Pudendal Neuralgia Male: Symptoms, Causes, Treatment

Pudendal neuralgia is a rare but potentially debilitating nerve condition that can severely impact a man’s quality of life. It involves irritation or entrapment of the pudendal nerve, an important nerve that supplies the pelvic floor, causing persistent pain and dysfunction in the lower pelvic region.

How Does Pudendal Neuralgia Manifest In Males?

Pudendal neuralgia is a chronic pain condition stemming from compression, irritation, or inflammation of the pudendal nerve. This nerve travels from the lower spine through the pelvis, branching out to supply sensation and motor control to areas such as the penis, scrotum, perineum, rectum, and anal canal.

In males, dysfunction of this nerve can lead to a wide range of distressing symptoms affecting bladder, bowel, and sexual function.

The hallmark of pudendal neuralgia is sharp, burning, or stabbing pain that is aggravated by sitting and relieved by standing or lying down. It often follows a “hammock” distribution (the pudendal nerve’s path across the pelvis resembles a hammock, making it vulnerable to compression or stretching), affecting areas one would contact while sitting on a bicycle saddle.

This condition can mimic other diagnoses, making it difficult to recognize without specialized assessment. While it’s not life-threatening, it can be life-altering, impacting everything from urination and defecation to intimate relationships.

Recognizing The Signs And Symptoms Of The Condition

Because the pudendal nerve serves multiple functions in the pelvic region, its irritation can present with a broad array of symptoms. These may be localized or radiate to other regions of the lower body. Below are some of the hallmark presentations of pudendal neuralgia in males:

Rectal Pain

A deep, sharp, or throbbing pain in the rectum is common in pudendal neuralgia. This may be mistaken for hemorrhoids or proctitis, but the pain usually lacks a clear anatomical cause on physical examination. It is often described as pressure, fullness, or stabbing sensations, especially when sitting.

Perineal Pain

The perineum, the area between the scrotum and the anus, may become hypersensitive or painful. Men may describe it as a persistent ache, burning, or sharp jabbing pain that worsens with pressure or prolonged sitting.

Genital Pain

Men may experience aching or burning pain in the penis or scrotum. The discomfort can range from mild irritation to severe neuralgia and may also include feelings of numbness or tingling.

Sexual Dysfunction

The pudendal nerve plays a vital role in sexual arousal and function. Its dysfunction can lead to erectile difficulties, loss of sensation, pain during or after ejaculation, and a decrease in libido. These symptoms can be emotionally distressing and affect relationships.

Urinary Issues

Disrupted nerve signaling can lead to urinary urgency, frequency, burning during urination, or incomplete emptying of the bladder. These symptoms often mimic urinary tract infections but persist despite negative cultures.

Persistent Pelvic Pain

Many men report a general sensation of tightness, pressure, or aching in the pelvis. This discomfort can be constant or intermittent, and it tends to worsen after long periods of sitting or certain physical activities.

Butt Pain

Throwing this question out to the social-media masses is sure to bring out the cyber “comedians” among us, but the truth is when you really do have butt pain, it’s no laughing matter. So we’re glad you came here to ask because we actually do see many patients in our clinic with this problem. There are a number of issues that can cause butt pain, but the root causes we most often discover are hamstrings tendinopathy, a pinched low-back nerve, or sacroiliac joint syndrome. Let’s take a look at each of these individually. – Hamstrings Tendinopathy: The hamstrings are actually a collection of large muscles…

Lower Back Pain When Sitting

After a long day on your feet sitting down is supposed to be way to relaxing. Unfortunately for some sitting for any length of time can be painful. Most people experience low back pain at some point in their life. The lifetime prevalence of low back pain is 85% (1). Let’s take a deeper look at the different types of pain and causes of low back pain when sitting. Pain can present in many different ways. It can be intermitent or constant. The quality of the low back pain can also vary depending upon the actual source of injury. Common examples include: Sharp and Stabbing, Dull and Aching, Throbbing/ Pulsating, Pins and Needles, Burning, Electrical

Read More About Lower Back Pain When Sitting

Gastrointestinal (GI) Problems

Gastrointestinal (GI) problems can be debilitating comprising one’s wellbeing and ability to confidently engage in life. Symptoms vary and can include nausea, bloating, constipation, diarrhea, delayed motility, abdominal pain, irritable bowel-like symptoms, heartburn, and reflux. GI problems can be due to structural and functional problems within the gut itself. Examples include hiatal hernia and bacterial overgrowth. Less appreciated is the fact that many patients with Craniocervical instability (CCI) can also have significant GI problems. Regrettably, many of these patients undergo extensive, costly GI evaluations only are told that their examinations and studies are normal. This can be extremely frustrating. For these patients…

Read More About Gastrointestinal (GI) Problems

Sit Bone Pain / Ischial Tuberosity

The ischial tuberosity, also called your Sitz bone, sis a pair of rounded bones that extends from the bottom of the pelvis. They are the bones that we sit on. The pelvis consists of three strong bones fused together: the ilium, ischium and pubis. The ilium are the tall, thin bones that create the iliac crest aka the waist bone. The pubis bones are the small anterior bones that are joined together by the pubic symphysis. The ischium forms the lower and back part of the pelvis. It is situated between the ilium and pubis A tuberosity is defined as a large prominence…

Read More About Sit Bone Pain / Ischial Tuberosity

Possible Causes Of Pudendal Nerve Irritation In Males

Pudendal neuralgia can develop gradually or follow a specific triggering event. The underlying causes generally relate to mechanical compression, inflammation, or systemic conditions. Here’s a breakdown of potential contributors:

Prolonged Pressure On The Nerve

Long-distance cycling, motorcycle riding, or sedentary work that involves sitting on hard surfaces for hours can compress the pudendal nerve. The entrapment often occurs in the Alcock’s canal, a narrow passage within the pelvis.

Complications From Surgery

Pelvic surgeries, such as hernia repairs, prostatectomy, or hemorrhoidectomy, can inadvertently stretch, entrap, or damage the pudendal nerve. Scar tissue or mesh may also lead to the delayed onset of nerve pain.

Injury And Trauma To The Pelvis

Falls, direct trauma, or pelvic fractures can disrupt the pathway of the pudendal nerve. Even minor injuries may lead to lasting irritation, especially if pelvic alignment or soft tissue structures are altered.

Infections And Diseases

Certain infections and chronic diseases can affect the pudendal nerve:

Urinary Tract Infection (UTI): Though UTIs don’t typically affect the pudendal nerve directly, they can lead to inflammation and increased pelvic sensitivity.
Viral Infections: Viruses like herpes zoster (shingles) or HIV can cause neuropathic pain involving the pudendal nerve.
Multiple Sclerosis (MS): MS can damage the protective myelin sheath around nerves, including the pudendal nerve, leading to pain and functional issues.
Diabetes: Long-term high blood sugar can lead to peripheral neuropathy, potentially affecting the pudendal nerve.

Tumors And Cysts

Benign or malignant growths in the pelvic region can compress the pudendal nerve, potentially causing discomfort or other symptoms. Cysts, particularly Tarlov cysts located near the sacral nerve roots, can also cause referred symptoms of pudendal neuralgia.

Diagnosis And Assessment Methods Used To Identify The Cause

Because pudendal neuralgia can mimic other conditions, a thorough diagnostic process is essential. Clinicians typically begin with a detailed medical history and physical exam focused on the pelvic floor, neurological function, and musculoskeletal alignment.

Common diagnostic tools include:

Physical Exam: Includes palpation of the pelvic floor muscles and nerve pathways, checking for tenderness or referred pain.
MRI: Used to rule out structural abnormalities, tumors, or signs of entrapment.
Pudendal Nerve Block: A temporary anesthetic injection near the nerve. Relief of symptoms can confirm pudendal neuralgia.
Electromyography (EMG): Measures nerve and muscle function to assess for neurogenic abnormalities.
Pudendal Nerve Terminal Motor Latency Testing (PNTML): A specialized test measuring nerve conduction speed to identify delays or dysfunction.
Quantitative Sensory Testing: Assesses sensory nerve thresholds to detect hyper- or hypo-sensitivity in the nerve distribution.

Treatment Options That May Help Relieve Discomfort

Treatment for pudendal neuralgia depends on its severity, cause, and duration. A multimodal approach—addressing inflammation, mechanical compression, and nerve repair—is often the most effective.

Decompression Surgery: If conservative treatments fail and nerve entrapment is confirmed, surgical decompression may be considered. This involves freeing the pudendal nerve from tight ligaments or scar tissue. While invasive, it can provide long-term relief in select patients.
Sacral Neuromodulation (SNM): This involves the implantation of a small device that stimulates sacral nerves to modulate pain and pelvic function. SNM may be considered in refractory cases involving bladder and bowel dysfunction.

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition. After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day. I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Nerve Repair Supplementation

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Prolotherapy Injections

It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…

PRP Injections

PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…

Nerve Hydrodissection

Nerve Hydrodissection is a medical procedure that aims to free up scar tissue or adhesions on a given peripheral nerve. The procedure utilizes ultrasound guidance to visualize both the needle and the targeted nerve. Medication is then injected through the needle to free up the scar tissue. Nerve Hydrodissection is a minimally invasive treatment option for many peripheral nerves that are compressed or entrapped by scar tissue.Pain is an uncomfortable and at times painful sensation. It varies significantly from patient to patient. There are many different types of pain which include inflammatory, nociceptive, and neuropathic. Neuropathic pain is pain that arises from nerve compression or injury.

Supportive Strategies To Minimize Risk

Preventing pudendal neuralgia or reducing its recurrence involves a combination of ergonomic awareness, lifestyle modifications, and pelvic health maintenance. These supportive strategies are especially crucial for individuals who are prone to nerve irritation due to occupational habits, previous injuries, or musculoskeletal imbalances.

Avoid Prolonged Sitting

Sitting for long periods; especially on firm, narrow, or unpadded surfaces; puts direct pressure on the pudendal nerve as it passes through the ischial spine and Alcock’s canal. This pressure can cause nerve irritation or worsen existing inflammation.

If your occupation or daily routine involves prolonged sitting (e.g., desk jobs, truck driving), schedule regular standing or walking breaks every 30 to 60 minutes to relieve pressure on the pelvic floor and improve blood circulation.

Use Cushioned or Donut-shaped Pillows When Sitting

Specialized seat cushions, particularly donut-shaped or split-seat ergonomic pillows, can significantly reduce pressure on the perineal area and sit bones. These cushions redistribute body weight away from the sensitive pudendal nerve pathway and promote a more neutral pelvic alignment.

Using them consistently—at work, during travel, or while driving—can help prevent exacerbation of symptoms and provide comfort for those already experiencing nerve pain.

Maintain Good Posture

Poor posture can lead to imbalances in pelvic alignment, spinal curvature, and hip mechanics. Slouching, leaning to one side, or anterior pelvic tilts increase strain on the pelvic floor and adjacent nerve structures.

Practicing good posture, by keeping the spine neutral, shoulders relaxed, and feet flat on the floor, minimizes mechanical stress and supports pelvic nerve health. Ergonomic chair adjustments and physical therapy guidance may also help train your body to maintain better alignment throughout the day.

Avoid Activities That Strain or Compress the Pelvic Region

Certain physical activities exert significant pressure or repetitive strain on the pelvic floor. Heavy weightlifting, particularly when performed with improper technique or breath-holding (Valsalva maneuver), can cause excessive intra-abdominal and pelvic pressure, irritating the pudendal nerve.

Likewise, long-distance cycling is a known risk factor for pudendal neuralgia due to continuous pressure on the perineum from narrow saddles. To reduce risk, modify workouts to avoid strain, use a wide, padded bicycle seat, or consider switching to recumbent cycling if needed.

Perform Pelvic Floor Relaxation And Stretching Exercises

A hypertonic (overactive or tense) pelvic floor is commonly seen in men with pudendal neuralgia. Unlike strengthening exercises such as Kegels, relaxation-based movements focus on releasing tension in the pelvic muscles.

Deep diaphragmatic breathing, yoga stretches (like child’s pose or happy baby pose), and physical therapy-guided myofascial release techniques can help decompress the pudendal nerve and improve pelvic mobility. Consistent practice of these gentle exercises may alleviate pain and prevent future flare-ups.

Manage Bowel Habits to Prevent Constipation and Straining

Straining during bowel movements places direct pressure on the pudendal nerve and surrounding pelvic structures. Chronic constipation can lead to or worsen nerve irritation over time.

To maintain healthy bowel habits, ensure an adequate intake of fiber (from fruits, vegetables, and whole grains), drink plenty of fluids, and stay physically active to support digestion. The use of a footstool (such as a Squatty Potty) while on the toilet can also help maintain optimal anorectal positioning and reduce straining. In some cases, consulting a gastroenterologist or a pelvic floor physical therapist may be beneficial.

How The Centeno-Schultz Clinic Approaches Pelvic Issues

The Centeno-Schultz Clinic specializes in diagnosing and treating musculoskeletal and nerve-related pain. While CSC does not directly treat pudendal neuralgia, it evaluates and manages pelvic dysfunction that may contribute to pudendal nerve irritation.

Pelvic instability, sacroiliac joint dysfunction, or ligament laxity can place abnormal tension on the pudendal nerve. Through advanced imaging, regenerative therapies, and functional assessments, CSC helps patients address underlying mechanical issues that may be exacerbating their symptoms.

Don’t Wait, Get the Right Care for Pudendal Nerve Pain

Pudendal neuralgia in men is often misunderstood and misdiagnosed. If you are struggling with unexplained pelvic pain, genital discomfort, or sitting intolerance, don’t ignore these symptoms. Early evaluation and personalized care can restore your quality of life.

At Centeno-Schultz Clinic, we offer a comprehensive approach to pelvic pain rooted in musculoskeletal science and regenerative medicine. Reach out today to learn if your symptoms could be linked to pelvic instability or nerve irritation—and explore non-surgical solutions that target the root of your pain.

Considering orthopedic factors that may be contributing to nerve symptoms? Learn more about the care options available.

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Our Doctors

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics.

Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who travel to Colorado to undergo innovative, non-surgical treatments. Dr. Centeno has chaired multiple international research-based conferences. He also maintains an active research-based practice, with multiple publications listed in the US National Library of Medicine. Dr. Centeno has also served as editor-in-chief of a medical research journal dedicated to traumatic injury.

Dr. Centeno trained at the Baylor College of Medicine, Texas Medical Center, and the Institute for Rehabilitation Research. He hails from both Florida and New York and currently resides in Boulder, Colorado with his wife and three children.

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

A smiling man wearing scrubs and a patterned surgical cap.

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…