Pudendal Neuralgia in Charlottesville, VA

Find relief from chronic pelvic nerve pain with expert care.

What is Pudendal Neuralgia?

The pudendal nerve carries sensations to/from the external genitals, the lower rectum, and the perineum (between the genitals and the anus). There is a pudendal nerve on each side of the pelvis. Neuralgia is pain coming from a nerve. So, pudendal Neuralgia is a nerve pain in the rectal and genital region coming from the pudendal nerve. The terms neuralgia and neuropathy are both used and essentially mean the same thing when referring to the pudendal nerve.

According to the International Pelvic Pain Society (IPPS), “Damage to the pudendal nerve can occur suddenly as a result of trauma, such as surgery in the pelvic region, falls, bicycle accidents or childbirth; and sometimes even from severe constipation. It can also occur from sustained trauma over time, such as from bicycle riding or aggressive weightlifting that strains the pelvic muscles. It can be caused by diseases such as diabetes or multiple sclerosis. Trauma may cause stretching or compression of the nerve directly, or by causing fibrosis which can pinch the nerve. Pudendal neuralgia is often associated with pelvic floor muscular dysfunction as well.

Pudendal neuralgia is a condition that can cause long-lasting pain in vulva, vagina, perineum, and rectum.
Pain from pudendal neuralgia can feel sharp, burning, or aching and often gets worse while sitting. The condition can develop from things like injury, surgery, or long-term pressure on the nerve.

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Symptoms of Pudendal Neuralgia

Pudendal neuralgia can cause a range of symptoms, including:

Burning, stabbing, or aching pain in the genital or pelvic area
Increased pain when sitting
Numbness or tingling sensations
Pain during intercourse
Feeling like there is something foreign in the vaginal or rectal area
Improvement in symptoms when sitting on a toilet seat (relieves pressure on the nerve)
The patient does not wake you up in the middle of the night, but may make falling asleep difficult
There is no identifiable loss of sensation.

What is the Treatment for Pudendal Neuralgia?

Treatment for pudendal neuralgia focuses on relieving any pressure on the nerve and reducing pain. Your provider might recommend a combination of treatments, such as:

Medications to manage nerve pain
Nerve blocks or injections to calm irritation and confirm a diagnosis
Lifestyle changes to avoid activities that worsen symptoms
Physical therapy to release the pelvic floor muscles

In some cases, surgery, neurostimulator placement, or nerve ablation might be an option if other treatments do not help.

Who Needs Treatment for Pudendal Neuralgia?

Treatment might be recommended for individuals who have:

Ongoing pelvic pain or genital pain that lasts longer than a few months
Pain that increases when sitting and improves when standing
Discomfort during or after intercourse
Trouble with bowel or bladder control
A history of pelvic surgery, trauma, or prolonged pressure in the area

What are the Risks?

Without treatment, pudendal neuralgia can interfere with daily activities, sexual health, and your overall quality of life. Since the pain is nerve-related, it might become harder to manage over time if not addressed. Early care can help prevent symptoms from getting worse.

Some treatments, like nerve blocks or medications, can cause side effects such as temporary numbness, mild bruising, or drowsiness. Your provider will review these with you and help you weigh the benefits of each option.

What To Expect

If you are experiencing symptoms that suggest pudendal neuralgia, your provider will review your health history, discuss your symptoms, and perform a pelvic exam. You might have imaging tests or nerve studies to better understand what is causing your pain.

They might also check the pudendal nerve through a physical assessment to see if certain movements or positions trigger any symptoms. From there, your provider will work with you to create a personalized treatment plan, focusing on both short-term and long-term relief.

Treatment often starts with conservative care like physical therapy and medication. Your provider will guide you through your options, explain what to expect, and support you throughout your recovery.

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Why Choose The Center For Advanced Gynecology

The Center for Advanced Gynecology, established in 2018, is dedicated to improving your health by offering expertise in various areas, with a specific focus on gynecological care and advanced surgical techniques when surgery is needed.

Our team provides specialized expertise in non-surgical treatment of chronic pelvic pain, painful intercourse, pudendal neuralgia, and vaginal, vulvar, and bladder pain.

Since opening our doors, we have recognized the need in our community for more than just specialty care and have a growing practice in routine gynecologic care, cancer screening, Pap smears, menopausal management, hormonal imbalances, hormone replacement therapy, breast care, contraceptive care, urinary incontinence, and pelvic organ prolapse.

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Frequently Asked Questions

The pudendal nerve runs through your pelvis and supplies feeling to the genital and anal areas. When irritated or compressed, it can lead to pudendal nerve pain, which often feels like burning, stabbing, or aching sensations.

Pudendal nerve entrapment is one possible cause of pudendal neuralgia. It happens when the nerve gets compressed by the surrounding tissues or vessels, leading to pelvic pain that worsens with sitting.

Yes, physical therapy focused on releasing and lengthening the pelvic floor muscles can reduce pressure on the pudendal nerve and provide lasting pain relief.

A pudendal nerve block involves an injection near the pudendal nerve. Pudendal nerve block injections are often used to confirm a diagnosis and to relieve pain.

Pudendal nerve decompression is a procedure used to relieve nerve entrapment when other treatments, like physical therapy and nerve blocks, have not worked. There are a handful of doctors across the country that do this procedure laparoscopically and some who do it as an open/external incision.

Yes, because the pudendal nerve affects sensation in the genital area, pudendal neuropathy can contribute to sexual dysfunction like pain during intercourse, clitoral pain, or hypersensitivity to touch.

Chronic pelvic pain is a broad term that describes ongoing pain in the pelvic area, while pudendal neuralgia is a specific type of nerve pain caused by pain signaling from the pudendal nerve.

No, most people with pudendal nerve pain find relief through nonsurgical treatments like physical therapy, medication, and nerve block procedures. Surgery like pudendal nerve decompression is considered only if other options have not worked as the success rate is modest at best.

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