Pudendal Neuralgia

Pain where you sit – Pudendal Neuralgia

This is a pain you may not have heard of before. The pudendal nerve is the nerve that goes to the muscles and skin between our legs where we sit. Some people call this the ‘saddle area’, which means that it affects the part of you that would touch a saddle if you were riding a horse.

The pudendal nerve travels through some tight places around the inside of your pelvis, where it can get irritated or be put under pressure, especially with cycling or childbirth. Sometimes no cause for the problem is found.

There are many different symptoms but they are usually worse when sitting. The symptoms include:

• pain in the area of the pudendal nerve anywhere from the clitoris or penis back to the anal area. It may be on one side or both sides, near the front, or further back. This pain is usually a burning or sharp ‘electric’ feeling.
• sexual problems with less feeling in the penis or clitoris
• difficulty opening your bowels
• numbness in the area affected

When you do sit, use a ‘U-shaped’ foam cushion with the front and centre area cut out, or sit on 2 towels rolled up under each buttock so there is no pressure in the centre. While pressure on the pudendal nerve may have been the problem that started the pain, it is common for pelvic muscle pain or spasm to develop as well. Tight pelvic muscles can also be the cause of pressure on the nerve. They are commonly inter-related. Once pain has been present for more than three to six months, there will also be the changes to nerve pathways described as chronic pain.

A pelvic physiotherapist who understands how to ‘down train’ pelvic muscles (not tighten them) can teach you how to relax and lengthen your pelvic muscles, to take pressure off the nerve and reduce muscle pain.

Avoid straining when you pass urine or open your bowels, and avoid overly strengthening your pelvic muscles

Some centres offer botox to the pelvic floor muscles or pudendal nerve blocks for this problem.

To help the nerve recover, you should avoid activities that put pressure on the nerve, such as sitting, or cycling.

For more information, we highly reccommend this brochure on Chronic Pelvic Pain, Genital Pain and Pudendal Neuralgia, from Pudendalhope.org. It describes the diagnosis and management of Pudendal Neuralgia.

Health Organisation for Pudendal Chronic Pain brochure (569kb)

From the Women’s Health & Research Institute of Australia
Use the password ‘pudendal‘ to view the video on vimeo.com

WHRIA Judy’s Story from WHRIA