Meet Kate
Mostly Symptom-Free
Riding with Adjustments
MTB, Gravel & Road
Riding Type
Climbing, endurance
Riding Speciality
Sharp, burning vulvar pain
Primary Symptoms
Stress and anxiety, bike fit issues
Likely Cause of PN
How it Started
My symptoms began in the winter of 2017. At first, I noticed vague burning and pinching sensations during and after rides, but nothing severe enough to stop me. As a cyclist - especially one who loved climbing - I was used to pain and discomfort, so I didn’t immediately recognize these sensations as warning signs.
During one ride, things changed. On an otherwise easy spin, I suddenly had difficulty sitting on the saddle and felt a sharp, intensely focused pinching sensation in my labia. I finished the ride standing and went home confused, assuming it was a saddle or clothing issue. I continued riding for a while, believing I could push through it, until it became clear something was wrong.
Symptoms
Over time, my symptoms extended beyond the bike and into daily life. I experienced a general burning sensation of the vulva that often felt like the start of a UTI, along with sharp, stabbing pain.
​
Sitting became uncomfortable, wearing tight clothing and underwear was difficult, and I developed strong, intense pain when my bladder was partially full or full, often accompanied by urgency to urinate. These symptoms affected both my riding and my ability to move comfortably through everyday life.
Causes
Looking back, my symptoms were likely the result of both stress-related nervous system dysregulation and bike fit challenges.
​
At the time, I wasn’t managing stress well, and I was living much of my life in a constant state of anxiety. My nervous system was often stuck in a heightened, fight-or-flight mode. Over time, that made my body more sensitive, slower to recover, and less resilient to physical stress. I also tend to hold stress in my pelvis. For me, that meant those muscles were often tight and clenched without me realizing it. When muscles stay in that guarded state, they can keep nearby nerves irritated and make it harder for the nervous system to settle, which allows pain signals to continue firing and become reinforced.
​
My bike fit also played a role, but I don’t think it was the sole contributing factor. My nervous system was already primed for injury, and the bike fit issues compounded what was already happening. I was sitting crooked and too far back on the saddle, which meant I was placing pressure on soft tissue and muscle instead of my bony structures. That sustained pressure likely reinforced the nervous system irritation rather than being the original cause.
What Helped
Recovery required addressing both the physical and nervous system components of pudendal neuralgia.
I worked with pelvic PTs who focused on dry needling with neuromodulation, manual therapy such as nerve gliding and muscular releases, and correcting muscular imbalances - particularly addressing a high-tone, overly tight pelvic floor.
​
Lifestyle changes were just as important. I worked intentionally on stress and anxiety reduction, calming my nervous system, and learning how to relax my pelvic floor. Breathing techniques helped slow my nervous system and create more length and ease in the pelvic floor. ​Meditation became an important part of my recovery as well. I initially used it as a tool to help fully relax and release pelvic floor muscles, but over time it also helped me develop greater awareness of stress patterns and how my body responds to them. Learning to observe sensations and thoughts without reacting to them made it easier for my nervous system to settle and for my body to feel safe again.
​
Medication played a limited role. I used gabapentin very sparingly, only on bad days, which amounted to a few days per month.
Mind-Body Insights
Understanding the mind–body connection was one of the most important parts of my recovery from pudendal neuralgia.
​
Before this experience, I didn’t realize I was living with a dysregulated nervous system. If you had asked me at the time, I would have said I was fine - maybe a little stressed, but nothing unusual. Looking back, I had simply normalized what it felt like to live with constant cortisol in my system: a busy mind, elevated heart rate, and always being “on.” That state had become my baseline. We aren’t really taught how to rest, pause, or recognize what true regulation feels like. In a culture that rewards productivity and endurance, slowing down can even feel wrong. Living in a chronically dysregulated state is incredibly hard on the body. Learning how to feel into my body and return to a state of calm and regulation became a foundational skill in my recovery.
​
I also came to realize that I was using cycling as a way to avoid addressing deeper emotional pain. Being good at cycling felt protective - it gave me a sense of worth and safety. If something felt uncomfortable emotionally, I could always ride hard, burn off the excess energy, and come back exhausted enough not to feel it. Over time, cycling became a crutch. I pushed past normal bounds because I needed it to feel okay, not just because I loved the sport.
​
Losing cycling was devastating, but it was also a turning point. Without that outlet, I was forced to sit with vulnerability instead of outrunning it. In hindsight, that loss removed the armor I had been relying on and created space to address trauma, stress, and patterns I had been avoiding. That work - learning how to regulate my nervous system and feel safe in my body without needing to escape - became just as important as the physical aspects of healing.
Current Status
I consider myself fully recovered, with only occasional flare-ups that are closely tied to stress levels rather than riding itself.
​
I have made intentional adjustments to how I ride. I no longer ride road or gravel and now ride mountain bikes exclusively. Part of this decision was about safety - I had been hit by cars twice while riding previously. Becoming a mom really shifted my perspective on risk. Riding trails allows me to enjoy cycling without the constant concern of traffic.
​
Mountain biking has also been much more supportive for my body. It’s a more dynamic style of riding, with frequent changes in position and more time spent standing or moving around on the bike. The more upright posture has also been significantly more comfortable for me. Clothing has made a difference as well - I found that riding without a chamois reduces pressure, and I now ride exclusively in Ripton jorts with breathable underwear, which has been the most comfortable setup for me.
​
Perhaps the biggest change has been my relationship with riding itself. Cycling is no longer something I use to prove my worth. It’s something I do for enjoyment, to spend time in nature, and to stay connected to myself. That shift has been just as important to my recovery as any physical change.
Personal Note
Losing cycling was one of the hardest parts of this experience. Riding wasn’t just something I did - it was a major part of my identity and how I connected with others. Not being able to ride left me feeling isolated, unsure of where I belonged, and hesitant to talk openly about what I was experiencing.
​
Over time, learning what was happening in my body and understanding that recovery was possible changed everything. Being able to name the condition, understand its causes, and explain it to others helped me move out of fear and into agency.
​
Sharing my story and helping create space for others to share theirs has become an extension of my own healing. My hope is that by increasing awareness, education, and openness around pudendal neuralgia, fewer cyclists feel alone and more people find a clearer path forward.