Pudendal Neuralgia: Symptoms, Causes and What Actually Helps

A London specialist explains pudendal neuralgia, why it happens, and how pelvic health physiotherapy can help

Pudendal neuralgia is one of the most misunderstood causes of pelvic pain in men.

Many men are told they have it, worry that it is permanent, or are unsure what it actually means.

Others have the symptoms but have never been given a clear diagnosis.

This is something we see regularly in clinic, and while it can be very uncomfortable, it is often treatable with the right approach.

The key thing to understand is this.

Pudendal neuralgia does not usually mean the nerve is damaged.

In most cases, it is irritated, sensitive, or affected by surrounding muscle tension.

The pudendal nerve runs through the pelvic region and is responsible for sensation and function in areas including the penis, perineum, and around the anus.

When this nerve becomes irritated, symptoms can include:

Burning, tingling or aching in the pelvic area
Pain when sitting
Discomfort in the penis, testicles or perineum
Symptoms that improve when standing or lying down
Increased sensitivity or altered sensation

For many men, sitting is one of the biggest triggers.

This is because prolonged sitting increases pressure through the pelvic region and can irritate both the nerve and surrounding tissues.

One of the most common drivers we see is pelvic floor overactivity.

When the pelvic floor muscles are tight or overactive, they can place pressure on the nerve and contribute to ongoing irritation.

This often develops gradually and can be linked to:

Prolonged sitting
Periods of stress or anxiety
Changes in activity levels
Cycling or direct pressure through the saddle area
Previous injury or strain

Once symptoms begin, they can persist due to a cycle of tension, sensitivity, and increased awareness of symptoms.

Many men understandably become focused on the pain, which can increase nervous system sensitivity and keep symptoms going.

Medication can sometimes help reduce symptoms, but it does not address the underlying cause if muscle tension and movement patterns are driving the problem.

At London Men’s Health, we take a structured and practical approach.

Assessment focuses on understanding your symptoms, identifying triggers, and assessing pelvic floor function, movement, and lifestyle factors.

Treatment may include:

Pelvic floor relaxation and downtraining
Breathing and nervous system regulation
Reducing pressure through the pelvic area
Advice on sitting and activity modification
Gradual return to normal activity

The aim is to reduce irritation, improve function, and break the cycle that is keeping symptoms going.

Most men improve with the right approach.

The key is not to ignore symptoms or assume this is something you have to live with.

If you are experiencing symptoms of pudendal neuralgia, it is worth getting it properly assessed.

If you would like to book an appointment, you can do so here:
https://www.londonmenshealth.physio