What is the pudendal nerve?  By Dr. Hailey Jackson

What is the pudendal nerve? 

The pedal nerve is the main nerve of the perineum, pelvic floor, muscles and external anatomy.

The pudendal nerve is a mixed nerve containing sensory, motor, and autonomic function. This means, because of this nerve, you can feel things, move your muscles, and it should work automatically. 

This nerve originates from the primary ventral roots of S2-4 in the sacral plexus (comes out of the front of the sacrum), exits the pelvis under the piriformis muscle, just behind the sacrospinous ligament, and then loops around the sacrospinous ligament to enter the perineum through the lesser sciatic foramen, and then exits the lesser sciatic foramen and enters the perineum and runs through a sheet of connective tissue called Alcocks canal. As it continues, it then branches off into three branches and heads towards the pubic symphysis. These three branches include the inferior rectal nerve, the perineal nerve, and the dorsal nerve of the penis/clitoris.

As you can tell, this nerve has a torturous route and can be compressed in many areas. Sometimes this is due to tense muscles irritating the nerve (pudendal nerve irritation), while it can also be caused by scar tissue from previous pelvic surgeries (pudendal neuralgia).

Diagnostic criteria for pudendal neuralgia includes: 

• Pain in the area of the pudendal nerve 

• Pain predominantly while sitting 

• Pain does not wake the patient at night

• No objective sensory impairment 

  

  
  

• Pain relieved by a pudendal nerve block 

Other signs/symptoms people with pudendal neuralgia will report: 

• Reflex pain triggered by defecation 

• Allodynia in the pudendal nerve territory 

• Rectal or vaginal foreign body sensation (golf ball in the rectum is what I hear most often clinically) 

• Burning, shooting, stabbing one sided pain 

Because of the area of the body this nerve innervates, entrapment and/or irritation to the pudendal nerve can cause bladder, bowel, or sexual dysfunction, which is where pelvic floor PT enters the chat. Addressing the muscles and/or scar tissue around the path of this nerve is huge for pain relief and elimination of pelvic floor related symptoms. 

If this is something you have been diagnosed with or think you might have, we would love to help you on your journey. To schedule an appointment, call 903-962-2600 or email hello@txpelvichealth.com.