Pudendal neuralgia
Burning, aching or a raw, sitting-on-a-golf-ball feeling around the saddle area — often worse the longer you sit. It has a physical cause, and it can settle.
What it is
Pudendal neuralgia is one of the most misunderstood causes of pelvic pain, leaving many people searching for answers without finding lasting relief. At Birmingham Men’s Health Physiotherapy, Gerard Greene and his specialist team regularly assess and treat men with complex pudendal neuralgia, from those experiencing severe pain that makes sitting difficult to cyclists, runners and other active individuals whose symptoms are linked to sport.
Our aim is to identify what is driving your symptoms, explain your condition clearly and develop a personalised treatment plan to help you return to everyday life with greater comfort and confidence.
You're in the right place if…
You don’t need to recognise every one of these. If a few feel familiar, you’re in the right place for a proper look.
- Burning, aching or shooting pain around the perineum, penis, scrotum or anus
- Pain that builds the longer you sit, and eases when you stand
- A sensation of sitting on a lump, ridge or “golf ball”
- Numbness, tingling or hypersensitivity in the saddle area
- Discomfort during or after ejaculation, or when opening the bowels
- An urgent or frequent need to pee
- Symptoms that started after cycling, surgery, a fall or a long stressful period
- Tests and scans that came back clear, yet the pain is very real
Why does it happen?
Pudendal neuralgia develops when the pudendal nerve becomes irritated, compressed or over-sensitised anywhere along its route. That can follow prolonged pressure (long-distance cycling is a classic trigger), a fall onto the tailbone, surgery or strain on the pelvis, or a long period where the pelvic floor muscles have been tight and guarding.
Often it’s a combination rather than one clear culprit — a nerve that was irritated by something specific, then kept sensitive by surrounding muscle tension and a nervous system that has turned up the volume on pain over time. Understanding your particular pattern is exactly what a thorough assessment is for.
How we help
Your first appointment is an unhurried conversation followed by a careful physical assessment — how your pelvic floor, hips, lower back and the nerve itself are behaving. The goal is to find what’s actually driving your pain rather than treating it blind.
From there, treatment is practical and hands-on: releasing and down-training the muscles that are compressing or irritating the nerve, desensitising techniques, guidance on sitting, cycling and daily habits that are keeping it flared, and a graded plan to rebuild your tolerance. Where it helps we’ll talk you through other options too — but a great deal can be achieved with skilled physiotherapy aimed at the root of the problem.
What your journey looks like
Recovery is usually a steady course rather than an overnight fix — and most men can expect meaningful change with the right plan. Here’s the shape of it:
- A thorough first assessment. Time to hear your full story and examine what’s going on — in complete privacy, at your pace.
- A clear explanation. We tell you, in plain terms, what’s irritating the nerve and what we’re going to do about it.
- A hands-on plan. Treatment in clinic plus simple things to do at home, reviewed regularly and adjusted as you improve.
The questions men actually ask
How do you examine the Pelvic floor and Is this going to involve an internal examination?
Ultrasound Imaging of the Male Pelvic Floor
Initially we examine your pelvic floor externally with ultrasound imaging. This is done on the lower abdomen and also the perineum . It allows us to look inside but stay outside. It also in the words of my brilliant Ultrasound Colleague Dr Alime Buyuk, "Makes the invisible visible". We always start with ultrasound imaging to explore the pelvic floor and this is included in the appointment cost.
Perineal Assessment
We also examine the pelvic floor through outer perineal palpation or gentle pressure .
Internal Pelvic Floor Assessment
With many patients it may also be necessary to examine the pelvic floor because it’s the most direct way to assess the pelvic floor . Gerard and his team are very skilled at this and we can do it gently and sensitively in a way that involves you and is well explained to you. It is only ever done with your explicit consent, fully explained first, and never forced.
Is pudendal neuralgia permanent?
For most men it isn’t. Symptoms that have been present for a while can take time to settle, but with the right treatment the majority see real, lasting improvement. We’ll give you an honest picture for your situation after assessing you.
I love cycling — will I have to stop?
Rarely for good. During a flare we may adjust or pause it for a while, but the aim is to get you back on the bike with the right saddle, set-up and tolerance. We’ll plan that with you rather than simply telling you to stop.
How many sessions will I need?
It varies with how long you’ve had symptoms, but most men are looking at a course over a few months rather than open-ended treatment. We review progress regularly so you always know where you stand.
You don’t have to live with this
If any of the above sounds like you, the next step is simple. Ask us anything in confidence — no pressure, and no obligation to book.
Ask Gerard a question in confidence