded shorts can lower the pressure. Talk to a doctor if symptoms start.
Will a cushion really help?
Many people get relief from a cushion with a cutout under the pelvis, because it takes pressure off the nerve. It does not work for everyone, but it is a simple and low-risk step to try.
Is it the same as pelvic floor problems?
They are related but not the same. Tight or weak pelvic floor muscles can squeeze the nerve and add to the pain. Physical therapy often treats both issues at once.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
