Symptoms of Pudendal Neuralgia

These sensations are indicative of nerve irritation or damage and can range from mild tingling to severe numbness. Patients might feel as if the affected area is asleep with a “pins and needles” sensation, or they might experience a loss of sensation altogether, which can interfere with daily activities and personal safety, especially if the feet or legs are affected.

Pudendal neuralgia can cause severe pain that makes prolonged sitting difficult. Sufferers may also experience discomfort in the abdomen and groin, making it painful to wear tight clothing. 

Pudendal neuralgia often shows a distinct pattern throughout the day; the pain typically worsens at night and improves in the morning. This pattern may be related to the cumulative effect of sitting and activities carried out during the day, which can exacerbate nerve compression or irritation, with relative relief coming after a night’s rest when the nerve has had a chance to decompress.

The intensity of pain can fluctuate significantly, often without a clear trigger. This variability can be particularly frustrating as it makes the condition unpredictable. Some days might be manageable, while others are overwhelmed by intense discomfort, complicating treatment and daily planning.

Pudendal neuralgia’s symptoms are notably postural. Pain typically intensifies when sitting, as this position can increase pressure on the pudendal nerve, especially where it travels through structures like the Alcock’s canal. Standing or lying down tends to relieve this pressure, often resulting in symptom improvement, which can be a key factor in diagnosis and management.

Increased sensitivity or hypersensitivity in the pelvic region can make simple acts, like wearing underwear or light touching, painful or uncomfortable. This hypersensitivity is due to nerve irritation, making the skin and underlying tissues react more intensely to stimuli that would normally not cause pain.

Patients often report a feeling of swelling or a sensation as though there’s an object like a ball in the perineum or anus, which is a direct reflection of nerve irritation or damage affecting sensory perception in these areas.

The feeling of needing to urinate urgently and frequently, without an actual increase in urine production, can be a distressing symptom. This urgency is often due to the pudendal nerve’s role in controlling the muscles and sensations of the lower urinary tract.

The act of defecation can become painful, often exacerbating the sense of an already sensitive perineal or anal region. This pain can lead to avoidance behaviors, which may worsen constipation and further irritate the area.

Sexual intercourse can become extremely painful or impossible for those with pudendal neuralgia. The nerve’s involvement in sensory transmission from the genital region makes any pressure or friction during sexual activity potentially agonizing.

Damage to the pudendal nerve can impair the sensory and autonomic pathways essential for achieving orgasm. This can result in a frustrating decrease in sexual satisfaction and affect intimate relationships.

For men, pudendal nerve damage may lead to erectile dysfunction, manifesting as difficulty achieving or maintaining an erection due to impaired nerve signaling necessary for the vascular response.

A broader impact of pudendal nerve damage can include numbness, a sensation of cold, or a complete loss of sensation in the legs, feet, and buttocks. This can affect balance, walking, and the ability to sense temperature changes, potentially leading to injury.