Pudendal Neuralgia

Pudendal Neuralgia is a neuropathic nerve condition in which the pudendal nerve (the main nerve of the pelvis which supplies the vulva, clitoris and anus) is compressed, irritated or inflamed. This can cause symptoms of burning at the entrance of the vagina or anus and can be felt on one or both sides of the vulva. The pudendal nerve supplies the clitoris, labia minora, the perineum and the entrance of the anus (external anal sphincter). Sitting on firm surfaces may make pain worse, while sitting on a toilet seat may relieve pain. Pain normally will not bother someone at night but may gradually worsen as the day progresses. 

What causes it?

There are several reasons for why someone may be experiencing pudendal neuralgia: 

• Post-surgical trauma of the nerve
• Post radiotherapy neuropathy
• Compression along the nerve pathway
• Entrapment of the nerve along its pathway (e.g. from sitting on a bike seat).

What are the symptoms? 

• The pain presents on/around the vulva, perineum or anus entrance. 
• Pain with sexual intercourse, with tight clothing or with bladder/bowel movements
• The pain is more commonly felt only on one side but it can present on both 
• The pain presents as burning or shocking in nature (nerve pain)
• The pain is worse with sitting and relieved with lying down or sitting on a toilet. 

How is it treated?

• Pelvic Floor Physiotherapy: your physio may perform release techniques around the pelvis, glutes and pelvic floor. A physio may also provide you with stretches and mobility exercises that work to release through tissues that may be compressing your pudendal nerve pathway. In some cases this may involve using dilators or a pelvic floor wand. 
• Medically: A pudendal nerve block can be used to assist with pain
• Surgically: A pudendal nerve decompression surgery can be performed to relieve pressure on the nerve pathway

NOTE: This is general advice only and should not replace medical advice. If you have any concerns or are unsure if you have any contraindications to perineal massage, please speak to your health care provider.