r/PudendalNeuralgia

I had unguided pudendal nerve blocks done bilaterally May 2025. The gyno didn't fully inform me so I wasn't aware they could be done by CT or ultrasound. An MRN prior to the blocks showed no abnormalities along the pudendal path. She also did botox into the coccygeus muscles, I have no idea why as pelvic floor exam showed a tender spot on left obturator internus nowhere else.

Anyway I developed bowel incontinence almost immediately which finally has improved but still present. I also had an MRN done 5 weeks after the procedure that showed new, from prior mrn, hyperintensity of the left pudendal nerve at the entrance and into Alcocks canal. I had another mrn done Dec 2025 and hyperintensity was still present.

Prior to any intervention I had discomfort sitting like a feeling of fullness/swelling in the perinium and heaviness like a ball in vagina when standing.

I don't have a hypertonic pelvic floor, can't take any of the usual medications due to permanently low sodium, have had 2 anesthesia only ultrasound blocks with 90% relief but very short lived, two rounds of pulsed radiofrequency which didnt help but didn't make things worse plus hydrodisection which flared me badly. I have remained active by walking but the new type of pain after the blocks is stabbing, burning, vice like, deep ache. I'm really not sure what I can try or do next except for stimulator or decompression. Live on either ice or heat and tolerate tramadol which brings pain down a notch in the morning but no effect later in the day. Any suggestions or thoughts much appreciated.

I may have missed it but I haven't seen this symptom listed in the pinned posts but I have the typical symptoms of PN of urinary, bowel, null orgasm, hard flaccid, etc. The only difference in my case seems to be that instead of pain there is numbness. I get occasional jolts of pain here and there in my groin and shaft maybe 2-3 times a week but my penis consistently has maybe 30-40% of its normal sensation.

The past week or two there have been instances where i've woken up and my penis felt slightly cold to the touch. I sleep with a fan on and have holes in my sleeping boxers so I didn't think too much of it. I saw that it's usually a symptom of/alongside hard flaccid syndrome.

However, this morning I woke up and my penis was ice cold to the touch and completely numb. I got out of bed, went to the bathroom (had more resistance than usual) and just standing for a bit considering whether to go the ER. After about 10 minutes there was slight sensation, after around 30 there was noticeable improvement, and after an hour it was back to baseline if not a tad better.

I had some type of "flare" last night after doing stretches that my PFPT assigned (it's not the first time) and felt tighter than usual in my right hip and glute area which i think has to have had contributed to all this. Alongside the cold penis this morning, I have had that slight pain/pressure like feeling on and around the anus.

hi all,

35 queer amab here.

was invited to this sub by one of the mods who saw my post in r/pelvicfloor. idk if what i have is PN. I’m more worried it’s levator ani syndrome. kind of freaking out, trying to stay calm.

so, two nights ago i had anal sex with someone who has a very big penis. he went really hard for a while, and at one point i noticed i was experiencing a sharp pain deep in my rectum, so i asked us to take a break. a little while later we continued, and the pain was still there but less so and i was able to continue for a little while longer with much less pain.

since then the pain hasn’t fully gone away, tho its not ever-present. it’s mainly a sharp pain that’s pretty deep in my rectum, tho sometimes it’s a dull ache. it does feel like a muscular pain rather than a fissure or hemorrhoids, both of which i’ve had and usually present more as a burning pain. also i’ve detected no blood in the area, so a fissure or hemorrhoid seems less likely.

tho not always, the pain mainly pops up when i’m sitting or lying down, esp on my stomach. just now even it spiked while i was sitting for a bit. i got up to walk around and the pain persisted for a bit while standing/walking. it’s gone now tho.

when i manually palpate the area internally i can trigger the pain to some degree. it feels like it’s mostly localized to the area of my rectum just beyond my prostate, on that same side (genitals-side rather than tailbone-side). it’s pretty deep in there. like, it’s hard to reach with my fingers.

while mainly sharp, i wouldn’t describe the pain as the “sitting on a golf ball/golf ball stuck in rectum” feeling that is normally associated with levator ani syndrome. additionally, i did sit for 30 minutes in a car right after the initial episode without any issues, and no pain has woken me up at night (pain while sitting and rectal pain that wakes you up are listed online as typical levator ani syndrome symptoms). there’s also no pain when i’ve taken a bowel movement thankfully. maybe a tiny bit earlier today but nothing bad.

anyway, have been doing some research on what it would be and came across levator ani syndrome. i’m worried it might be that, which sounds like hell.

additional info: i messaged a pretty well known butt doctor on instagram who has a podcast about this stuff. he was really lovely and got back to me with some info (and is even gonna talk about this on his forthcoming episode!). his initial thought is:

“Most likely scenario
Post-traumatic pelvic-floor myalgia/levator ani spasm, particularly if there is:
• Dull, aching, pressure-like rectal pain
• Pain worsened by sitting and sometimes after defecation or intercourse
• Symptoms lasting ≥30 minutes or recurring
• Reproduction of the characteristic pain with posterior traction/palpation of the puborectalis or levator muscles

*Rome IV requires chronic or recurrent rectal aching, episodes lasting at least 30 minutes, puborectalis tenderness, and exclusion of structural/inflammatory causes; symptoms should generally be present for 3 months, with onset at least 6 months before formal research classification.

But you need to make sure there’s not a tear or an abscess or something, causing the pain.”

*this paragraph i think is him talking about the likelihood of it being levator ani syndrome.

so yeah that’s what’s been going on. im trying not to freak out. people on r/pelvicfloor were very lovely and supportive, as was this doctor. that’s helped some but the flare ups of pain today have me worrying. i don’t want to have to give up or worry like crazy about anal intercourse. can anyone offer some insight and thoughts? am i being a total hypochondriac? could it just be a minor spasm of some kind that won’t develop into levator ani syndrome or PN or something? am i for sure gonna need professional treatment of some kind?

thank you!

I’m a 27-year-old male with almost five years of progressively worsening urinary, sexual and sensory symptoms. I don’t have the classic burning pelvic pain usually associated with pudendal neuralgia, but I’m wondering whether pudendal nerve irritation or compression could cause predominantly numbness and loss of function instead.

It began with a sudden constant urge to urinate, difficulty emptying, a weak/split stream and repeatedly straining to pass more urine. Sometimes I could continue passing small amounts for hours. Semen would also remain in the urethra and need to be milked out.

I was treated for suspected prostatitis with doxycycline. Four days into treatment, while sitting, I suddenly felt something “change” around my urethra and the underside of my penis. From that exact moment, I completely lost the internal sensation of urinating and ejaculating. I can still physically urinate, ejaculate, orgasm and maintain erections, but I cannot feel the urine or semen passing.

The sensory loss has gradually progressed:

• The underside of my penis is completely numb, including to ice and sharp touch.
• Sensation in the glans is severely reduced.
• I can contract the muscles that normally “bounce” the penis, but no longer feel the contraction.
• Testicular sensation has become markedly reduced.
• Anal sensation when passing stool is also reduced.
• I still experience incomplete emptying, post-void spurts and occasional weaker flow.

Around two years ago, a contrast urethrogram appeared to show a distal urethral narrowing. Initially the dye would not flow properly, but when I relaxed and used deep abdominal breathing, it began flowing and the narrowing appeared to open. I was nevertheless diagnosed with a stricture.

I had a flexible cystoscopy yesterday. The scope passed easily, and the urologist said my urethra and bladder were completely normal and that I do not have a stricture.

Pelvic, lumbar, thoracic and cervical MRI investigations have also not found a cause.

Because the apparent narrowing changed with relaxation, I wonder whether years of urgency, straining and constant guarding caused a severely hypertonic pelvic floor, which may now be irritating or compressing the pudendal nerve or one of its branches. My perineum also becomes extremely hard/tight during erections, although it isn’t painful.

Has anyone here experienced pudendal neuropathy primarily as genital numbness and loss of urinary or ejaculatory sensation, without the characteristic severe pain? Does the distribution underside of the penis, glans, scrotal/testicular area and anus msound potentially consistent with pudendal involvement?
I understand nobody here can diagnose me.

After almost five years of progression and several urologists saying they cannot help, and impying this is a mental issue, I need some assistance.

I’m mainly trying to identify the correct specialist and testing pathway.

Would this be the dorsal branch of my pudendal nerve compressed? I’ve been dealing with this issue for years and years. I’m nervous to get any type of surgery because I don’t have the pain symptoms many people report from PN. Surgery isn’t guaranteed to fix the sensation issue either

Has anyone here improved sensation issues? Looking for any help

I have a question about healing symptoms. This is a throwaway account as I don't want this on my main profile.

I am a 28 yo female who has been dealing with this for 6+ months. I have been slowly healing with time, but I don't think I'm out of the woods yet. I have a question about something I've noticed.

I have noticed that I get this pulsing sensation, almost like a tiny mini orgasm, after I go to the bathroom, or sometimes after walking for a bit, or just when it's agitated. It is triggered mainly when I lay down. After it does that, it almost always feels better, less pressure, less burning. Does this mean anything to anyone? This has been going on for a couple of months now, with decreasing frequency as time has passed. When I have a flare, it happens more. I would appreciate any insights if anyone has experience with this. I've asked doctors about this but they don't really have any thoughts.

Would also be curious if anyone has dealt with a raw feeling right at the entrance of their vagina. As the agonizing burning symptoms have moved away from the urethrae/labia, I have been dealing with a raw, sometimes itchy vaginal opening. Would you also consider this a positive sign? I think yes, but am looking for any other opinions.

Thank you. For those dealing with this, sending my love <3

What experiences have people had with this procedure? Risks? Potential for healing?

I am seeing a new neurologist who specializes in the pudendal nerve. I've lived with pudendal neuralgia for 12 years and it's been 2 years since I have had any noticeable improvement in my symptoms. I live in a 6 or 7 out of 10 pain scale rating any time I'm not standing or walking.

He recommends performing a radiofrequency pudendal nerve ablation. I don't know much about this yet, but he says it will burn off the pain receptors in the nerve and that it will take approximately 6 months for them to grow back.

The plan is to aggressively pursue pelvic floor physical therapy and other treatment options while these pain receptors are gone.

All symptoms listed below have been constant for 12 years bilaterally, although have improved to a small extent from treatment over the years:

1. Constant muscle tension, pain, and irritation in: piriformis, glute medius and maximus, perineum, obturator internus, pubo-rectalis, bladder, and inner thighs. Symptoms are constant.

2. Constant muscle spasm in puborectalis

3. Constant burning, cold, and pins and needles sensation in glans, scrotum, underside of shaft, and perineum. Symptoms improve when I stand or walk.

4. Constant degree of numbness in glans, scrotum, perineum, and buttocks.

5. Overactive bladder.

6. Pain around pubic bone.

I have been officially diagnosed with pelvic floor dysfunction and dysenergenic defication.

I am wondering if there is a possibility I might be suffering from pudendal nerve neuralgia?

I have diminished sensation in vagina and clitoris. I have right side onsided shooting pain inside my vagina that comes and goes when I use a dialators to try to do PT exercises. I have a very hard time orgasming and can only orgasm if I hold my legs straight and hold tight playing with my clit. My orgasms are very weak and I can barely feel anything. Could these be signs and symptoms that I have pudendal nerve neuralgia? What are the labs and tests performed to diagnose with PN? I live in los angeles California, any recommendations for any specialist would be appreciated? Also what speciality is besr to be seen for this?

Hi guys, as the headline says I’m getting Botox in my pelvic floor and around my pudendal nerve next week. I’ve really dreaded doing anything that involves needles in that area but I feel like I’m running out of non invasive options.

I guess I’m writing this to ask if any of you have experience with having Botox in your pf?

I’ve really been going through it trying to find something that will help me.. So far I’ve seen several gynos,physical therapists, a psychologist, urologist, been to so so many dr appointments over the past almost three years of this. I’ve tried estrogen cream, supplements, more water, vaginal moisturizers, switching my birth control, stretches/belly breathing, a pelvic wand and honestly the list goes on. I feel like I’ve tried everything. Even tried nortriptyline, but it made my heart go crazy so had to stop only after three months on it

It’s reeeally getting old trying to figure this out😅 thanks for reading/listening. Please let me know if you have any advice 🙏🏼

&#x200B;

Hello. I would like to know if I am the only one who suffers from pudendal neuropathy with these symptoms: burning, sunburn sensation, and itching in the perineal area, genitals, and thighs. I also have symptoms when standing, not just sitting.

Has anyone found a reliable surgeon that does spinal or sacral stimulators for their pudendal neuralgia/neuropathy?

Curious what your outcomes were and how you went about getting one, good and bad outcomes welcome !

I recently had a hip injury occur while walking my dog, but had severe nerve issues while it happened, and experienced electric shock like sensations down my leg. A couple months later- now my hip feels better but I’m left with patchy, insane-inducing burning, tingling, crawling, and itching sensations ALL OVER my body!! My doctors have no idea why, and say it doesn’t have to do with the hip. It began at a similar time so my intuition tells me that it must be part of the hip healing process, and that maybe it’s pressing on some part of my back nerves. This is constant weird sensations in my body, and I’m young, at 22 years old. The crawling sensations are still there but have developed into more itching, which just makes me crazy!!! Anyone, please help.

Has anyone experienced widespread numbness along with penile numbness?
I’m wondering if anyone with pudendal nerve issues has experienced something similar.
I have reduced sensation in my penis, but I’ve also noticed reduced sensation in many other parts of my body — my face, forehead, nipples, beard, scalp/hair, and basically my whole body. Things just don’t feel as sensitive as they used to.
What makes this confusing to me is that I don’t have erectile problems, urinary problems, bowel problems, muscle weakness, or any issues with movement.
I understand that the pudendal nerve mainly affects a specific area, so I’m struggling to understand how a pudendal nerve problem could be associated with reduced sensation throughout the entire body.
Has anyone here experienced something similar? Could a pudendal nerve issue somehow coexist with a more generalized sensory problem, or would this point more toward something else affecting the nervous system?
I’d really appreciate hearing from anyone who has had a similar experience.

I’m looking for a self pay estimate for a Pudendal Nerve Block. I don’t have insurance. I’ve called several people in several different departments over the past month, and I’ve gotten nowhere. My hospital admitted that they are so backed up, it’s taking weeks to respond to patients.

What a joke our health system is.
I’m so sad/mad/emotional/lost.
If I can’t afford it I can’t get it.

So my question is, if you had to pay out of pocket for a pudendal nerve block, how much did it cost?

Is anyone familiar with this? My Urogynecologist offered it for my pelvic floor pain. Just wondering if anyone has heard of it or tried it?

Hi everyone. I’m hoping to find someone who has experienced something similar and can share their experience with me.
For about four months now, I’ve been experiencing a constant, unwanted sensation of arousal in my clitoris, together with significant hypersensitivity and discomfort. I have absolutely no sexual desire associated with the sensation — in fact, it is very distressing and makes me anxious.
The symptoms are present throughout the day and seem to become worse when I sit for a long time. Interestingly, walking seems to relieve them slightly. On a couple of occasions, I also noticed a more noticeable pulsating sensation in the area during the night.
I was examined by a gynecologist,urologist, neurologist, psychiatrist (spent time,money and energy) and lastly by one uro gynecologist who specializes in pelvic health. During the pelvic examination, there was one particular area that caused significant discomfort, and I was told that I have some pelvic floor hypertonicity.
I was also given a 20-day treatment with ice and a corticosteroid ointment. I may have felt slightly better during that period, but overall the sensation has remained fairly constant.
I was also suggested to make some pelvic floor physiotherapy appointments.
I found this disorder by trying to find constantly information.
I am feeling quite scared and overwhelmed by all of this. I would really appreciate hearing from anyone who has experienced similar symptoms, especially if you also had symptoms that became worse with sitting or had pelvic floor hypertonicity.
Did anything help you? Did your symptoms improve over time?
Thank you so much. ❤️

Hi! I’m hoping someone here could help me find a relatively local gynecologist, urologist, pain doctor, colorectal surgeon, or whoever else takes insurance and can do pudendal nerve block injections. I don’t care what speciality or the dr’s gender. As long as I can get an appt and they take insurance.

My PT suggested looking into it. She thought it might make me more comfortable, at least temporarily. The nerve pain is making it hard to make any progress in PT.

Most of what I’ve been finding online seems to be private practices that do not take insurance and that PRM protocol place, which also doesn’t take my insurance.

Thanks in advance and hang in there, ya’ll.

Hi everyone,
I’m looking for people who have had either a ganglion impar block or a superior hypogastric plexus block for chronic pelvic pain, pelvic/perineal tension, vulvar pain, rectal pain, or similar symptoms.
I’m especially interested in hearing about the medications/anesthetics used during the blocks. For example:
Was Marcaine/bupivacaine used?
Was lidocaine used?
Were both used together?
Was a steroid such as dexamethasone or another corticosteroid included?
Did you have the block with local anesthetic only, without steroids?
Effectiveness
For those who had these blocks, how effective were they for your symptoms?
Specifically, did the block help with:
Pelvic floor/pelvic tension
Perineal tightness or pressure
Vulvar pain
Rectal/anal pain or pressure
Burning or aching
Pudendal-type symptoms
Muscle tightness that seems to happen because of the pain
Did you experience immediate relief from the local anesthetic, and if so, how long did it last? If a steroid was used, did you notice additional improvement over the following days or weeks?
I’m also interested in whether anyone had a temporary reduction in pelvic tension even if the block didn’t completely eliminate the pain.
Side effects
What side effects did you experience afterward?
For example:
Increased pain temporarily
Numbness
Tingling
Changes in bowel movements
Changes in urination
Dizziness or lightheadedness
Headache
Bleeding/bruising
Increased pelvic pressure
Temporary weakness
Any unusual sensations in the pelvis, rectum, vagina, or perineum
And how long did those side effects last?
Most importantly
If you’ve had both a ganglion impar block AND a superior hypogastric plexus block, which one helped you more and what symptoms did each one target?
Also, if you had either block without steroids, I’d especially appreciate hearing about your experience.
Thanks in advance! I’m trying to understand whether either of these blocks could potentially help with chronic pelvic tension/pain and what people’s actual experiences have been.

I’m looking to get some feedback here to see what people think. Male, 47.

For the last month, I’ve been dealing with numbness in my saddle area, glute, back of my thigh and bottom of my foot (all on one side). I’ve noticed I can’t feel internally on the right when I defacate. Also there is a significant pain on the right side of my penis if I masturbate.

I’ve gotten a lumbar and sacral spinal MRI that came out clean. So far my leg strength tests have all been good, but I’m concerned if the numbness continues for longer. I have an EMG next week. I’ve seen a couple of orthopedics and a neurologist. They’re not really sure what’s going on but they are assuming some sort of pudendal neuralgia.

My symptoms are pretty much numbness except for my penis which has that pain. I’m not noticing any positions that bring on any extra numbness or pain (except for sexual arousal). I don’t have any back pain at all.

Does anyone have any thoughts? I’m happy to answer any questions and entertain any ideas. Thanks.