If you’re a man living with pelvic pain that worsens when you sit, cycle, or have sex, you may have heard the term pudendal neuralgia. This nerve-related condition is often misunderstood, but recognising it early can make a big difference in recovery.

What Is Pudendal Neuralgia?

The pudendal nerve runs through the pelvis, supplying sensation to the perineum, penis, and rectum. If the nerve becomes irritated, compressed, or injured, it can cause ongoing pain, this is known as pudendal neuralgia.

Common Symptoms in Men

Pain, burning, or numbness in the perineum, penis, scrotum, or rectum
Pain that worsens when sitting and improves when standing or lying down
Pain with sex or after ejaculation
Urinary or bowel symptoms (urgency, difficulty emptying, or leakage)
A sensation of a foreign body or pressure in the rectum/perineum

👉 Symptoms may be one-sided or both-sided, and they can range from mild discomfort to severe, daily pain.

What Causes Pudendal Neuralgia?

Prolonged sitting (e.g. office work, driving)
Cycling or activities that put pressure on the saddle area
Childbirth or pelvic surgery (less common in men, but possible after abdominal or prostate procedures)
Pelvic floor overactivity compressing the nerve
Trauma or injury in the pelvic region

How Is It Diagnosed?

There’s no single test. Diagnosis usually includes:

Medical history and symptom patterns (e.g. worse when sitting)
Pelvic floor assessment (internal exam is always optional)
Imaging or nerve studies (sometimes) to rule out other causes

How Physiotherapy Can Help

Physiotherapy is a key part of managing pudendal neuralgia:

Pelvic floor relaxation: teaching the muscles to release instead of spasm
Manual therapy: to reduce tension and free tissues around the nerve
Breathing and posture: improving alignment and reducing compression
Lifestyle modifications: cushions, posture changes, breaks from sitting
Education about pain: reducing fear and regaining confidence in movement

When to Seek Help

See a professional if you have:

Ongoing pelvic or genital pain when sitting
Pain during or after sex
Bladder or bowel changes alongside pelvic pain
Symptoms that don’t improve with rest or time

Pudendal neuralgia in men is real and often overlooked but it can be managed. With the right diagnosis, pelvic floor physiotherapy, lifestyle changes, and multidisciplinary care, many men find relief and return to normal activities.

✨ Think you may have pudendal neuralgia? Book a consultation with our men’s pelvic health physiotherapists at Renard Clinic for personalised, evidence-based support.