Pelvic Floor Physical Therapy for Pudendal Neuralgia

How Physical Therapy Reduces Stress and Tension on the Pudendal Nerve


Pudendal neuralgia is a condition where the pudendal nerve - a vital nerve that runs through the pelvic floor - is irritated. The primary symptom of pudendal neuralgia is pain, but it can present in a variety of ways.  Some patients with pudendal neuralgia report a burning sensation, a stabbing pain, a dull ache, the feeling of a lump within the pelvic floor ("like sitting on a golf ball"), or the feeling of a hot poker.  


Because the pudendal nerve runs through the entire pelvic floor, symptoms can manifest anywhere the nerve reaches - often it's experienced between the sitbones, in the genitals (for both men and women), or in the perineum.

While it may be difficult to get a definitive pudendal neuralgia diagnosis, doctors use the following criteria:

  • Pain in the territory of the pudendal nerve: from the anus to the penis or clitoris

  • Pain is predominantly experienced while sitting

  • The pain does not wake the patient at night

  • Pain with no objective sensory impairment

  • Pain relieved by diagnostic pudendal nerve block



Physical therapy has been proven to be the most effective approach to pudendal neuralgia - 88% of patients saw significant improvement with pelvic PT.  Their pain and symptoms were reduced by more than 70%, and many saw complete pain relief and were able to avoid unnecessary surgery.

The pain and symptoms of pudendal neuralgia are the result of the nerve being irritated.  When there is additional pressure or tension on the nerve, it can cause referred pain anywhere that the nerve reaches in the pelvis.  The goal of pelvic floor physical therapy is to release the tight muscles and relieve tension on the pudendal nerve.  

Many patients have already had at least one pelvic surgery for their pudendal neuralgia prior to coming to physical therapy. In this case, physical therapy can also work to help release the scar tissue that adheres, or sticks, to the surrounding tissue and clear the inflammation in the area that can build up after a surgery.

"The excellent and precise treatment I have received has shifted me from a plateau where I was still very disabled, despite nearly three years of varied treatments, to feeling nearly pain-free for a full two weeks! I had given up hope that I would ever experience anything more than a temporary respite from intractable pain.  I am extremely grateful!"


At PelvicSanity, your physical therapist will be a specialist in the field and an expert in dealing with pudendal neuralgia and chronic pelvic pain.  Many of our patients have been to multiple doctors for their symptoms before finding success here at PelvicSanity.

We believe full-length sessions are crucial to success with pelvic PT, so all appointments at PelvicSanity are an hour in length and spent entirely with a pelvic floor specialist. You’ll never be hooked up to electrodes, see an aide instead of a physical therapist, or be told to ‘just do your Kegels.’  We create a positive, calm environment for healing in private treatment rooms.

We also believe the pelvic floor can’t be treated in isolation, so your treatment will address both the pelvic floor and the external muscles that connect and influence the entire pelvis for optimal results. 


Your initial evaluation will be an hour in length, and have three major components:

  • Consultation: Most of our patients have been to multiple doctors, but have never really felt listened to in their appointments.  In your initial evaluation you’ll have a chance to go through your medical history with your physical therapist.  We’ll listen to you and ask about your personal goals for physical therapy.

  • Assessment:  Next your physical therapist will do a complete assessment.  They will look at your posture, hip and pelvic alignment, fascia, scar tissue, and anything else influencing your pelvis.  Then they will do an internal evaluation, looking for trigger points and dysfunction within the pelvic floor muscles.

  • Treatment:  We also want to know how your body responds to treatment, so your initial evaluation also includes targeted treatment.  You’ll also leave with ‘homework’ that you can be doing in between your visits to build on the improvements with physical therapy.


"I have been to other physical therapists....but they did not have the training or experience to help me. I highly recommend giving yourself a chance and allowing PelvicSanity to help you."


Tight pelvic muscles, like the glutes, are often contributing to the nerve irritation and can be released with pelvic PT.

Nearly 90% of patients with pudendal neuralgia reported improvement with physical therapy in one clinical trial.  In another, pelvic PT reduced male pelvic pain and improved quality of life.

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