Pudendal neuralgia

The main symptom of pudendal neuralgia is sharp, shooting, burning or tingling pain (nerve pain) or numbness in your:

• genitals (your vagina, vulva and clitoris or penis and scrotum)
• bottom and anus
• perineum (the area between your genitals and anus)
• pelvis

The pain may be worse when sitting down and may get worse throughout the day.

Other symptoms can include:

• needing to pee more often
• pain when peeing or pooing
• constipation
• a feeling of swelling or fullness in your anus or vagina
• difficulty getting an erection
• difficulty reaching orgasm
• pain when having sex

• you have pain in your genitals, bottom, anus or pelvis that does not get better

Pudendal neuralgia can be hard to diagnose because it's rare and the symptoms are similar to other conditions.

It's usually diagnosed based on your symptoms and by ruling out other causes.

A GP may refer you for tests to look for what's causing your pain. Tests you may have include:

• a vaginal or rectal examination – a doctor will use their finger to feel for any problems inside your vagina or rectum (bottom)
• scans such as an MRI scan, CT scan or ultrasound scan
• a test called electromyography (EMG), where electrical signals sent from small sensors are used to check how your nerves work
• injections to numb one of the nerves in your pelvis

Pudendal neuralgia can be hard to treat. The treatment will depend on how severe your pain is and what's causing it.

A GP may recommend treatments such as:

• physiotherapy, including advice on exercises
• medicines that can help with nerve pain, such as amitriptyline, duloxetine, gabapentin or pregabalin
• a strong painkiller called tramadol, if other pain relief does not work and you need pain relief for a short time while you're waiting to see a specialist

If you have severe pain or it's affecting your daily activities, the GP may refer you to a specialist in nerve conditions (neurologist) or a specialist pain clinic.

Treatment from a specialist may include:

• injections to reduce pain
• surgery, if something is putting pressure on a nerve and other treatments have not worked
• psychological therapies such as cognitive behavioural therapy to help you cope with pain

If you have pudendal neuralgia there are things you can do to help with the symptoms.

A specialist may be able to suggest lifestyle changes that can help.

• eat plenty of fibre and drink lots of water to help prevent constipation or pain when pooing

• if you want to keep riding a bike, try using a different type of saddle to see if it helps your pain

• do not sit for long periods – get up regularly and move around

• do not wear tight underwear or trousers

• do not do activities that make your pain worse such as activities that involve a lot of squatting, bending or lifting

Pudendal neuralgia is caused by damage to the pudendal nerve, which is one of the main nerves in your pelvis.

Possible causes include:

• an injury
• damage from surgery
• giving birth
• activities that put pressure on the nerve such as cycling, horse riding or sitting for a long time
• a growth or tumour that puts pressure on the nerve
• infections such as genital herpes

Sometimes it's not clear what causes it.

If you have pudendal neuralgia you can get support from charities including:

• the Pelvic Pain Support Network
• Action on Pain

Symptoms of pudendal neuralgia include pain or numbness in your genitals, bottom, anus or pelvis that may be worse when sitting.

Pudendal neuralgia is usually diagnosed based on your symptoms and ruling out other causes. Tests may include scans and injections.

Treatments for pudendal neuralgia may include physiotherapy and medicines to help with nerve pain.

Eating plenty of fibre, not sitting for long periods and avoiding activities that make your pain worse can help with symptoms of pudendal neuralgia.