Pudendal Neuralgia · Kitchener, Waterloo & Cambridge
Pudendal neuralgia is nerve pain in the genitals, the perineum, the anus or the pelvis, often worse when you sit. It can last a long time, and it is hard to diagnose because it is rare and looks like other conditions. Treatments can help, though research has not shown any one of them to be clearly better than the rest. A physician or nurse practitioner rules out other causes first; at CARESPACE the first visit is with a pelvic health physiotherapist.
What pudendal neuralgia is
The pudendal nerve is one of the main nerves of the pelvis. When it is damaged or irritated, pain is felt in the areas it supplies: the genitals, the perineum (the area between the genitals and the anus), the anus and bottom, and the pelvis. It resembles other conditions that cause pain in the same region, which is part of why it is hard to diagnose. Our pages on tailbone pain, interstitial cystitis and prostate health cover three of them.
Symptoms of pudendal neuralgia
- Sharp, burning, shooting or tingling pain, or numbness, in the genitals, perineum, anus, bottom or pelvis
- Pain that is worse when sitting. Sitting on a toilet seat is typically much better tolerated, and people with pain on one side often sit on one buttock
- Needing to pee more often
- Pain when peeing or passing stool, or constipation
- A feeling of swelling or fullness in the anus or vagina
- Pain during sex, difficulty reaching orgasm, or difficulty getting an erection
What causes pudendal neuralgia
- Pressure on the nerve over time. Long periods of sitting are the more frequent pattern, which matters in a region where so many people work at a desk. Prolonged cycling and horse riding are named too. If you ride the Iron Horse Trail or the roads around the region regularly and have this pain, mention it.
- Childbirth. Nerve pain from birth trauma is thought to resolve in most cases over a period of months.
- Pelvic surgery, and injuries to the area.
- A growth or tumour pressing on the nerve.
- Infections such as genital herpes.
- Sometimes no cause is found.
How pudendal neuralgia is diagnosed
From your symptoms, and by ruling out other causes: tumours, infection, injury and spinal problems are the ones to exclude. A physician may do a vaginal or rectal examination and arrange a scan (MRI, CT or ultrasound) or a test of how the nerve and muscles are working. Those tests often come back normal even when the nerve is the source. An injection of local anaesthetic at the nerve may be used to help make the diagnosis.
When to get medical help
Pudendal neuralgia has no emergency signs of its own in what we read. Pain in the genitals, bottom, anus or pelvis that does not get better needs a visit to a physician or nurse practitioner. Two other sets of signs matter, because other causes have to be ruled out.
Call 911 or go to an emergency department if you have pelvic pain that is severe, getting worse, or hurts when you move or touch the area, or pelvic pain together with feeling faint, dizzy or lightheaded or passing out, pain in the tip of your shoulder, difficulty breathing, heavy bleeding from the vagina, or sudden confusion. Do not drive yourself. These are the signs the NHS, the UK’s health service, lists for emergency care.
Call 911 or go to an emergency department as well if you have back pain together with any of the NHS’s emergency signs for back pain: pain, tingling, weakness or numbness in both legs; loss of feeling around the genitals or anus; changes in your bladder or bowels, such as difficulty peeing or losing control; changes in how your penis or vagina feels during sex, or being unable to get an erection or to orgasm; chest pain; or back pain that started after a serious accident, such as a car accident.
The emergency departments in Waterloo Region are:
- WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
- WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
- Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge
If you cannot get there safely, call 911.
See a physician or nurse practitioner the same day, or go to an urgent care clinic or an emergency department, if you have pelvic pain and any of these: difficulty peeing or passing stool; blood in your urine or stool; unusual discharge, fluid or bleeding from the vagina; pain when you pee, or needing to pee more than usual; a very high temperature, or feeling hot, cold or shivery; vomiting and diarrhoea, or feeling sick; or you are or might be pregnant. If you are 20 weeks pregnant or more, contact your midwife or your hospital’s birthing unit.
Painful or frequent peeing, difficulty passing stool, numbness around the genitals or anus and changes in sexual function can all be part of pudendal neuralgia. Until a physician or nurse practitioner has assessed them, treat them as these lists say, and if you also have back pain, the 911 list is the one that applies.
What the evidence says about treating pudendal neuralgia
- No treatment has been shown to be best. A 2025 review pooled 37 studies of surgery, injections and pulsed radiofrequency. All eased pain to a similar extent and none was clearly superior. The authors graded 95% of the studies C for quality, described them as poor-quality, and found side effects more severe with surgery.
- Results vary enormously. An earlier review of 28 studies and 1,013 people found reported success anywhere from 100% to under 10%, depending on the treatment and how long afterwards it was measured, and noted that there are no current recommendations based on how well the treatments work. Its authors concluded that surgery appears to offer the best long-term results, while saying that no scientifically robust consensus exists on the best treatment; the newer review above found no treatment clearly superior.
- Treat it as nerve pain. The European urology guideline’s one recommendation for pudendal neuralgia is to use the standard approaches for nerve pain, which in practice starts with medicines prescribed by a physician or nurse practitioner. It rates that recommendation strong, its firmer label, which reflects how confident its panel is and not only the quality of the research.
- Physiotherapy is a usual early step, without trials of its own. The NHS lists physiotherapy, including advice on exercises, among the first treatments a family doctor may suggest. Neither review includes a trial of physiotherapy for pudendal neuralgia; the earlier one says only that physiotherapy is advised when pelvic pain comes with overactive muscles.
- Psychological treatment helps with living with the pain. Specialists may offer cognitive behavioural therapy to help people cope, and the European guideline strongly recommends psychological treatment focused on pelvic pain when the pain causes significant distress.
- Injections, radiofrequency and surgery are specialist options. In the one randomized trial of decompression surgery that the European guideline describes, 66% of people whose pain had lasted under six years saw some improvement, against 40% of those with longer-lasting pain. Surgery is not the answer for everyone, and pulsed radiofrequency is still being developed.
What a doctor may offer
Medicines for nerve pain, such as amitriptyline, duloxetine, gabapentin or pregabalin, and referral to a neurologist or pain clinic for injections or, where something is pressing on the nerve and other treatments have not worked, surgery.
How each CARESPACE service treats pudendal neuralgia
Pelvic Health Physiotherapy
A pelvic health physiotherapist can assess the pelvic floor muscles and the positions and activities that bring your pain on. Treatment can include exercises, work on pelvic floor muscles that are overactive, and practical changes to sitting, cycling and lifting. No trial tests this for pudendal neuralgia specifically, so it is worth reviewing after a few visits whether it is helping. An internal examination is always your choice.
About pelvic health physiotherapy →
Counselling & Psychotherapy
Counselling does not treat the nerve; it is there to help you cope with long-lasting pain. CARESPACE counsellors, who are Registered Psychotherapists and Registered Social Workers, offer cognitive behavioural therapy (CBT), the therapy specialists may offer for this purpose.
Other services people ask about
Acupuncture. The European guideline recommends it for prostate pain syndrome but makes no recommendation for pudendal neuralgia, and neither review covered it. Massage therapy. Not covered either; for pelvic muscle pain in general there is no evidence that manual trigger point techniques beat no treatment. Osteopathy. Two published reports, each of a single person, with no outcome data.
Where most people start
See a physician or nurse practitioner first if nobody has ruled out other causes. Then book with a pelvic health physiotherapist, who assesses and treats at the first visit.
How your team works together
Pudendal neuralgia is mostly looked after by one CARESPACE practitioner, your pelvic health physiotherapist, alongside the physician or nurse practitioner who prescribes and refers. A counsellor can be added when the pain is wearing you down.
Browse by service: physiotherapists and counsellors.
What to expect at your first visit
- The history. Where the pain is, what sitting does to it, what you ride or lift, and which tests and treatments you have had.
- Questions drawn from the warning signs above. Some answers mean a physician or a hospital comes first.
- An examination, which can include how sitting and movement affect the pain, and is internal only if you choose.
- Treatment at that visit, and a plan, which can start with changes to sitting and activity.
What you can do at home
- Do not sit for long periods. Get up regularly and move around.
- Do not wear tight underwear or trousers.
- Avoid activities that make the pain worse, such as those with a lot of squatting, bending or lifting.
- If you want to keep cycling, try a different type of saddle to see whether it helps.
- Eat plenty of fibre and drink lots of water, to prevent constipation and pain when passing stool.
Outlook
Pudendal neuralgia can last a long time. After childbirth it is thought to resolve within months in most cases. In the surgery trial, people who had been in pain for less than six years did better than those who had waited longer. Beyond that, our sources give no typical recovery time.
Pudendal neuralgia treatment in Kitchener, Waterloo and Cambridge
Kitchener. Physiotherapy in Kitchener and Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.
Waterloo. Physiotherapy in Waterloo and Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.
Cambridge. Physiotherapy in Cambridge and Counselling in Cambridge. Location: Hespeler Road.
The city pages linked above show the locations and practitioners for each service, with their next availability.
Common questions
Why does pudendal neuralgia hurt more when I sit?
Sitting for a long time is one of the activities that put pressure on the nerve. A toilet seat is typically much better tolerated than a chair.
Can cycling cause pudendal neuralgia?
It can contribute: cycling is one of the activities that put pressure on the nerve. If you want to keep riding, try a different type of saddle to see whether it helps.
Is there a test for pudendal neuralgia?
No single test. Scans and nerve tests are often normal, so the diagnosis rests on your symptoms and on ruling out other causes. A numbing injection around the nerve may help confirm it.
Do acupuncture or massage help?
The research we read does not say. Neither was covered in the two reviews of pudendal neuralgia treatment.
Where can I get help with pudendal neuralgia in Kitchener, Waterloo or Cambridge?
In all three cities, for both physiotherapy and counselling. To find a pelvic health physiotherapist, see the pelvic health physiotherapy page. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.
Do I need a referral?
No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →
Sources
- NHS (UK). Pudendal neuralgia, reviewed January 2024; Pelvic pain, reviewed November 2025; Back pain, reviewed March 2026.
- European Association of Urology. EAU Guidelines on Chronic Pelvic Pain, 2026 edition: chapters on causes, diagnostic evaluation and management.
- Andiman S, Maron J, Dandolu V, et al. Impact of treatment of pudendal neuralgia on pain: a systematic review and meta-analysis. International Urogynecology Journal, 2025.
- Murer S, Polidori G, Beaumont F, et al. Advances in the therapeutic approach of pudendal neuralgia: a systematic review. Journal of Osteopathic Medicine, 2022 (online November 2021).
Related conditions
Pelvic Pain · Tailbone Pain · Painful Intercourse & Vaginismus · Sciatica · Piriformis Syndrome
Ready to book?
Book online with a pelvic health physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.