Pudendal Nerve Pain: Understanding the Causes, Its Impact on Sexual Function, and the Physical Therapy Solution

Katie Beckham • July 29, 2025

If sitting hurts, if you feel fullness in the rectal area as if you are sitting on a golf ball, If sex feels different or painful. If you’ve brought up your symptoms and left the doctor’s appointment more confused than when you walked in, you’re not alone.Your symptoms may involve the pudendal nerve.

These experiences are often confusing , concerning and misdiagnosed. But in many cases, the root cause is something few people talk about: pudendal nerve pain/pudendal nerve compression. This type of pelvic nerve irritation can disrupt everything from your daily comfort to your most intimate moments.

Here’s what’s really going on, and what you can do to get your life back.


What Is the Pudendal Nerve?

The pudendal nerve is a key part of your pelvic anatomy. The pudendal nerve branches off the spinecord (S2–S4) and travels deep through your pelvis, passing through a narrow pathway called Alcock’s canal. It sends signals to your:

  • Genitals (clitoris, vulva, penis, testicles, anus, perineum)
  • Bladder and bowel muscles
  • The pelvic floor muscles help control urination, bowel movements, and sexual sensation

Think of it like the main communication cable between your brain and pelvic floor. When it’s working well, everything feels connected. When it’s not, pain, numbness, strange sensations or lack of sensations can happen.


What Causes Pudendal Nerve Pain?

When this nerve becomes compressed or irritated, it can trigger sharp, aching, or burning sensations throughout the pelvic area, often referred to as pudendal neuralgia.

Some common causes include:

  • Prolonged sitting (office work, driving, cycling)
  • Childbirth injuries or overstretching during delivery
  • Pelvic surgeries (hysterectomy, prolapse repair, mesh placements)
  • Blunt trauma, such as falling on the tailbone
  • Tight pelvic floor muscles, which can compress the nerve internally
  • Chronic constipation or straining
  • Scar tissue from previous procedures or infections

If you’re experiencing pudendal nerve pain in Memorial, Texas, know that there’s a clear path toward relief, and it doesn’t have to involve medication or surgery.


Sexual Dysfunction and Pudendal Neuralgia: A Quiet Link

One of the most overlooked consequences of pudendal nerve pain is its effect on sexual function. Because the nerve plays such a direct role in arousal and genital sensation, its dysfunction can show up in ways that are intimate, confusing, and difficult to talk about.

For Women:

  • Painful intercourse (dyspareunia)
  • Clitoral numbness or hypersensitivity
  • Reduced orgasmic response
  • Persistent Genital Arousal Disorder (PGAD)
  • Painful orgasm


For Men:

  • Erectile difficulties
  • Pain during or after ejaculation
  • Decreased genital sensitivity

It’s not uncommon for people seeking sexual dysfunction pelvic floor therapy in Memorial to describe symptoms that are clearly nerve-related, but never recognized as such. Connecting those dots is part of what I do.


How Physical Therapy Helps: A Targeted, Gentle Approach

Pelvic floor physical therapy is one of the most effective and research-supported ways to manage pudendal neuralgia, especially when the pain is related to muscle tension, nerve entrapment, or movement dysfunction.

This isn’t general PT. It’s focused, one-on-one care, rooted in both anatomy and experience. Here’s how it works:

Manual Therapy

Through both external and internal techniques, I work to release tight pelvic floor muscles, scar tissue, or trigger points that may be compressing the pudendal nerve.

Nerve Gliding

These are gentle, specific movements that help the pudendal nerve move more freely through surrounding tissues. Think of it as freeing a stuck cord without tugging on it.

Core & Breath Relationship Education 

You’ll learn how to support your pelvis through aligned posture, intentional breathwork, and body mechanics that reduce strain and guarding.

Education

We’ll talk about daily habits—how you sit, how you move, how you go to the bathroom—that can either worsen or support healing. Ergonomic tips, positioning, and pacing strategies are key.


Many people I work with from  pelvic floor physical therapy in Bunker Hill Villages begin treatment thinking they need to strengthen their core, when in reality, the healing starts calming and stabilising the muscle of the pelvic floor .


Most of my clients dealing with pudendal nerve pain in Memorial, Texas, see measurable improvement through therapy. Pelvic Floor Physical Therapy with a skilled and experienced physical therapist is essential to healing, that’s me.


Reach Out - It’s time to call me

If you're dealing with any of the following, it’s time to call me :


  • Burning, tingling, or shooting pain in your vulva, perineum, or rectum , clitoris, penis scrotum, testicles
  • Pain that worsens with prolonged sitting
  • Sexual discomfort, decreased sensitivity, or arousal challenges
  • Changes in bladder or bowel control
  • A feeling that something just isn’t right in your pelvic floor

And if you’ve already tried sexual dysfunction physical therapy in Bellaire or elsewhere and felt rushed, dismissed, or not seen, or unhappy with your results, I want you to know that “personalized, effective care happens with me.”


Let’s Work Together Toward Relief

I specialize in treating complex pelvic floor conditions, including pudendal neuralgia. My approach is personal, effective, calm and focused entirely on your symptoms and goals. 


Whether you’re seeking sexual dysfunction pelvic floor state therapy in Memorial or exploring options for pelvic floor physical therapy in Bunker Hill Villages, I offer one-on-one sessions designed around you.

You don’t have to keep living with pain, numbness, or fear around intimacy. You deserve answers, and the kind of care that treats without judgment. 

If this sounds like your story, I invite you to reach out today. Let’s talk.

By Katie Beckham July 29, 2025
That deep, persistent ache in your buttock that may radiate down your leg and makes sitting for long periods or moving in specific ways nearly impossible is more than frustrating. You may have been told it’s sciatica or piriformis syndrome. You’ve followed the usual advice: glute stretches, foam rolling, resting from activity. Yet the pain keeps returning, often without any clear reason. When common strategies don’t lead to meaningful relief, it’s time to consider whether something else might be contributing to the issue. Here’s something many people aren’t told: What if your piriformis isn’t actually the source of your pain? What if the true cause lies deeper, in an adjacent structure that’s often overlooked? If your symptoms haven’t improved with typical piriformis treatments, there’s a good chance something else is involved. The Usual Suspect: What Is Piriformis Syndrome? The piriformis is a small, triangular-shaped muscle that lies deep in your buttock. Its main job is to help rotate your hip outward. The sciatic nerve provides the motor function to the piriformis muscle, the largest nerve in your body. When the piriformis tightens, spasms, or gets irritated, it can press against that nerve and cause pain that mimics traditional sciatica. That’s what we call piriformis syndrome. The symptoms can be intense. Pain when sitting, soreness that radiates down the leg, difficulty walking, or sleeping. It’s a real condition—and it’s often the first thing doctors or trainers suggest when someone describes “sciatic pain.” But here’s the problem: Piriformis syndrome gets blamed for a lot of pain it isn’t causing. And that’s why so many people don’t get better with standard approaches like stretching or foam rolling. The Hidden Culprit: Your Pelvic Floor’s Role in Sciatic Pain The piriformis doesn’t operate in isolation. It’s part of a broader system of deep hip and pelvic muscles. And one of the most important—and most overlooked—players in that system is your pelvic floor. The pelvic floor is a group of muscles at the base of your pelvis. These muscles support your bladder, bowel, and reproductive organs, but they also help stabilize your hips and spine. One pelvic floor muscle in particular—the obturator internus —sits right next to the piriformis and also runs close to the sciatic nerve. If the obturator externus is tight or in spasm (a common feature of pelvic floor dysfunction), it can irritate the sciatic nerve in the exact same way the piriformis can. Your brain can’t always tell which muscle is doing the irritating—it just feels the nerve reacting. Think of it like a doorbell. It doesn’t matter whether the piriformis or the obturator internus presses on the nerve. The bell rings angrily either way. And in this case, the bell is your sciatic pain. That’s why so many women come to me for women’s pelvic floor dysfunction treatment in Memorial after months—sometimes years—of chasing the wrong diagnosis. How to Tell the Difference: Clues That Point to the Pelvic Floor If piriformis stretches haven’t helped—or seem to make things worse—it may be time to consider another source. Here are some signs your pain might be related to pelvic floor dysfunction instead: Ask yourself: Do you ever feel pelvic pressure or heaviness? Do you have urinary issues like leaking, urgency, or frequency? Is constipation or straining part of your routine? Have you experienced pain with intercourse? Do you notice tailbone or low abdominal discomfort? Do you have a low back or hip pain? These symptoms aren’t typically caused by piriformis syndrome. They may be closely tied to dysfunction in the pelvic floor. Getting to the Root: Why the Proper Diagnosis Matters The body is a connected system. A problem in one muscle often creates symptoms elsewhere. That’s why chasing pain rarely leads to lasting relief. You need a full-body evaluation, not just a local, myopic look. That’s exactly what I do during sessions for women’s pelvic floor dysfunction treatment in Memorial . I assess how your hips, back, core, and pelvic floor are all working together (or not). Sometimes the pain is coming from multiple sources. But more often than people realize, the pelvic floor is the missing piece. Consider consulting a pelvic floor physical therapist. Your Next Step Toward Real Relief If you’ve been stretching, massaging, and guessing your way through sciatic pain with no results, it’s time to try something different. You don’t have to live with chronic buttock pain or vague sciatica that keeps returning. I offer one-on-one sciatica pain physical therapy in Spring Branch that includes a full pelvic floor evaluation when appropriate. My practice is private, and focused entirely on helping you get to the root of your symptoms, not just mask them. Whether you’re recovering from birth, managing pelvic floor changes with age, or simply haven’t gotten real answers yet, women’s pelvic floor dysfunction treatment in Memorial might be the missing link. You deserve a treatment plan that looks at your whole body, not just one muscle. If you're ready for that kind of care, I am here to help.
By Katie Beckham July 25, 2025
Confidential pelvic floor therapy for men in Houston, Memorial, Spring Branch & Bunker Hill Villages. Treat pain, leakage & sexual dysfunction today.
By Katie Beckham July 3, 2025
Testicular pain, or orchialgia, is defined as discomfort that lasts longer than three months. It can come and go, stay in one spot, or move around. Some men feel it directly in the testicle, while others feel it in the groin, lower abdomen, or inner thigh. It might feel sharp, aching, or like a pulling sensation.
By Katie Beckham July 1, 2025
If you’ve been treating your endometriosis for years, but something still doesn’t feel right—pain that lingers, sex that hurts, or a bladder that just won’t cooperate—you’re not imagining it.
Pelvic Floor Dysfunction in Women: Causes, Symptoms.
By Katie Beckham June 4, 2025
Pelvic floor dysfunction (PFD) is more common than most women realize. It shows up in different ways, sometimes subtle, sometimes loud, but always disruptive. Beckham Physical Therapy & Wellness specializes in helping women get real answers — and real relief — through one-on-one, holistic pelvic floor care in a private home setting.
By Katie Beckham May 28, 2025
Most men rarely think about their pelvic floor—until something starts to feel off. Whether it's persistent groin pain, frequent trips to the bathroom, discomfort during intimacy, or unexplained lower back or hip pain, these issues are often silently endured and misunderstood. What many don’t realize is that these symptoms may be tied to a condition called pelvic floor dysfunction (PFD) . This condition is more common than most people—and many healthcare providers—realize. Thankfully, with the right care, it’s also highly treatable. What Is Male Pelvic Floor Dysfunction? The pelvic floor is a group of muscles, ligaments, and connective tissue at the base of your pelvis. In men, these muscles support important organs, including the bladder, rectum, and prostate, and are critical for bowel and bladder control, sexual function, and core stability. Pelvic floor dysfunction occurs when these muscles are too tight, too weak, or poorly coordinated . Instead of relaxing properly to allow urination or bowel movements, the muscles stay tense, leading to a wide range of symptoms that may affect everyday life. Common Symptoms in Men Pelvic floor dysfunction can show up differently for each person, but most symptoms fall into one or more of the following categories: Urinary Issues Frequent urge to urinate with little output Hesitation or difficulty starting the urine stream A sensation of incomplete bladder emptying Pain or burning during or after urination Dribbling after urination Bowel Dysfunction Constipation or straining during bowel movements A feeling of incomplete evacuation Pain before, during, or after bowel movements Gas or stool leakage Sexual Dysfunction Pain with arousal or ejaculation Erectile dysfunction or trouble maintaining erections Testicular, penile, or perineal pain Numbness or decreased sensation during sex Musculoskeletal Pain Pain in the perineum, tailbone, or sit bones Lower abdominal or groin pain Hip, lower back, or sacroiliac joint discomfort Tightness in the inner thighs or pelvic muscles These symptoms can be confusing and deeply personal, often leading men to delay seeking help. At Beckham Physical Therapy and Wellness, I frequently work with individuals who have struggled in silence for months or even years. Why the Condition Often Goes Undiagnosed One of the most frustrating realities of male pelvic floor dysfunction is how often it’s misdiagnosed . Many men are treated repeatedly for prostatitis , often with rounds of antibiotics—even when there’s no infection present. Unfortunately, most urologists receive little or no training in pelvic floor disorders during medical school, which means they may not recognize when muscle dysfunction, not infection, is the root cause. In fact, studies show that men with pelvic pain often spend up to seven years seeking an accurate diagnosis. During this time, symptoms may worsen, and quality of life may decline. This is why finding a knowledgeable pelvic floor therapist for men in Bellaire, Texas, is so crucial. What Causes Male Pelvic Floor Dysfunction? The causes of pelvic floor dysfunction can vary. Often, multiple contributing factors are at play. Some of the most common include: Post-surgical trauma (such as prostatectomy or vasectomy) Orthopedic injuries (spine, hip, or pelvic injuries) Excessive exercise or poor lifting mechanics Chronic constipation or habitual straining Long hours of sitting or a sedentary lifestyle Psychological stress, anxiety, or trauma Practices like jelqing or attempts at genital enhancement Not every case is tied to a dramatic event—sometimes, it’s the accumulation of stress, poor posture, or muscular imbalance over time. How Pelvic Floor Physical Therapy Helps The good news? Pelvic floor dysfunction is highly treatable, without surgery or medication. Working with a trained pelvic floor specialist allows men to address the root of the problem, not just the symptoms. As a leading pelvic floor physical therapist in Memorial, Texas , my approach includes: Manual therapy to release tight or spastic muscles Neuromuscular retraining to improve muscle coordination Breathwork and core training to restore pelvic stability Education on bladder/bowel habits, posture, and stress management Personalized exercise programs to support recovery at home I treat each individual holistically, recognizing that the pelvic floor is interconnected with the rest of the body—and that healing often involves addressing emotional and psychological components, too. Why Choose Beckham Physical Therapy and Wellness At Beckham Physical Therapy and Wellness, I specialize in one-on-one pelvic health care for both men and women. My setting in West Memorial is private, welcoming, and designed to put patients at ease. Many of my male clients tell me it’s the first time they’ve felt truly heard and understood. I’m proud to be a trusted pelvic floor therapist for men in Bellaire, Texas , offering: Over 40 years of clinical experience More than 15 years dedicated exclusively to pelvic health Gentle, evidence-based techniques Individualized treatment plans in a relaxed home-based setting And while this blog focuses on men’s health, I also offer expert care from a pelvic floor physical therapist for women in Memorial, TX , addressing conditions such as postpartum recovery, incontinence, pelvic organ prolapse, intercourse pain, endometriosis, and more. Whether you're navigating new symptoms or have been searching for answers for years, I am here to support your journey. Take the First Step Toward Relief If you’re experiencing pelvic pain, urinary urgency, bowel issues, or sexual discomfort, you’re not alone—and you don’t have to keep guessing. These are treatable conditions, and recovery is absolutely possible. Connect with a compassionate, experienced pelvic floor physical therapist in Memorial, Texas, who understands the unique challenges men face. At Beckham Physical Therapy and Wellness, I’m here to help you get back to living fully and comfortably. Relief begins with the right support. Schedule your consultation today.
By Katie Beckham February 24, 2025
HOUSTON – The pelvic floor is a set of muscles that works as a support system for the organs of the pelvis, including the bladder and the uterus. As those muscles weaken, the organs can fall south. However, new therapies allow for physical therapists to teach patients how to strengthen the pelvic floor muscles and eliminate a lot of problems. During a consultation for pelvic floor physical therapy, Katie Beckham, Houston Methodist West Hospital pelvic floor physical therapist, tells women how it works. She said weakening or over-tightening of the pelvic floor can happen after having children, after cancer treatments or simply with age. “One of the biggest mistakes people make, trying to pull up and exercise the pelvic floor but they’re holding their breath,” Beckham explained. ‘Then we perform the activity like picking up our grandchild carrier seat, we have to let that pressure out somewhere or we’re going to dribble.” Lacking support in the pelvic floor can lead to lower back pain, urine urgency or difficulty emptying the bladder. “A physical therapist that specializes in this, teaches a patient how to maintain its proper pressures, how to use body mechanics properly, how to strengthen the pelvic floor muscles, how to let them go, how to let things in and out,” Beckham said. Beckham teaches that by showing patients which lower ab muscles to strengthen. “Tightening two big sets of muscles, the lower abs, which I teach as skinny jeans,” she explained. “So, if you want to put on a pair of size 2 jeans and you really need a 12, you’re going to have to hollow out your belly, you’re going to have to pull your belly button towards your spine.” Showing patients with an internal exam is an option. Although maybe awkward, Beckham said it leads to fast, positive results. “Then the other big set, I teach it like an elevator, it’s the pelvic floor muscles, those are the muscles that shore up and close the opening to the urethra in the vagina and the rectum. So, we want to pull those up, it’s as if I had an exam finger in your vagina and I asked you to close the door of the elevator and pull the elevator up into your belly.” This kind of physical therapy can take anywhere from three weeks to three months. There are pelvic floor physical therapists at Texas Children’s Pavilion for Women, The Woman’s Hospital of Texas and these locations for Houston Methodist.