Pelvic Floor Symptom
Perineal Pain
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
There is an ache, pressure or burn between your genitals and anus. It builds when you sit, flares after a ride, a heavy lift or a long drive, and your scans have not explained it. The perineum is where several pelvic floor muscles and nerves meet, so pain here usually has a mechanical source Dr. Gordon can find and treat.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Perineal Pain
The perineum is the area between the genitals and the anus. Several pelvic floor muscles anchor into a central point here, called the perineal body, and branches of the pudendal nerve supply the skin and muscles of the region. That makes it a crossroads: tension, nerve irritation or pressure from nearby areas can all be felt in the same small space.
Perineal pain is a symptom rather than a single diagnosis. Common sources include pelvic floor muscles that stay contracted, trigger points in the inner thigh and obturator internus that refer pain inward, irritation of the perineal branch of the pudendal nerve, and the way the hips and trunk handle load during sitting, lifting and sport. It affects men and women and is common in cyclists, lifters, runners, people who sit for long hours, and after childbirth or pelvic surgery.
Medical causes such as infection, abscess, hemorrhoids, fissures and prostate problems should be ruled out first. When they are, Dr. Gordon's job is to find the muscle, nerve and movement drivers keeping the area sensitive and calm them directly.
Perineal Pain at a Glance
Where it is felt
Between the genitals and anus, sometimes spreading to the rectum, genitals, inner thighs or tailbone
Who it affects
Men and women, especially cyclists, lifters, runners, desk workers and people after childbirth or pelvic surgery
Common triggers
Prolonged sitting, bike saddles, heavy lifting, straining, childbirth, prostate or pelvic surgery
Typical workup results
Normal imaging, negative cultures, little lasting change with medication
Main drivers
Pelvic floor tension, inner thigh and obturator internus trigger points, nerve irritation, load and bracing patterns
The Gap in Care
Why Perineal Pain Is Often Left Unexplained
Ruling out medical causes comes first, and it matters. But once infection and structural problems are excluded, the remaining drivers are rarely visible on a scan.
What routine testing is looking for
- Infection of the prostate, bladder or urinary tract
- Abscess, hemorrhoids or anal fissures
- Hernias or other structural problems
- Findings on MRI, ultrasound or scope
What often keeps perineal pain going
- Pelvic floor muscles that stay tight around the perineal body
- Trigger points in the inner thigh and obturator internus that refer pain inward
- An irritated perineal branch of the pudendal nerve
- Breath holding and bracing during lifting and sport
- Sitting habits and saddle pressure that load the area all day
These are identified by mapping trigger points and testing how the region handles load, which is exactly how Dr. Gordon's evaluation is built.
Signs & Symptoms
Does This Sound Like You?
Perineal pain can feel different from person to person. These are the patterns Dr. Gordon sees most.
Ache or pressure between the genitals and anus
A dull, deep pressure or a feeling of sitting on something, often building as the day goes on.
Pain that builds with sitting
Hard chairs, car seats and bike saddles make it worse, while standing or lying down brings relief.
Flares after lifting or sport
Symptoms that spike after squats, deadlifts, running, cycling or any activity that loads the pelvis.
Burning, tingling or electric pain
Nerve-type sensations in the perineum that can come and go or linger after activity.
Pain that spreads
Discomfort that travels to the rectum, genitals, inner thighs, groin or tailbone.
Pain with emptying or intimacy
Discomfort during or after bowel movements, urination or sex, with no clear medical cause.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Identifying which one leads makes treatment more efficient.
Pelvic floor tension and trigger points
The muscles that anchor into the perineal body can hold constant tension. Trigger points here produce deep aching and pressure that feels like it is coming from inside the perineum.
Inner thigh and obturator internus referral
The adductors and obturator internus attach close to the pelvic floor. Trigger points in these muscles often refer pain directly into the perineum and groin.
Pudendal nerve irritation
The perineal branch of the pudendal nerve supplies this area. When it is compressed or irritated, pain takes on a burning, tingling or electric quality and gets worse with sitting.
Load and bracing patterns
Breath holding, heavy bracing and stiff hips during lifting, running and cycling push pressure down into the pelvic floor and keep it from resting.
Your First Visit
How Dr. Gordon Evaluates Perineal Pain
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of what is driving your pain, a written plan, a realistic timeline, and in most cases your first treatment.
Records and history review
Dr. Gordon goes through your imaging, urology, gynecology or colorectal notes, and when your pain changes during the day or with activity.
Trigger point mapping
Hands-on assessment of the inner thighs, hips, buttocks, abdomen and perineum to find the tender points that reproduce your pain.
External pelvic floor assessment
The pelvic floor muscles are examined from the outside, with no internal exam. With you draped for comfort, gentle pressure around the perineum, sit bones, tailbone and inner thighs checks tone, tenderness and trigger points.
Load and sitting testing
Dr. Gordon looks at how you sit, breathe, brace and move under load, including your training or cycling setup if relevant.
Plan and coordination
A clear plan, plus communication with your physician or pelvic floor PT when that helps your care.
When to see a physician first
- Fever with swelling, redness or a painful lump near the anus or perineum
- Inability to urinate
- Visible blood in the urine or stool
- Sudden, severe testicular or pelvic pain
- Unexplained weight loss
- New numbness in the saddle area or loss of bladder or bowel control
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for perineal pain, chosen from your exam findings.
Primary approach
Intrapelvic & Extrapelvic Dry Needling
Dr. Gordon holds ASE certification in both intrapelvic and extrapelvic dry needling. Treatment targets the pelvic floor, adductors, obturator internus and deep hip muscles that refer pain into the perineum. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum.
Learn about pelvic floor treatmentNerve focus
Neuro-Functional Acupuncture
Gentle electro-acupuncture along the sacral and pudendal nerve pathways to settle burning, tingling and sitting-related nerve pain.
See servicesBetween visits
Sitting, Training & Team Plan
Practical changes to sitting, saddle setup, breathing and lifting technique, flare control strategies, and coordination with your physician or pelvic floor PT.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Visits 1 to 3
Find the source
Dr. Gordon confirms which muscles and nerves are driving the pain and begins reducing guarding. Many people notice they can sit a little longer or feel less pressure.
Visits 4 to 8
Improve tolerance
Sitting, driving and training become more comfortable, and flares after activity are milder and shorter.
Visits 9 to 12 and beyond
Return to full activity
Visits are spaced out as function holds. You get back to your normal training, riding or workday with a plan for early flare control.
Most patients are seen weekly or every other week during active care. Individual results vary with how long symptoms have been present and how active you are. Progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
"Dr. Gordon is thoughtful, thorough and incredibly knowledgeable. He has significantly helped me with pain management and pelvic floor issues. I am grateful to have his expertise in my corner."
Dina Isola, Google Review
Perineal Pain Questions
Answers About Perineal Pain
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
No. Nerve irritation is one possible cause, but perineal pain is more often driven by pelvic floor tension and trigger points in the inner thigh and hip muscles that refer pain into the area. The exam helps separate muscle pain from nerve pain so treatment is aimed correctly.
Sitting puts direct pressure on the perineum and the tissue around it. If the muscles there are already tight or the nerve is sensitive, that pressure is enough to cause pain. Scans are good at finding structural problems but do not show muscle tension or nerve sensitivity.
No. The pelvic floor is examined externally, with no internal exam. Many patients respond well to treating the inner thighs, hips and buttock muscles externally, and any other treatment options are explained before Dr. Gordon begins.
Usually yes, with some adjustments. Dr. Gordon looks at your saddle, lifting technique, breathing and training load, and helps you modify what is aggravating the area rather than stopping everything.
Many people with perineal pain need a course of eight to twelve sessions with reassessment along the way, typically weekly at first and then spaced out. Dr. Gordon gives you an estimate at your first evaluation.
Seek medical care promptly for fever with swelling or a painful lump, inability to urinate, blood in the urine or stool, sudden severe pain, or new numbness in the saddle area. These are not symptoms to wait on.
Before You Book
General Questions
The clinic is an out-of-network practice. The initial evaluation is $300 and follow-up visits are $250. After each visit you receive a detailed superbill to submit to your PPO plan for possible reimbursement. FSA and HSA cards are accepted, and the clinic can run a complimentary benefits check before your first appointment. The check is a courtesy, so please confirm your coverage with your plan. See Insurance & Fees for details.
The first evaluation is 60 to 75 minutes and usually includes treatment. Follow-up visits run 45 to 60 minutes.
Yes. Call (516) 597-5400 or send a message through the contact page. This is especially helpful if your case is complex and you want to understand the approach before committing to a full evaluation.
1508 Union Turnpike, Suite 133, North New Hyde Park, NY 11040, with free parking on site. The clinic is an easy drive from Manhasset, Great Neck, Garden City, Lake Success, Floral Park and Mineola. Early morning, evening and weekend hours are available.
Most people feel a quick muscle twitch or a deep ache that lasts a few seconds. That twitch is a normal sign the trigger point is releasing. Mild soreness for 24 to 48 hours afterward, similar to a hard workout, is common. Depth, angle and stimulation are adjusted to your comfort.
Both use the same fine, sterile, single-use needles. Dry needling targets specific trigger points and tight bands in muscle based on your exam. Neuro-functional acupuncture targets nerve pathways, often with gentle electrical stimulation, to calm nerve sensitivity. For perineal pain, Dr. Gordon commonly uses both.
When performed by a trained, licensed provider with detailed knowledge of anatomy, it has a strong safety record. Tell Dr. Gordon if you take blood thinners, have a bleeding disorder, are pregnant or have a weakened immune system so he can plan accordingly.
It is a technique that reaches the deep pelvic floor muscles, including the levator ani, obturator internus and coccygeus, to release trigger points and restore normal muscle function. The needles go in through the skin of the buttock, perineum or inner thigh, never through the vagina or rectum. Dr. Gordon holds ASE certification in this technique, which few practitioners in New York have.
Yes. Your privacy and comfort come first. When undressing is needed for the area being treated, you are fully draped. Needles are placed through the skin only, and nothing is ever inserted into the vagina or rectum. You can pause or stop at any time.
Yes. Perineal pain affects people of every gender, and Dr. Gordon treats adults of all genders and identities in a respectful, welcoming setting.
It helps to have had a medical workup so serious causes have been checked. If you have not seen a physician for your pelvic symptoms yet, call the clinic to talk through the best order of steps.
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Perineal Pain
Book a full evaluation with Dr. Gordon and find out which muscles and nerves are behind your perineal pain and what it will take to calm them.
Early morning, evening and weekend appointments available. Free on-site parking.
Further Reading
How Pudendal Neuralgia Is Diagnosed, and Why It Takes So Long
From the blog: No single test confirms pudendal neuralgia. How doctors use the Nantes criteria and a nerve block, and why the road to a clear answer is often long.
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