Overview of pudendal neuralgia

Learn About Pudendal Neuralgia

This quick guide helps you understand pudendal neuralgia (PN), including its symptoms, how it’s diagnosed, and what can cause it.

This information is not a substitute for medical advice. Please consult your healthcare provider with any questions or concerns.

What is Pudendal Neuralgia (PN)?

Pudendal neuralgia is a type of chronic pelvic pain caused by irritation or compression of the pudendal nerve. The pudendal nerve is a major nerve in the pelvis which carries sensory and motor signals to the genitals, perineum, and parts of the pelvic floor. It also plays an important role in bowel and bladder function.

Neuralgia simply means nerve-related pain. In PN, pain is caused by the pudendal nerve becoming irritated or overstimulated, often due to inflammation, pressure, or surrounding muscle tension. In most cases, this does not involve permanent nerve damage or indicate a more serious underlying condition. While symptoms can be persistent and disruptive, this type of nerve pain does not typically mean you are causing harm to your tissues or organs.

Pudendal neuralgia is sometimes referred to as “cyclist’s syndrome” due to its prevalence among cyclists and endurance athletes, but it can affect people of all activity levels and genders.

What Causes Pudendal Neuralgia?

Pudendal neuralgia can have many contributing factors, and for many people there isn’t one single cause. Often, symptoms develop when the pudendal nerve becomes irritated or overly sensitive over time, rather than from one clear injury or event. This can make it frustrating to pinpoint exactly what triggered symptoms. In many cases, PN is associated with prolonged or repetitive pressure, such as long periods of sitting or extended time on a bicycle saddle. Pelvic muscle tension or imbalance - especially a high-tone or overly tight pelvic floor - can also play a role by increasing pressure around the nerve and limiting its ability to settle and recover.

PN can also be linked to trauma or injury in the pelvic region, including accidents, childbirth, infections, or pelvic surgeries. Inflammatory or autoimmune conditions may contribute as well, particularly when nerves are already sensitive.

Stress and nervous system regulation are an important part of this picture. Chronic stress can keep the nervous system in a heightened, protective state, making nerves more reactive and pain more persistent over time.

For cyclists, mechanical factors may add another layer. Saddle fit, riding posture, and long hours in a fixed position can increase pressure on the pudendal nerve - especially when combined with muscle tension or a sensitized nervous system.

For many people, pudendal neuralgia develops from a combination of physical and nervous system factors. Understanding your own contributing factors and working with a knowledgeable healthcare provider can be an important step toward recovery.

What does Pudendal Neuralgia feel like?

Pudendal neuralgia affects everyone differently, but the main symptom is pain along the pudendal nerve or its branches, which can include the rectum, anus, urethra, perineum, and genital area. This pain can feel like burning, numbness, sharp or stabbing sensations, electric-like pain, or achy/pressure-like discomfort.

Beyond pain itself, pudendal neuralgia can significantly affect daily life. Many people find sitting painful or uncomfortable, especially on a bicycle saddle or hard chair. Tight clothing may become uncomfortable, and activities like urination or bowel movements can cause pain or strain. Sexual function may also be affected. Over time, living with chronic pain can increase stress, anxiety, or changes in mood, which may further influence symptoms.

How is Pudendal Neuralgia diagnosed?

Diagnosing pudendal neuralgia isn’t always straightforward. There isn’t a single test, scan, or lab result that definitively confirms PN. Because of this, diagnosis is usually a process rather than a single moment.

For many people, diagnosis begins after common or easily identifiable conditions are ruled out (see What to Rule Out First for a checklist). If symptoms persist despite testing or treatment, this may point toward a nerve-related pain condition such as pudendal neuralgia.

A pudendal neuralgia diagnosis is typically based on a combination of factors, including:

A detailed review of symptom patterns and how they’ve evolved over time
Medical history and known triggers (such as sitting, cycling, stress, or activity)
Clinical evaluation by a provider familiar with pelvic pain or nerve conditions
Response to targeted treatments, such as pelvic physical therapy or a diagnostic nerve block

Finding the right provider can make all the difference. Working with someone who understands pelvic nerve pain and truly listens to your experience matters.

Conditions to Rule Out First

Some conditions can cause symptoms that feel similar to pudendal neuralgia. A few of these are relatively straightforward to test for or evaluate with a clinician. Ruling them out can help reduce uncertainty and clarify next steps. This list isn’t exhaustive or diagnostic - it’s a starting point for conversations with your healthcare provider.

Rule These Out First These are common issues that can cause similar symptoms and are easily evaluated with basic testing.

Urinary tract infection

Yeast infection

Bacterial vaginosis (if you have a vagina)

Prostatitis* (if you have a prostate)

Sexually transmitted infections

Other Conditions That Can Overlap or Contribute Here are a few other conditions that can overlap with or contribute to pelvic and nerve-related symptoms, and may require a more in-depth evaluation with a knowledgeable provider.

Endometriosis** (if you have a vagina)

Pelvic inflammatory disease (if you have a vagina)

Vulvodynia or localized vulvar pain (if you have a vagina)

Irritable bowel syndrome

Inflammatory bowel disease

If these conditions are ruled out, or if treatment doesn’t resolve symptoms, it may point toward a nerve-related pain condition such as pudendal neuralgia, often influenced by nerve irritation, muscular tension, nervous system sensitization, or stress.

*It’s not uncommon for people to be evaluated for prostatitis, receive negative test results, and still be prescribed antibiotics. This can happen because prostatitis-like symptoms overlap with other pelvic pain and nerve-related conditions like PN. If symptoms persist despite negative tests or antibiotic treatment, it may be worth exploring other contributing factors with a provider familiar with pelvic pain. Scott, one of the riders who shared his story on this site, was initially misdiagnosed with prostatitis. You can read Scott's story here >

**Endometriosis is another condition that can be overlooked or diagnosed late. Symptoms such as pelvic pain, urinary discomfort, burning, or pain with activity can overlap with pudendal neuralgia and other pelvic pain conditions. Because endometriosis does not always appear on imaging and often requires specialized evaluation to diagnose, many people spend years without clear answers. If symptoms persist despite treatment for nerve or muscular causes, it may be worth exploring gynecologic contributors with a knowledgeable provider. Sarah, one of the riders who shared her story on this site, ultimately learned that her symptoms were driven by endometriosis rather than PN. You can read Sarah's story here >

PN & Cycling

Learn About Pudendal Neuralgia

What is Pudendal Neuralgia (PN)?