Pudendal Neuralgia

Burning pelvic pain that gets worse when you sit down might be pudendal neuralgia - and it has real treatment options.

Pudendal neuralgia is a chronic nerve-related pelvic pain condition that is significantly underdiagnosed. Many women spend years searching for answers, seeing multiple providers, and being told their pain is "unexplained" - when in reality, their pudendal nerve is the source. Getting the right diagnosis changes everything.

Pudendal neuralgia is a real, diagnosable condition. If your pelvic pain worsens with sitting, is often one-sided, and comes with burning or a sensation of something inside the vagina or rectum - this deserves a specialist evaluation.

What is the pudendal nerve - and what happens when it's irritated?

The pudendal nerve is the primary sensory nerve of the pelvic floor, running from the lower spine through the pelvic region to the clitoris, vulva, perineum, and rectum. When this nerve becomes irritated, compressed, or injured, it causes chronic neuropathic pain in these areas - often described as burning, stabbing, or electric-like.

Common symptoms

Burning or tingling in the vulva, perineum, or rectum
Pain that worsens with sitting
One-sided or asymmetric pain
Sensation of a foreign object
Pain with orgasm
Unwanted genital arousal sensations
Gradual onset, sometimes after childbirth or surgery

Treatment options

Activity modification to reduce pressure on the pudendal nerve
Nerve-calming medications: tricyclic antidepressants, SNRIs, gabapentinoids
Pelvic floor physical therapy to release tension and improve function
Pudendal nerve blocks for diagnostic confirmation and therapeutic relief
For refractory cases: radiofrequency ablation, cryotherapy, neuromodulation, or surgical decompression

Comfort during procedures: For nerve blocks and any other procedures, Dr. Toubi offers nitrous oxide (laughing gas) to minimize discomfort and anxiety.

Frequently asked questions

What is pudendal neuralgia?

Pudendal neuralgia is a chronic pain condition involving the pudendal nerve - the main sensory nerve of the pelvic floor. It causes pain in the clitoris, vulva, perineum, and rectum that typically worsens with sitting. It is frequently underdiagnosed and can develop gradually, sometimes without a clear cause.

What does pudendal neuralgia feel like?

Pain is often described as burning, stabbing, tingling, or a sensation of a foreign object in the vagina or rectum. It's frequently one-sided and worsens with sitting, often improving when standing or lying down. Some patients also experience unwanted genital sensations or pain with orgasm.

How is pudendal neuralgia diagnosed?

Diagnosis is clinical - based on the pattern, location, and character of pain. A pudendal nerve block is often used both diagnostically (to confirm nerve involvement) and therapeutically (to provide relief). Dr. Toubi uses a comprehensive evaluation to identify the likely site of nerve irritation and rule out other causes of pelvic pain.

What are the treatment options?

Treatment begins conservatively with activity modification, pelvic floor physical therapy, and nerve-calming medications (tricyclics, SNRIs, gabapentinoids). Pudendal nerve blocks provide both diagnostic clarity and temporary relief. For persistent cases, advanced options include radiofrequency ablation, cryotherapy, neuromodulation, or surgical decompression. Management is stepwise and individualized.

Is pudendal neuralgia related to sitting too much or cycling?

Yes - prolonged sitting or cycling can compress the pudendal nerve and contribute to or worsen neuralgia. Activity modification is often one of the first steps in management. Other risk factors include vaginal childbirth, pelvic surgery, trauma, and spinal conditions.

You don't have to keep searching for answers.

If you've been dealing with unexplained pelvic pain, especially pain that worsens with sitting, a specialist evaluation may finally provide the diagnosis and treatment path you've been looking for. Dr. Toubi's Beverly Hills practice has expertise in diagnosing and treating complex pelvic nerve conditions.

Schedule an evaluation

Pelvic pain specialistBeverly HillsNerve block expertise

{“@context”:”https://schema.org”,”@type”:”FAQPage”,”mainEntity”:[ {“@type”:”Question”,”name”:”What is pudendal neuralgia?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Pudendal neuralgia is a chronic pain condition involving the pudendal nerve — the main sensory nerve of the pelvic floor. It causes pain in the clitoris, vulva, perineum, and rectum that typically worsens with sitting. It is frequently underdiagnosed and can develop gradually, sometimes without a clear cause.”}}, {“@type”:”Question”,”name”:”What does pudendal neuralgia feel like?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Pain is often described as burning, stabbing, tingling, or a sensation of a foreign object in the vagina or rectum. It’s frequently one-sided and worsens with sitting, often improving when standing or lying down. Some patients also experience unwanted genital sensations or pain with orgasm.”}}, {“@type”:”Question”,”name”:”How is pudendal neuralgia diagnosed?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Diagnosis is clinical — based on the pattern, location, and character of pain. A pudendal nerve block is often used both diagnostically (to confirm nerve involvement) and therapeutically (to provide relief). Dr. Toubi uses a comprehensive evaluation to identify the likely site of nerve irritation and rule out other causes of pelvic pain.”}}, {“@type”:”Question”,”name”:”What are the treatment options for pudendal neuralgia?”,”acceptedAnswer”:{“@type”: “Answer”,”text”:”Treatment begins conservatively with activity modification, pelvic floor physical therapy, and nerve-calming medications (tricyclics, SNRIs, gabapentinoids). Pudendal nerve blocks provide both diagnostic clarity and temporary relief. For persistent cases, advanced options include radiofrequency ablation, cryotherapy, neuromodulation, or surgical decompression. Management is stepwise and individualized.”}}, {“@type”:”Question”,”name”: “Is pudendal neuralgia related to sitting too much or cycling?”,”acceptedAnswer”:{“@type”:”Answer”,”text”:”Yes — prolonged sitting or cycling can compress the pudendal nerve and contribute to or worsen neuralgia. Activity modification is often one of the first steps in management. Other risk factors include vaginal childbirth, pelvic surgery, trauma, and spinal conditions.”}} ]} .kt-page{font-family:inherit;font-size:16px;line-height:1.75;color:inherit;max-width:780px} .kt-page h1{font-size:2em;font-weight:700;line-height:1.2;margin:0 0 .85rem} .kt-page h2{font-size:1.4em;font-weight:600;margin:2.25rem 0 .6rem} .kt-page p{margin:0 0 1rem} .kt-callout{background:#fff0f0;border-left:4px solid #c05050;border-radius:0 8px 8px 0;padding:14px 20px;margin:1.5rem 0;font-size:.95em} .kt-callout p{margin:0} .kt-comfort-bar{background:#f0faf5;border:1px solid #a8d5bc;border-radius:10px;padding:14px 20px;margin:1.25rem 0;font-size:.9em} .kt-comfort-bar p{margin:0} .kt-symptom-list{display:flex;flex-wrap:wrap;gap:8px;margin:.75rem 0 1.5rem;padding:0;list-style:none} .kt-symptom-list li{background:#fff0f0;border:1px solid #e8a0a0;border-radius:20px;padding:4px 14px;font-size:.88em;color:#7a2020} .kt-tx-list{margin:.75rem 0 1.5rem;padding-left:1.2em} .kt-tx-list li{margin-bottom:.4rem;font-size:.95em} .kt-faq{margin:1rem 0} .kt-faq-item{border:1px solid #e0ddd8;border-radius:10px;margin-bottom:10px;overflow:hidden} .kt-faq-q{font-size:.97em;font-weight:600;padding:14px 18px;cursor:pointer;display:flex;justify-content:space-between;align-items:center;background:#fff;margin:0} .kt-faq-q:hover{background:#f9f8f6} .kt-faq-icon{font-size:1.3em;font-weight:300;color:#999;transition:transform .2s;flex-shrink:0;margin-left:12px} .kt-faq-a{display:none;padding:0 18px 14px;font-size:.92em;line-height:1.65;color:#444} .kt-faq-item.kt-open .kt-faq-a{display:block} .kt-faq-item.kt-open .kt-faq-icon{transform:rotate(45deg)} .kt-cta{background:#fff0f0;border:1px solid #e8c0c0;border-radius:12px;padding:24px 28px;margin-top:2.5rem} .kt-cta h3{font-size:1.15em;margin:0 0 .5rem} .kt-cta p{font-size:.93em;margin:0 0 1.1rem} .kt-cta-btn{display:inline-block;text-decoration:none;font-size:.92em;font-weight:600;padding:11px 22px;border-radius:8px;margin-right:10px;margin-bottom:8px;cursor:pointer} .kt-cta-btn.primary{background:#c05050;color:#fff;border:none} .kt-trust{display:flex;flex-wrap:wrap;gap:10px;margin-top:14px} .kt-trust span{font-size:.82em;color:#666;display:flex;align-items:center;gap:5px} .kt-trust span::before{content:””;display:inline-block;width:6px;height:6px;border-radius:50%;background:#c05050;flex-shrink:0} hr.kt-divider{border:none;border-top:1px solid #e8e5e0;margin:2.25rem 0}

Burning pelvic pain that gets worse when you sit down might be pudendal neuralgia — and it has real treatment options.

Pudendal neuralgia is a chronic nerve-related pelvic pain condition that is significantly underdiagnosed. Many women spend years searching for answers, seeing multiple providers, and being told their pain is “unexplained” — when in reality, their pudendal nerve is the source. Getting the right diagnosis changes everything.

What is the pudendal nerve — and what happens when it’s irritated?

The pudendal nerve is the primary sensory nerve of the pelvic floor, running from the lower spine through the pelvic region to the clitoris, vulva, perineum, and rectum. When this nerve becomes irritated, compressed, or injured, it causes chronic neuropathic pain in these areas — often described as burning, stabbing, or electric-like.

Common symptoms

Burning or tingling in the vulva, perineum, or rectum
Pain that worsens with sitting
One-sided or asymmetric pain
Sensation of a foreign object
Pain with orgasm
Unwanted genital arousal sensations
Gradual onset, sometimes after childbirth or surgery

Treatment options

Activity modification to reduce pressure on the pudendal nerve
Nerve-calming medications: tricyclic antidepressants, SNRIs, gabapentinoids
Pelvic floor physical therapy to release tension and improve function
Pudendal nerve blocks for diagnostic confirmation and therapeutic relief
For refractory cases: radiofrequency ablation, cryotherapy, neuromodulation, or surgical decompression

Comfort during procedures: For nerve blocks and any other procedures, Dr. Toubi offers nitrous oxide (laughing gas) to minimize discomfort and anxiety.

Frequently asked questions

What is pudendal neuralgia?+

Pudendal neuralgia is a chronic pain condition involving the pudendal nerve — the main sensory nerve of the pelvic floor. It causes pain in the clitoris, vulva, perineum, and rectum that typically worsens with sitting. It is frequently underdiagnosed and can develop gradually, sometimes without a clear cause.

What does pudendal neuralgia feel like?+

Pain is often described as burning, stabbing, tingling, or a sensation of a foreign object in the vagina or rectum. It’s frequently one-sided and worsens with sitting, often improving when standing or lying down. Some patients also experience unwanted genital sensations or pain with orgasm.

How is pudendal neuralgia diagnosed?+

Diagnosis is clinical — based on the pattern, location, and character of pain. A pudendal nerve block is often used both diagnostically (to confirm nerve involvement) and therapeutically (to provide relief). Dr. Toubi uses a comprehensive evaluation to identify the likely site of nerve irritation and rule out other causes of pelvic pain.

What are the treatment options?+

Is pudendal neuralgia related to sitting too much or cycling?+

Yes — prolonged sitting or cycling can compress the pudendal nerve and contribute to or worsen neuralgia. Activity modification is often one of the first steps in management. Other risk factors include vaginal childbirth, pelvic surgery, trauma, and spinal conditions.

You don’t have to keep searching for answers.

If you’ve been dealing with unexplained pelvic pain, especially pain that worsens with sitting, a specialist evaluation may finally provide the diagnosis and treatment path you’ve been looking for. Dr. Toubi’s Beverly Hills practice has expertise in diagnosing and treating complex pelvic nerve conditions.

Schedule an evaluation

Pelvic pain specialistBeverly HillsNerve block expertise

function ktToggle(el){var item=el.parentElement;item.classList.toggle(‘kt-open’)}