Pudendal Neuralgia Is One of the Most Misdiagnosed Pain Conditions in Medicine
Pudendal neuralgia is a chronic pain condition caused by irritation, compression, or entrapment of the pudendal nerve — the primary nerve supplying the perineum, genitals, and surrounding pelvic structures. It produces pain that is often described as burning, stabbing, electric, or crushing in the perineal region, genitals, rectum, or tailbone — and it is one of the most disabling and least understood chronic pain conditions affecting the pelvic region.
Patients with pudendal neuralgia frequently spend years — sometimes decades — cycling through providers without a diagnosis. The pain is often attributed to prostatitis, vulvodynia, interstitial cystitis, or psychological factors — because the pudendal nerve and its clinical presentation are not well understood by most providers outside of specialized pelvic health care. When the diagnosis is eventually made, patients are frequently told that options are limited — injections, surgery, or indefinite pain management.
That is not the full picture. The musculoskeletal contributors to pudendal neuralgia — pelvic floor hypertonicity, myofascial entrapment, and lumbopelvic dysfunction — are addressable through manual therapy, pelvic floor rehabilitation, and chiropractic care. For many patients, these approaches produce meaningful improvement in a condition they were told was untreatable.
At Bray Chiropractic & Wellness in Glastonbury, pudendal neuralgia is evaluated and treated as a clinical problem with identifiable musculoskeletal contributors — for both men and women.
What Is the Pudendal Nerve?
The pudendal nerve originates from the sacral nerve roots S2, S3, and S4 and travels through the pelvis via a complex anatomical pathway — passing through the greater sciatic foramen, around the sacrospinous ligament, through Alcock's canal in the obturator fascia, and into the perineum where it branches to supply the clitoris or penis, the perineal muscles, the external anal sphincter, and the external urethral sphincter.
Because of this complex pathway, the pudendal nerve can be irritated or entrapped at multiple points — including at the sacrospinous ligament, within Alcock's canal, at the ischial spine, or within the pelvic floor musculature itself. The location of entrapment affects the distribution and character of symptoms and has implications for treatment.
What Does Pudendal Neuralgia Feel Like?
Pudendal neuralgia produces a characteristic pattern of symptoms that distinguishes it from other pelvic pain conditions:
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Pain in the perineum, genitals, rectum, tailbone, or inner thighs — often burning, stabbing, electric, or crushing in quality
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Worsened by sitting — particularly on hard surfaces — and relieved by standing or lying down
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Worsened by activities that increase pressure on the perineum — cycling, prolonged sitting, and sometimes bowel movements
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Associated with urinary urgency, frequency, or hesitancy
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Associated with sexual dysfunction — pain with intercourse, arousal, or orgasm
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Often described as a foreign body sensation in the rectum or vagina
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Frequently unilateral — affecting one side more than the other
The positional nature of pudendal neuralgia — significantly worse with sitting and better with standing — is one of the most important diagnostic features and distinguishes it from other pelvic pain presentations.
Common Causes and Contributing Factors
Pelvic floor hypertonicity and myofascial entrapment
Excessive tension in the pelvic floor muscles — particularly the obturator internus — is one of the most common contributors to pudendal nerve irritation. The pudendal nerve passes in close proximity to the obturator internus, and hypertonicity in this muscle can compress or irritate the nerve within Alcock's canal.
Pelvic floor manual therapy directed at reducing obturator internus tension is frequently one of the most effective interventions available for pudendal neuralgia. Learn more about Pelvic Floor Dysfunction.
Sacral and sacropelvic dysfunction
Dysfunction at the sacral level — including SI joint dysfunction and sacral nerve root irritation — can contribute to pudendal nerve sensitization and symptom amplification. Addressing sacropelvic mechanics is an important component of comprehensive pudendal neuralgia management. Learn more about SI Joint Dysfunction.
Trauma and compression
Prolonged cycling, a fall onto a hard surface, difficult childbirth, or pelvic surgery can directly traumatize or compress the pudendal nerve. Post-traumatic pudendal neuralgia frequently has both a peripheral nerve component and a central sensitization component that requires a comprehensive treatment approach.
Postpartum pudendal nerve injury
Labor and delivery — particularly prolonged pushing and instrumental delivery — can stretch or compress the pudendal nerve, producing postpartum perineal pain and pudendal neuralgia. This presentation is frequently undertreated in the postpartum period. Learn more about Postpartum Pelvic Floor Care.
Central sensitization
In patients with chronic pudendal neuralgia, the nervous system frequently develops central sensitization — amplifying pain signals from the pudendal nerve distribution beyond what the peripheral nerve injury alone would produce.
Addressing central sensitization alongside the peripheral contributors is essential for meaningful improvement in chronic presentations. Learn more about Central Sensitization & Chronic Pain.
Pudendal Neuralgia in Men and Women
Pudendal neuralgia affects both men and women — though it is more commonly recognized in women. In men, pudendal neuralgia frequently presents as perineal pain, penile or scrotal pain, pain with ejaculation, or urinary symptoms that are attributed to prostatitis without evaluation of the pudendal nerve.
Male pudendal neuralgia is assessed and treated at this practice with the same clinical thoroughness as any other presentation. Learn more about Pelvic Floor Care for Men.
How Pudendal Neuralgia Is Evaluated at This Practice
Assessment of pudendal neuralgia at Bray Chiropractic & Wellness includes:
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Detailed health history — symptom character, distribution, positional behavior, onset, prior medical and musculoskeletal evaluation, and treatment history
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Full lumbopelvic musculoskeletal assessment — lumbar spine, sacroiliac joints, and hips
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Pudendal nerve provocation assessment — evaluating nerve sensitivity and entrapment points along the pudendal nerve pathway
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External pelvic floor assessment — evaluating tone, tenderness, and trigger point activity with specific attention to the obturator internus and surrounding pelvic floor musculature
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Internal pelvic floor assessment when clinically appropriate and with full informed consent
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Neurological screening — assessing sacral nerve root contributions and central sensitization indicators
How Pudendal Neuralgia Is Treated at This Practice
Treatment for pudendal neuralgia at Bray Chiropractic & Wellness is individualized based on assessment findings and may include:
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Pelvic floor manual therapy — external and internal soft tissue treatment targeting obturator internus hypertonicity and trigger points along the pudendal nerve pathway
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Chiropractic manipulation and mobilization of the sacropelvic structures
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Dry needling for pelvic floor and obturator internus trigger points contributing to nerve compression
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Neurodynamic mobilization — gentle neural mobilization techniques to restore mobility and reduce sensitivity of the pudendal nerve
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Rehabilitative exercise targeting pelvic floor relaxation and sacropelvic mechanics
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Clinical nutrition guidance when systemic inflammation and central sensitization are contributing factors. Learn more about Clinical Nutrition at this practice.
Learn more about Pelvic Floor Therapy, Chiropractic Care, and Dry Needling at this practice.
Pudendal Neuralgia Treatment in Glastonbury, CT
Patients with pudendal neuralgia in Glastonbury, South Glastonbury, Hebron, Marlborough, East Hartford, Manchester, and the surrounding Hartford County area will find a musculoskeletal and pelvic floor-integrated approach to pudendal nerve care at Bray Chiropractic & Wellness that addresses the contributors most providers don't evaluate.
No referral is required. New patients can schedule directly online or by calling or texting (203) 303-4760. Bray Chiropractic & Wellness is in-network with Aetna, Anthem BCBS, Cigna (ASH), and CT Medicaid (Husky). Self-pay and HSA/FSA options are also available.