Pudendal Neuralgia: When Sitting Hurts - A PT's Perspective

"I've seen every specialist and tried everything, but no one can tell me why sitting has become so uncomfortable."

I hear variations of this statement almost weekly in my clinic. While pudendal neuralgia is often associated with cycling injuries, I frequently see it in postmenopausal women who are puzzled by the sudden onset of mysterious symptoms. After years of specializing in pelvic health, I've learned that this condition often goes unrecognized, leaving many women feeling frustrated and alone in their search for answers.

Understanding the Symptoms: More Than Just "Pain Down There"

When my perimenopausal and postmenopausal patients first describe their symptoms, they often use words like:

• "A burning sensation in my private area"

• "Persistent itchiness that doesn't respond to typical treatments"

• "Pain that gets worse when I sit for long periods"

• "Discomfort that's hard to pinpoint but impossible to ignore"

These descriptions often come after months of frustration and multiple healthcare visits. Many women arrive in my office having already tried various treatments for what they thought might be skin conditions, infections, or hormonal issues.

Breaking Down the Mystery: What's Really Happening?

Here's what often surprises my patients: those burning or itching sensations they're experiencing aren't necessarily coming from where they feel them. Instead, they're often the result of muscles putting pressure on a nerve - specifically, the pudendal nerve.

Think of it like this: if you've ever had your foot "fall asleep" from sitting in an awkward position, you've experienced how pressure on a nerve can create unusual sensations. The pudendal nerve works similarly, but its location and the muscles around it make the situation more complex.

The Menopause Connection

During menopause, our bodies go through significant changes that can contribute to pudendal neuralgia:

• Hormonal shifts can affect tissue elasticity

• Changes in muscle tension patterns

• Altered nerve sensitivity

• Modifications in how our bodies process pain signals

These changes don't cause pudendal neuralgia directly, but they can create conditions that make us more susceptible to nerve irritation.

Beyond the Physical: The Emotional Impact

Let me share something personal: I once experienced severe nerve pain *down there* from a muscle spasm after trying a new workout. Though it lasted only a day, it was nearly impossible to think about anything else. Now, imagine dealing with similar sensations for months on end.

Many of my patients describe how these symptoms have gradually eroded their quality of life:

• Giving up beloved hobbies

• Avoiding social situations

• Experiencing intimacy challenges

• Struggling to focus at work

• Limiting travel and activities

The emotional toll is real, and validation of these experiences is an essential part of the healing process.

Starting the Healing Journey: A Comprehensive Approach

1. Education First

One of our first steps together involves looking at anatomical images to understand:

• The pathway of the pudendal nerve

• How different muscles can impact the nerve

• Why certain positions or activities affect symptoms

Understanding the "why" behind your symptoms can be incredibly empowering and often brings immediate relief - simply knowing there's a mechanical explanation for your symptoms can reduce anxiety.

2. Hands-On Solutions

I always ensure my patients leave their first session with practical tools they can use at home, including:

• Specific self-myofascial release techniques

• Position modifications for symptom relief

• Simple exercises to begin addressing muscle tension

  
  

3. Lifestyle Modifications

For my postmenopausal patients, I've found several approaches particularly helpful:

• Creating designated movement breaks throughout the day

• Developing better body awareness

• Learning to recognize and respond to early warning signs

• Building a sustainable self-care routine

  
  

4. Mind-Body Connection

Many of my postmenopausal patients have spent years putting everyone else's needs before their own. Part of our work together involves:

• Learning to tune into body signals

• Setting appropriate boundaries

• Developing a toolkit for symptom management

• Building confidence in their ability to manage symptoms

  
  

Red Flags: When to Seek Immediate Care

While pudendal neuralgia is typically manageable with conservative treatment, see your healthcare provider promptly if you experience:

• Sudden onset of severe symptoms

• Loss of bladder or bowel control

• Progressive weakness in the pelvic region

• Symptoms accompanied by unexplained weight loss

• Severe pain that doesn't respond to position changes

  
  

Moving Forward: Hope and Healing

If you're reading this and recognizing your own symptoms, know that you're not alone and that help is available. While pudendal neuralgia can feel overwhelming, it's a condition that typically responds well to appropriate treatment and management strategies.

The journey to healing often requires patience and a multi-faceted approach, but I've witnessed countless women reclaim their quality of life through proper education, treatment, and self-care strategies.

Remember: Your symptoms are real, they're not "all in your head," and you don't have to figure this out alone. Whether you're just starting to experience symptoms or have been dealing with them for months or years, it's never too late to seek help and start your healing journey.

Ready to take the first step? Schedule a free consultation call to see if virtual pelvic floor coaching can help you. If not, I'll help you find a pelvic expert in your area to set you on the path to healing.