What is Pudendal Neuralgia and Why Does It Happen?

Have you birthed a baby and now noticed some numbness, sharp burning pain, or a swollen feeling “down there”? Or maybe you're having a high incidence of urine or fecal incontinence? 

This may be  Pudendal Neuralgia and unfortunately, this condition happens in about 32% of vaginal births.  

What is Pudendal Neuralgia? 

Pudendal neuralgia means damage or irritation to the pudendal nerve that can cause pain, discomfort, or numbness in the pelvis, genitals, and surrounding areas. This pain and discomfort or numbness may be transient or become worse when you sit for prolonged periods of time. 

Identifying The Culprit: The Pudendal Nerve and Its Anatomy. 

To understand pudendal neuralgia it's important to know where the pudendal nerve is located and its function.

The pudendal nerve comes from the sacral plexus, a complex intersection of nerves at the base of the spine.  It splits into left and right branches, each one supplying sensory and motor information from the left and right sides of the pelvis.


The pudendal nerve provides sensory information such as touch, pleasure, pain, and temperature to the: 

  1. Penis 

  2. Vagina

  3. Perineum

  4. Anal Canal

This nerve also provides motor function to the pelvic muscles, the anal sphincter which helps hold in poop, the urethral sphincter which helps hold in pee and provides information about the movement and sensation in the thighs, legs, feet, and pelvis. 

Understanding the anatomy and the function of this nerve provides insight into why damage to this nerve can cause symptoms such as:  

  1. Fecal and urinary Incontinence

  2. Sharp burning pain in the genital area

  3. Sexual dysfunction and pain with sex

  4. Pain with sitting

  5. Numbness or tingling in the pelvic area

  6. Increased sensitivity in the genital area

How Does Pudendal Neuralgia Happen? 

As stated above, pudendal neuralgia occurs in 32% of women who give birth naturally. This is likely due to the pressure of baby’s head as it moves through the pelvis and into the birth canal. This temporary pressure can injure the pudendal nerve causing the above symptoms. 

While common in women who give birth, it also can occur in men and women who have never been pregnant. Other causes of pudendal neuralgia can include: 

  • Horseback riding

  • Prolonged bike riding

  • Accidents or trauma 

  • Diabetes

  • Tumors/Cysts 

How Do You Treat Pudendal Neuralgia?? 

The first step is realizing you have a problem and consulting a pelvic floor physical therapist. The good news is that most often, if the damage is from childbirth, the symptoms are temporary and healing can be facilitated with physical therapy. 

Some interventions a pelvic floor physical therapist can implement to help you achieve recovery and function are: 

Help you with relaxation and deep breathing to connect to your pelvic floor. 

Most people have hypertonic pelvic floors muscles. When the pelvic floor is in a hyper-toned state, it can restrict and compress the nerves, impeding blood flow and causing dysfunction in the contraction and relaxation of the muscles. Learning to relax your pelvic floor and connect it to your breathing will help restore your inner core piston and allow it to achieve balance. 

Dry Needling

This is similar to acupuncture in that it involves small needles inserted into the skin. But when completed in physical therapy, your physical therapist will assess your pain pattern, posture, movement dysfunctions, and other assessment tools to find trigger points, or tight bands of muscles, to help the muscle relax, increase blood flow to the area, and reduce pain. 

Manual Therapy Techniques For The Pelvic Floor Muscles

These are techniques a trained therapist can implement to help mobilize, alleviate, relax, and lengthen pelvic floor muscles and surrounding tissues. 

Stretching and Nerve glides 

Sometimes nerves can get stuck from adhesions and scar tissue surrounding the nerves. By stretching and lengthening soft tissue and helping the nerve to glide along its pathway we can help to restore function to the nerve. 

Strengthening What’s Weak

Strengthening weak muscles can help improve posture and movement mechanics to reduce pressure on the nerve. 

Posture Education

Posture is key when it comes to pain and movement dysfunctions. Identifying “poor” posture habits and working to correct them to realign the spine can significantly improve pain. 


By working with a trained pelvic floor physical therapist and consistently working through your exercise program, pudendal neuralgia can significantly improve or go away entirely.