Pelvic Nerve Condition
Pudendal Neuralgia
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
It hurts to sit, it eases when you stand or lie down, and the pain has a burning, electric or stabbing quality that is hard to describe to anyone. That combination is the signature of an irritated pudendal nerve. It is often treatable once the pinch points along the nerve are found and calmed.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
What Pudendal Neuralgia Actually Is
The pudendal nerve starts from the sacral spine and travels through the deep pelvis to supply the anus, perineum and genitals. It carries sensation from these areas and controls the muscles that help with bladder, bowel and sexual function. Pudendal neuralgia is pain along this nerve's territory when the nerve becomes irritated, compressed or overly sensitive.
The nerve has a few tight spots on its route: between two strong pelvic ligaments near the sit bones, and inside a narrow tunnel that runs along the obturator internus muscle, known as Alcock's canal. Long hours of sitting, cycling, childbirth, pelvic surgery, a hard fall on the tailbone, or chronic straining can load these spots. When the surrounding muscles tighten and stay tight, the nerve loses room to glide and starts firing pain signals with ordinary pressure.
True surgical entrapment exists but is uncommon. Far more often, the nerve is irritated by the muscles, fascia and joint mechanics around it. Those are things Dr. Gordon can assess by hand and treat directly, while staying in contact with your physician about anything that needs medical management.
Pudendal Neuralgia at a Glance
Also called
Pudendal nerve entrapment, Alcock's canal syndrome, cyclist's syndrome
Hallmark sign
Pain that worsens with sitting and eases when standing, lying down or sitting on a toilet seat
Where it is felt
Anus, perineum, genitals, and sometimes the tailbone or inner sit bone, often more on one side
Common triggers
Prolonged sitting, cycling, childbirth, pelvic surgery, falls, chronic constipation or straining
Main drivers
Nerve sensitivity at pinch points, obturator internus and pelvic floor tension, hip and pelvic ring mechanics
The Gap in Care
Why Pudendal Neuralgia Is So Often Missed
Standard testing matters, and red flags should always be ruled out first. The problem is that an irritated nerve and the tight tissue around it rarely show up on routine scans.
What routine testing is looking for
- Disc herniation or stenosis on a lumbar MRI
- Infection, cysts or masses in the pelvis
- Structural damage to the bladder, bowel or prostate
- Visible nerve damage on standard imaging
What often keeps the nerve irritated
- An obturator internus that squeezes the nerve's tunnel
- Tight pelvic floor and deep hip muscles along the nerve's path
- A nerve that is sensitive to stretch, pressure and sitting
- Tailbone, sacroiliac or sitting mechanics that load the pinch points
- A nervous system that has learned to overreact
The items on the right are found by tracing the nerve and testing the tissue around it by hand. That tracing is the core of Dr. Gordon's evaluation.
Signs & Symptoms
Does This Sound Like You?
Pudendal symptoms can be confusing because the nerve touches several organs at once. These are the patterns Dr. Gordon sees most often.
Pain that builds with sitting
Comfortable for a few minutes, then burning or aching that climbs the longer you sit. Standing, lying down or sitting on a toilet seat usually helps.
Burning, electric or stabbing pain
Nerve-type pain in the perineum, anus or genitals that can come in jolts or sit in the background as a constant burn.
A foreign object feeling
The sensation of a ball, stone or object in the rectum or vagina even though nothing is there.
Pain with bowel movements or urination
Discomfort during or after emptying, a sense of incomplete emptying, or urgency without a clear medical cause.
Sexual pain or changed sensation
Pain during or after intimacy, numbness or tingling in the genitals, or unwanted arousal sensations.
One-sided or tailbone pain
Symptoms that favor one side, or a deep ache at the tailbone or inner sit bone that follows the nerve's route.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one factor keeping the nerve irritated. Treatment moves faster once Dr. Gordon knows which one leads.
Nerve sensitivity at the pinch points
The nerve can become touchy where it passes between the pelvic ligaments and through Alcock's canal. A sensitive nerve reacts to pressure and stretch that would normally be ignored.
Obturator internus and pelvic floor tension
The obturator internus forms one wall of the nerve's tunnel. When it and the surrounding pelvic floor muscles hold tension, the tunnel narrows and the nerve has less room to move.
Deep hip and gluteal muscles
Tight piriformis, gemelli and gluteal muscles can pull on the tissue around the nerve and refer pain into the buttock, sit bone and pelvis.
Pelvic ring and sitting mechanics
Tailbone position, sacroiliac joint stiffness, bike saddles and hard chairs change how much pressure lands on the nerve each day.
Your First Visit
How Dr. Gordon Evaluates Pudendal Neuralgia
The initial evaluation runs 60 to 75 minutes. You leave with a clear picture of where the nerve is being irritated, a written plan, a realistic timeline, and in most cases your first treatment.
Records and history review
Dr. Gordon looks at your imaging, prior nerve blocks, specialist notes and treatment history, plus exactly when and where the pain changes during your day.
Nerve tracing
Dr. Gordon follows the pudendal nerve's route from the sacrum through the buttock and sit bone area to find the spots 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.
Spine, hip and sitting screen
Dr. Gordon checks the low back, sacrum, tailbone and hips to rule in or out other contributors, and looks at how you sit, cycle or train.
Plan and coordination
A clear plan, plus communication with your physician, pain specialist or pelvic floor PT when that helps your care.
When to see a physician first
- Fever or chills with pelvic or urinary symptoms
- 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 pudendal neuralgia, chosen from your exam findings.
Primary approach
Intrapelvic & Extrapelvic Dry Needling
Dr. Gordon holds ASE certification in both intrapelvic and extrapelvic dry needling. Precise needling of the obturator internus, pelvic floor and deep hip muscles releases the tension that crowds the nerve and gives it room to glide again. 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 nerve sensitivity and reduce the burning and electric symptoms.
See servicesBetween visits
Sitting Strategy & Team Coordination
Practical changes to how you sit, drive, cycle and train, flare control strategies, and shared goals with your physician or pelvic floor PT.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Visits 1 to 3
Calm the nerve
Dr. Gordon finds the main pinch points and reduces the most reactive symptoms. Many people notice a longer comfortable sitting window or fewer sharp jolts.
Visits 4 to 8
Widen your limits
Sitting, driving and work days become easier to get through, and flares settle faster when they happen.
Visits 9 to 12 and beyond
Build lasting tolerance
Visits are spaced out as function holds steady. You leave with a plan for sitting, activity and 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 sensitive the nerve is. 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
Pudendal Neuralgia Questions
Answers About Pudendal Neuralgia
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
A toilet seat supports you on the outer thighs and sit bones while leaving the center of the pelvis open. That takes pressure off the path of the pudendal nerve. Relief on a toilet seat, or when standing or lying down, is one of the classic clues that the nerve is involved.
Not exactly. Neuralgia describes nerve pain. Entrapment means the nerve is physically trapped, which is less common and sometimes treated surgically. Most people Dr. Gordon sees have an irritated, sensitized nerve surrounded by tight tissue rather than a true surgical entrapment, and that responds to conservative care.
No. Standard MRI is good at finding discs, masses and structural problems, but it usually cannot show a nerve that is irritated by muscle tension or poor gliding. Diagnosis relies mainly on your symptom pattern and a careful hands-on exam.
Yes. Nerve blocks can help confirm the diagnosis and give temporary relief. Dr. Gordon's work focuses on the muscles and mechanics that keep irritating the nerve, so the two approaches can fit together. Please bring your block and procedure notes to your first visit.
Some people feel mild soreness or a short increase in symptoms for a day or two, especially early on. Dr. Gordon starts conservatively with sensitive nerves and adjusts depth, stimulation and the areas he treats based on how you respond.
Long-standing pudendal neuralgia usually needs 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.
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 pudendal neuralgia, 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. Pudendal neuralgia 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 nerve 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 bioFurther Reading
Why Sitting Makes Pelvic and Buttock Pain Worse
From the blog: Pain that climbs the longer you sit usually has a specific source. Where you feel it points to the cause, and why a toilet seat feeling better is a clue.
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.
Persistent Genital Arousal Disorder: A Plain Explanation
From the blog: PGAD causes unwanted genital arousal sensations unrelated to desire. What it is, how nerves and the pelvic floor can be involved, and who to see first.
Book an Evaluation for Pudendal Neuralgia
Book a full evaluation with Dr. Gordon and find out where your pudendal nerve is being irritated and what it will take to calm it down.
Early morning, evening and weekend appointments available. Free on-site parking.
Symptoms
Common Symptoms of Pudendal Neuralgia
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