Pudendal Neuralgia After Birth

As a pelvic health physical therapist, I work closely with postpartum individuals navigating the changes after giving birth. One condition that doesn’t get nearly enough attention is pudendal neuralgia, a cause of persistent pelvic pain that can deeply impact recovery, daily life, and emotional wellbeing after delivery.

If you’ve had a baby and are experiencing unexplained pelvic pain, numbness, or sensitivity, you’re not alone — and help is available.

What Is Pudendal Neuralgia?

The pudendal nerve is a major nerve that runs from your lower spine through your pelvis, branching out to provide sensation and motor control to the genitals, perineum, and anus. It’s responsible for things like bladder and bowel control, sexual function, and pelvic floor stability.

Pudendal neuralgia occurs when this nerve becomes irritated, compressed, or damaged, leading to nerve pain in the areas it supplies.

Birthing can put pressure on the pudendal nerve if the baby’s head compresses the nerve, forceps or other birth interventions compress the nerve or if pushing is prolonged causing a stretch of the pudendal nerve. 

Common Symptoms of Pudendal Neuralgia

If you're wondering whether what you're feeling is normal postpartum healing or something more, here are signs that may point to pudendal neuralgia:

1. Burning, shooting, or stabbing pain in the vagina, rectum, perineum. This could also be tingling or  numbness. Typically this increases with sitting, especially hard surfaces and reduces by lying down. Pain with standing is common if prolonged pushing and a nerve traction (stretch) injury is the problem.

2. Pain with touch in the vulvar and anal region that would not normally be painful. This could be pressure/touch with a hand or wearing underwear or pants. 

3. Feeling like you’re sitting on a golf ball. Pudendal nerve irritation can cause this feeling of a lump or ball in the rectum or vagina.

4. Bladder and bowel difficulties are also common. This could be difficulty emptying the bladder and bowels or difficulty preventing leakage.  Pain with bowel movements could also increase as this stretches the pudendal nerve, especially if you are straining or pushing to poop.

5. Pain with sexual activity, decreased sensation or pain with orgasm may also be present.

Why It Can Be Misdiagnosed or Missed

Many postpartum individuals are told that pain is "normal" after delivery — and while some soreness is to be expected, nerve pain is not normal and shouldn't be brushed off.

Because symptoms of pudendal neuralgia overlap with other postpartum issues (like pelvic floor dysfunction or simple muscle soreness), it often goes unrecognized. This can delay proper treatment and prolong suffering unnecessarily.

Solutions

Although pudendal neuralgia can feel scary, many people see major improvements with proper treatment. Early recognition and intervention give you the best chance for full recovery.

Pain after childbirth is common — but sharp, burning, or nerve-like pain that persists or worsens should always be evaluated. Your postpartum journey deserves care, understanding, and expert support.

If you think you might be experiencing pudendal neuralgia, don't hesitate to reach out. You deserve to heal fully and feel at home in your body again.