Is It the Pudendal Nerve or Pelvic Floor Dysfunction? Understanding the Root of Male Pelvic Pain
Pelvic pain, numbness, or dysfunction in men can feel frustrating and isolating, especially when it’s difficult to pinpoint where the problem is coming from. Many men wonder: Is it my pudendal nerve? Or is this pelvic floor dysfunction? The answer isn’t always black and white, and in many cases, it’s both.
Let’s break down the difference, how they're connected, and what you can do about it.
Understanding the Pudendal Nerve
The pudendal nerve is the primary nerve of the perineum. It’s responsible for sensation in the penis, scrotum, anus, and perineal region. It also helps activate the pelvic floor muscles that control urination, defecation, and sexual function.
Common symptoms of pudendal nerve irritation or entrapment include:
Burning, tingling, or sharp pain in the perineum, penis, or anus
Pain worsened by sitting
Numbness or altered sensation in the genitals
Pain during or after ejaculation
A feeling of “golf ball” pressure in the rectum
Increased urinary urgency or frequency without infection
But here’s the kicker: many of these symptoms also show up with pelvic floor dysfunction.
What Is Pelvic Floor Dysfunction in Men?
The pelvic floor is a group of muscles and connective tissues that support the pelvic organs, stabilize posture, and help regulate bowel, bladder, and sexual function.
In men, pelvic floor dysfunction can result from:
Chronic stress and tension
Posture issues
Overtraining core or glute muscles
Constipation and straining
Prolonged sitting (think desk jobs or cycling)
Surgery or trauma to the pelvis
Scar tissue and fascial restrictions
When these muscles become overactive (tight and guarded) or underactive (weak and uncoordinated), they can compress nerves, including the pudendal nerve.
So, Is It the Pudendal Nerve or the Muscles?
Often, it’s both. Pudendal neuralgia (nerve pain) is frequently caused or worsened by myofascial pelvic floor dysfunction, tight muscles, trigger points, or fascial adhesions pressing on the nerve.
Think of the pudendal nerve like a garden hose. If tight pelvic floor muscles are “stepping” on that hose, you get less flow, less nerve signal and more pain.
This means that even if the pudendal nerve is inflamed or irritated, you need to address the muscular and fascial environment around it.
What About Imaging or Nerve Tests?
Unfortunately, there’s no perfect test to diagnose pudendal neuralgia or pelvic floor dysfunction. MRI and nerve conduction studies often come back normal.
Instead, diagnosis relies heavily on:
A detailed symptom history
Physical examination by a trained pelvic floor therapist or specialist
Ruling out other conditions (like prostatitis, hernias, or spinal issues)
How Pelvic Floor Therapy Can Help
Whether your issue is purely muscular or involves the pudendal nerve, pelvic floor physical therapy is often a first-line treatment.
A skilled therapist can:
Identify trigger points and overactive muscles
Release tension through manual therapy and stretching
Re-educate and retrain the muscles for better function
Address posture, movement habits, and breath mechanics
Help you find sitting and movement strategies that reduce symptoms
This approach reduces compression on the pudendal nerve and restores normal pelvic function.
At-Home Signs You Might Have a Pelvic Floor Component
Symptoms improve when lying down and worsen with prolonged sitting
Gentle pelvic floor stretches or breathing exercises relieve symptoms
Pain fluctuates with stress, posture, or bowel/bladder habits
You’ve been diagnosed with “prostatitis” but antibiotics don’t help
A Whole-Body Approach
Nerves don’t exist in isolation. They pass through layers of fascia and muscle. Addressing the whole-body system, including the spine, hips, core, and nervous system, can improve outcomes, especially when fascial restrictions or postural imbalances are involved.
Bottom Line
If you're struggling with pelvic pain, numbness, or urinary/sexual dysfunction, it's not always easy to distinguish whether the culprit is the pudendal nerve or pelvic floor dysfunction. But often, they go hand in hand.
Rather than chasing nerve-specific diagnoses or relying on medication alone, a pelvic floor therapist trained in male pelvic health can help identify and treat the root cause—muscle, nerve, and/or fascial tension—so you can get back to living comfortably.
Have questions or think this might be you? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.