What is Pudendal Neuralgia?

Lateral view illustration of the male pelvis showing the sacral spinal nerves, pudendal nerve, dorsal nerve of penis, scrotal nerves, and associated perineal branches.

Pudendal Neuralgia is a pain and sensory condition involving the pudendal nerve, the main sensory nerve of the male pelvic region.
Originating from the lower spine (S2–S4), this nerve travels beneath the pelvis, supplying sensation to the perineum, penis, scrotum and anus. When it becomes compressed or irritated, it can cause pain, tingling, or numbness that interferes with sitting, training, or sexual activity.

Although relatively uncommon, pudendal neuralgia is increasingly recognised in male athletes, especially those who spend long hours on the saddle or in seated positions.

Symptoms of Pudendal Neuralgia

Pudendal neuralgia presents differently from person to person. Common symptoms include:

  • Numbness or pins and needles in the perineum (“taint”), penile shaft or glans, scrotum, or anus
  • Burning, stabbing, or electric-like pain in the pelvic floor or genital area
  • Pain that worsens with sitting, especially on hard surfaces or after long rides
  • Sexual dysfunction, including pain during or after intimacy, reduced sensation, or erectile difficulties
  • Bladder symptoms, such as pain or urgency to urinate

Many men first notice symptoms during or after long training sessions — particularly cycling — as transient tingling or numbness that may resolve at first but worsen over time if unaddressed.

Sports at Risk for Pudendal Neuralgia

Pudendal neuralgia is most commonly seen in sports and activities involving prolonged pressure on the perineum or repetitive pelvic loading:

  • Cycling – narrow saddle noses and forward-leaning positions increase perineal compression.
  • Rowing – sustained seated postures and repetitive hip hinge movement can irritate the nerve.
  • Horseback riding – saddle pressure over the pelvic floor.
  • Weightlifting – straining or excessive intra-abdominal pressure can exacerbate pelvic floor tension.

Cyclists are particularly at risk. Aggressive aero positions, firm saddles, and poor saddle tilt can concentrate pressure on the pudendal nerve.
Early recognition and bike-fit modification are key to preventing long-term nerve irritation.

How Pudendal Neuralgia is Diagnosed

Pudendal neuralgia is usually diagnosed based on clinical history and physical examination, often guided by the internationally recognised Nantes criteria. These include pain in the pudendal nerve territory, worsening with sitting, and improvement when standing or lying down.

Additional assessments may include:

  • Pelvic floor muscle testing
  • Nerve block to confirm diagnosis or relieve pain
  • Imaging to exclude other pelvic or spinal causes

Diagnosis is best made by clinicians familiar with pelvic pain and nerve entrapment syndromes, especially in active men.

Treatment & Recovery

Early treatment is essential to reduce nerve irritation and support recovery.
Most men improve with conservative care when addressed promptly.

Load & Position Modification

  • Adjusting saddle design, tilt, and height to reduce perineal pressure
  • Standing or repositioning during long rides
  • Using cut-out or split-nose saddles to reduce nerve compression
  • Avoiding prolonged sitting on firm surfaces

Targeted Exercise & Nerve Care

  • Postural correction, pelvic mobility and core strengthening to reduce load on the pelvis
  • Stretching through the hips and lower back to ease nerve entrapment
  • Pelvic floor down-training and nerve glides where appropriate

Manual Therapy & Pelvic Floor Release

  • Targeted soft tissue work, including perineal and pelvic floor release
  • Myofascial release and trigger point therapy to ease tension around the nerve
  • Performed by therapists experienced in treating male pelvic pain

Medical Support (When Needed)

  • Pudendal nerve blocks for pain relief and diagnosis
  • Medications for neuropathic pain
  • Surgical decompression is rare and reserved for severe, persistent cases.

With early and targeted intervention, most men experience significant improvement within weeks to months. Chronic nerve pain can be more complex but still manageable with the right care.

Book Now at Coffs Coast Sports Physiotherapy

When to Seek Help

Book an assessment if you experience:

  • Numbness or tingling in the perineum or penis lasting more than a few days after activity
  • Discomfort that worsens with sitting
  • Persistent burning, stabbing or electric-like sensations
  • Erectile or urinary symptoms associated with pelvic pain

Early intervention can prevent nerve sensitisation and avoid long-term complications.

Get Support

The Athlete’s Guild offers specialised manual therapy for male pelvic pain and cyclist-specific pudendal neuralgia management — including posture correction, bike-fit guidance, pelvic floor release, and structured return-to-ride planning.

Call Coffs Coast Sports Physiotherapy or book with sports massage therapist Trent Renshaw to start your recovery and return to comfortable training.

Trusted information partners:

Key Takeaways

  • Pudendal neuralgia is not degenerative, but can become chronic if ignored.
  • Cyclists are at higher risk due to saddle pressure on the perineum.
  • Early recognition, load modification, and pelvic therapy can reverse symptoms.
  • Return-to-ride strategies can help you stay active without aggravating the nerve.