Peudandal neuralgia

When Sitting, Movement or Everyday Life Starts to Hurt

Pelvic health for every body

Read the introduction

Maybe sitting used to be something you never thought about. You drove to work, sat through dinner, worked at your desk, exercised, cycled, or relaxed on the couch without giving your pelvis a second thought. Then something changed. Sitting started to burn. You noticed tingling, pressure, numbness, or a deep uncomfortable sensation around the vulva, vagina, penis, scrotum, perineum, rectum, or anus. Standing might bring some relief, but as soon as you sit again, the symptoms slowly return.

You may have changed your chair, bought different cushions, stopped cycling, shortened car rides, or started standing through activities you once enjoyed. Perhaps you've seen several healthcare providers because the pain is difficult to describe and difficult to locate. When scans or tests do not provide an obvious explanation, it can leave you wondering whether anyone understands what you are feeling.

If this sounds familiar, pudendal neuralgia may be one condition your healthcare team considers. Pudendal neuralgia refers to neuropathic pain involving the pudendal nerve, an important nerve that supplies sensation to areas of the genitals, perineum and anus and contributes to pelvic floor, bladder, bowel and sexual function. Symptoms commonly include burning, shooting, tingling or electric-type pain and are often aggravated by sitting.

At Peloraa

At Peloraa, if your assessment suggests that something falls outside the physiotherapy scope or needs additional investigation, we will discuss that with you and encourage appropriate medical follow-up.

Understand your journey

What You Should Know About Peudandal neuralgia

Find clear, supportive answers to common questions about urinary incontinence, bladder leakage, symptoms, treatment, and pelvic health physiotherapy.

What Is Pudendal Neuralgia?

The pudendal nerve travels from the lower part of the spine through the pelvis and into the perineal and genital region. Because of where this nerve travels, irritation or injury…

The pudendal nerve travels from the lower part of the spine through the pelvis and into the perineal and genital region. Because of where this nerve travels, irritation or injury can create symptoms in areas that may feel very private and difficult to explain, including the vulva, vagina, clitoris, penis, scrotum, rectum, anus and the area between the genitals and anus.

Pudendal neuralgia occurs when the pudendal nerve becomes irritated, damaged or sensitized. For some people, pain is primarily burning or shooting, while others experience tingling, numbness, pressure, fullness or a feeling that something is present in the vagina or rectum even when nothing is there. Sitting commonly aggravates symptoms, and discomfort may become more noticeable as the day progresses. Some people also experience pain during sexual activity, urinary frequency, discomfort with urination or bowel movements, constipation, erectile difficulties, or changes in orgasm.

It is also important to understand that pudendal neuralgia and pudendal nerve entrapment are related terms but are not necessarily identical. Neuralgia describes pain involving the nerve, while entrapment refers more specifically to mechanical compression of the nerve. Not every person with pudendal nerve-type pain has a clearly identifiable entrapment.

Why Does Pudendal Neuralgia Happen?

There is not always one clear reason. The pudendal nerve travels through several areas of the pelvis where it may be affected by pressure, stretching, injury, surgery, childbirth,…

There is not always one clear reason. The pudendal nerve travels through several areas of the pelvis where it may be affected by pressure, stretching, injury, surgery, childbirth, repetitive activities, or other changes around the pelvic tissues. Activities involving prolonged pressure on the perineum, such as cycling, horse riding or extended sitting, have been associated with pudendal nerve irritation in some people. Pelvic surgery, childbirth and injury may also contribute, although sometimes no obvious cause can be identified.

When a nerve becomes sensitive, everyday pressure that would normally be harmless may begin producing pain. Sitting in a chair, wearing tight clothing, cycling, having intercourse, or even pressure from certain movements may suddenly feel very different. Over time, people understandably begin protecting the painful region. The pelvic floor tightens, the hips and abdomen brace, sitting positions change, and movement becomes more cautious.

These adaptations may initially feel protective, but they can sometimes create additional muscle tension and sensitivity around an already irritated nerve. This is why treatment often needs to look at both the nerve and the environment surrounding it, rather than assuming one tight muscle or one compressed area explains every symptom.

Why Is Pudendal Neuralgia Often Worse When Sitting?

Sitting places pressure through the pelvis and perineal region. Because the pudendal nerve travels through this area, sitting may increase irritation in people whose nerve is…

Sitting places pressure through the pelvis and perineal region. Because the pudendal nerve travels through this area, sitting may increase irritation in people whose nerve is already sensitive. This is why pain aggravated by sitting is one of the characteristics commonly considered when healthcare professionals assess possible pudendal nerve entrapment.

The widely used Nantes criteria for pudendal neuralgia associated with pudendal nerve entrapment include pain within the anatomical territory of the pudendal nerve, pain that is worse with sitting, pain that typically does not wake the person from sleep, no objective sensory loss on examination, and improvement following an appropriately performed diagnostic pudendal nerve block. These criteria help clinicians assess possible entrapment, but there is no single test that proves every case of pudendal neuralgia.

Because many other pelvic, neurological, spinal, musculoskeletal, urological and gynecological conditions can create similar symptoms, an appropriate medical assessment is important before assuming the pudendal nerve is the source of pain.

What Can Pudendal Neuralgia Feel Like?

Pudendal neuralgia is often described differently from typical muscle soreness. You may notice burning, tingling, pins and needles, electric shocks, stabbing pain, numbness,…

Pudendal neuralgia is often described differently from typical muscle soreness. You may notice burning, tingling, pins and needles, electric shocks, stabbing pain, numbness, hypersensitivity, aching or deep pressure. Some people describe feeling as though they are sitting on something or that there is a foreign-body sensation in the vagina or rectum.

The symptoms may involve only one side or both sides and can affect different parts of the pudendal nerve distribution. You may also experience urinary urgency or frequency, pain during bowel movements, painful intercourse, discomfort after ejaculation or orgasm, erectile difficulties, or increased sensitivity around the genital or perineal region.

Because these symptoms overlap with many other pelvic pain conditions, where the pain is located does not automatically tell us what is causing it.

When the Pelvic Floor Starts Protecting the Nerve

When an area repeatedly hurts, your body naturally tries to protect it. If sitting causes burning, you shift your weight. If intercourse triggers pain, your pelvic floor may…

When an area repeatedly hurts, your body naturally tries to protect it. If sitting causes burning, you shift your weight. If intercourse triggers pain, your pelvic floor may tighten before penetration. If bowel movements hurt, you may brace or hold your breath. If exercise causes a flare, you may gradually stop moving in certain ways.

Over time, muscles around the pelvis can become tense, tender or difficult to relax. Pelvic floor muscle overactivity does not necessarily cause every case of pudendal neuralgia, but it may coexist with nerve pain and contribute to the overall symptom experience.

This distinction matters because pelvic floor physiotherapy for pudendal neuralgia should not simply involve pressing on the painful area or trying to “release the nerve.” Treatment needs to consider nerve sensitivity, pelvic floor function, hip and spinal movement, breathing, activity tolerance and the person's overall pain experience.

How we support you

The Peloraa Way

The Peloraa Way: We Look Beyond the Nerve

At Peloraa, we understand how disruptive pudendal nerve pain can become. When sitting, working, driving, exercising, using the bathroom or experiencing intimacy begins triggering symptoms, pain can gradually influence almost every part of your day.

Our role as physiotherapists is not to diagnose pudendal nerve entrapment or replace neurological and medical investigation. Instead, when pudendal neuralgia has been diagnosed or pudendal nerve involvement is being considered by your healthcare team, we assess the musculoskeletal and pelvic floor factors that may be contributing to your symptoms and functional limitations.

Rather than focusing only on where the nerve hurts, we ask how your entire body has adapted around the pain.

First, We Listen to Your Story

Your first appointment begins with understanding how your symptoms developed. We may discuss when the pain began, exactly where you feel it, how the sensation changes during the day, whether sitting aggravates it, what positions provide relief, and whether you experience bladder, bowel or sexual symptoms.

We may also discuss previous pregnancies, childbirth, pelvic or abdominal surgery, cycling or other repetitive activities, previous injuries, low-back or hip symptoms, and any medical investigations or treatments you have already completed.

Most importantly, we want to understand what the pain has stopped you from doing. Perhaps you want to drive comfortably again, sit through your workday, return to cycling, enjoy intimacy without anticipating a flare, exercise more confidently, or simply sit through dinner with your family without needing to stand.

Those goals become part of your rehabilitation plan.

We Assess the Whole Nerve–Pelvic Floor Connection

Your Peloraa physiotherapist may assess your breathing, lower back, pelvis, hips, abdominal wall, pelvic floor function, muscle tension, coordination, movement patterns and the positions or activities that reproduce your symptoms.

Because the pudendal nerve passes through the pelvis near several muscles and connective tissues, we may assess whether surrounding muscles are overactive, sensitive or contributing to excessive pressure around the region. We may also look at sitting tolerance and how your symptoms respond to changes in posture or movement.

An internal vaginal or rectal pelvic floor assessment can sometimes provide useful information about muscle tension, tenderness and coordination, but it is never mandatory. We can begin externally, explain your options and proceed only according to your comfort and consent.

We Calm the Surrounding Muscles Instead of Chasing the Nerve

When nerve pain is present, aggressive treatment is not necessarily better. A highly sensitive nerve may become more irritated when treatment repeatedly provokes symptoms.

If your pelvic floor or surrounding muscles are overactive, physiotherapy may include gentle pelvic floor relaxation, diaphragmatic breathing, mobility work, movement retraining, body awareness and carefully selected hands-on techniques when appropriate. Treatment may also address the hips, glutes, lower back, abdomen and other structures that influence how you move and load the pelvis.

The goal is not to “stretch” or “release” the pudendal nerve aggressively. Instead, we work toward creating a less reactive environment around the pelvis and improving how your body moves without unnecessarily provoking the nerve.

We Help You Understand Sitting and Activity Without Avoiding Life

When sitting hurts, the obvious solution may seem to be avoiding sitting completely. But most people cannot realistically stand for the rest of their lives.

Rehabilitation may involve identifying positions that reduce unnecessary pressure, considering appropriate seating modifications, taking strategic movement breaks and gradually rebuilding sitting tolerance when possible.

We may also look at activities that repeatedly aggravate the perineal area, including cycling or prolonged seated exercise. The goal is not automatically to eliminate everything you enjoy forever. It is to understand what your symptoms can currently tolerate and gradually determine whether activities can be modified or reintroduced.

Recovery should expand your life—not make you increasingly afraid of movement.

We Work With Your Nervous System, Not Against It

Persistent nerve pain can make the nervous system increasingly protective. Over time, your body may begin responding strongly to pressure, movement or touch that it has learned to associate with pain.

This does not mean the symptoms are imagined. Pudendal neuralgia is neuropathic pain, and nerve-related pain is very real.

Physiotherapy may include pain education, graded movement, breathing strategies and gradual exposure to activities that have become difficult. Our aim is not to tell you to ignore the pain or push through severe symptoms. Instead, we help you find a level of movement your body can tolerate and gradually build from there.

What If Intimacy Hurts?

Pudendal neuralgia can affect sexual comfort because the pudendal nerve supplies sensation to the genital and perineal regions. Some people experience pain with penetration, sexual touch, ejaculation or orgasm, while others notice symptoms flare afterward.

When pain repeatedly occurs during intimacy, the pelvic floor may also begin tightening protectively. Physiotherapy can help address pelvic floor muscle tension, breathing, movement and other musculoskeletal factors that may be contributing to sexual pain.

Treatment should never involve forcing yourself through significant pain. Depending on your symptoms, collaborative care with a physician, gynecologist, urologist, sexual-health provider or sex therapist may also be appropriate.

Pudendal Neuralgia Care Often Works Better as a Team

Pudendal neuralgia is a condition where collaborative care is especially important. Current reviews and clinical guidelines describe treatment as multidisciplinary and may include activity modification, physiotherapy, medications for neuropathic pain, psychological support for chronic pain when appropriate, diagnostic or therapeutic nerve blocks, pain-management procedures and, in carefully selected cases of confirmed nerve entrapment, surgery. The available evidence varies between treatments, and there is no single approach that is best for every patient.

Depending on your symptoms, Peloraa may work alongside or recommend further assessment from your family physician, neurologist, pain specialist, gynecologist, urologist, colorectal specialist, pelvic pain specialist or another appropriate healthcare provider. A physician may help assess whether medication or additional diagnostic testing is appropriate, while a pain specialist may consider interventions such as a diagnostic pudendal nerve block when clinically indicated. If true nerve entrapment is strongly suspected, a specialist experienced in pudendal nerve conditions may be required.

Our role is not to replace these providers. Pelvic floor physiotherapy complements medical care by addressing pelvic floor muscle function, movement, sitting tolerance, breathing, musculoskeletal contributors, activity modification and the functional effects of persistent pain.

You should not have to choose between medical treatment and rehabilitation. The two can work together.

We Help You Return to the Life Pain Has Interrupted

The goal of pudendal neuralgia rehabilitation is not simply to make a treatment-room examination more comfortable. We want to understand what you actually want your body to do again.

For one person, the goal may be sitting through a meeting. For another, it may be driving, travelling, exercising, cycling, enjoying intimacy or going through a workday without constantly thinking about the pelvis.

Your rehabilitation should gradually connect what we work on in the clinic with those real-life activities.

Because the question is not only:

“Is the pain lower?”

It is also:

“Can you return to more of your life?”

Listen. Understand. Collaborate. Calm. Retrain. Restore Confidence.

That's the Peloraa Way.

A little more clarity

FAQs About Pudendal Neuralgia

What does pudendal neuralgia feel like?

It may feel like burning, tingling, shooting, stabbing, electric-type pain, numbness or pressure in the genital, perineal, rectal or anal area.

Is pudendal neuralgia always caused by nerve entrapment?

No. Pudendal neuralgia involves nerve-related pain, while entrapment specifically means the nerve is compressed.

Why is pudendal neuralgia worse when sitting?

Sitting increases pressure around the pelvis and perineum, which may irritate a sensitive pudendal nerve.

Can pelvic floor physiotherapy help pudendal neuralgia?

It may help address pelvic floor tension, movement limitations, sitting intolerance and other contributing factors as part of multidisciplinary care.

Should I do Kegels if I have pudendal neuralgia?

Not necessarily. If your pelvic floor is tense, relaxation may be more appropriate than strengthening.

Can pudendal neuralgia affect bladder, bowel or sexual function?

Yes. It may be associated with urinary, bowel or sexual symptoms, although other conditions can cause similar problems.

Do I need an internal pelvic floor examination?

No. An internal examination is optional. Assessment can begin externally and proceed only with your consent.

Will Peloraa work with my other healthcare providers?

Yes. Peloraa can collaborate with physicians, neurologists, pain specialists, gynecologists, urologists and other appropriate providers.

Pain Shouldn't Get to Choose How You Sit, Move or Live

You do not need to know exactly where along the pudendal nerve your symptoms are coming from before seeking support. You do not need to be ready for an internal pelvic floor examination, and you do not need to assume that persistent nerve pain is simply something you have to live around.

The first step is understanding the bigger picture.

Book a pelvic floor physiotherapy assessment with Peloraa for pudendal nerve pain, pelvic pain, genital or perineal pain, or related pelvic floor symptoms in Barrhaven, Ottawa.

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References & Clinical Credits

**NHS. **Pudendal Neuralgia. Provides patient information regarding pudendal neuralgia symptoms, possible causes, diagnosis, physiotherapy, medications, specialist pain management and surgical options.
Labat J-J, Riant T, Robert R, et al. Diagnostic Criteria for Pudendal Neuralgia by Pudendal Nerve Entrapment (Nantes Criteria). Neurourology and Urodynamics. Describes the widely used clinical criteria for assessing pudendal neuralgia related to pudendal nerve entrapment.
**European Association of Urology (EAU). **Guidelines on Chronic Pelvic Pain, 2026. Provides guidance regarding pudendal neuralgia and recommends established neuropathic-pain management approaches while recognizing the role of multidisciplinary chronic pelvic pain care.
The Diagnosis and Management of Pudendal Neuralgia — Systematic Review, 2025. Reviews current evidence regarding the clinical diagnosis and management of pudendal neuralgia and the role of the Nantes criteria.
Diagnosis and Treatment of Pudendal and Inferior Cluneal Nerve Entrapment Syndrome — Narrative Review.Supports a multidisciplinary approach that can include physiotherapy, activity modification, pharmacological treatment and other interventions based on individual presentation.

Medical Disclaimer‍

This information is intended for general educational purposes only and is not a substitute for medical diagnosis, individualized medical advice or treatment from your physician or another qualified healthcare professional. Pudendal neuralgia can be difficult to diagnose because genital, rectal, perineal and pelvic pain may have neurological, gynecological, urological, colorectal, musculoskeletal or other causes. Pelvic floor physiotherapy does not independently diagnose pudendal nerve entrapment and may be only one component of a broader multidisciplinary treatment plan.

Seek prompt medical assessment for new or rapidly worsening symptoms, particularly new significant numbness or loss of sensation, progressive leg weakness, changes in bladder or bowel control, inability to urinate, unexplained bleeding, fever, a new mass or swelling, severe night pain, or other new neurological symptoms. Pain that consistently wakes you from sleep, objective sensory loss or another neurological deficit may warrant investigation for causes other than typical pudendal nerve entrapment.

Peloraa works alongside appropriate medical providers when further investigation, medication, nerve blocks, specialist pain management or surgical consultation may be required.