I've dealt with right sided pudendal neuralgia for 9 years, following bunion surgery on my left foot - all started when I returned to my running, cycling, etc. Like many on this forum, I've seem many medical professionals who either misdiagnosed, admitted not knowing and sending me to someone else and of course, mistreatment saying it was in my head, and thus I have landed here with all you other brave souls who suffer from this invisible condition. Skipping many details of the journey, ~4 years ago, a pelvic PT was convinced it was my hip and I got an MRI and saw a hip surgeon. At that time, a small tear in my labrum (hip socket cartilage) was identified but deemed by surgeon "too small to be causing my pain" - I have zero typical hip pain. Tear probably occurred due to having all weight on that side for 6-8 weeks of crutches and boot during the recovery from foot surgery. However, they gave me a hip joint injection which dramatically altered my pain level (not immediately, but ~2 weeks later) - it took me from being in pain 85% of the time, to about 15% of the time, but I was unable to return to running, cycling, pilates, yoga, etc. and of course sexual relations without flares. My pain is odd, it never hurts during an activity, but comes 24-36 hours after. So I went back to my life relieved of daily pain and sick of dealing with doctors. I had two more over injections over the 4 years. So fast forward to now - more info is out there now and I am seeing anecdotal evidence that hip labral tears and pudendal nerve pain can be connected. Seeing pelvic floor PT again but the smallest of exercises started flaring pain. Considering labral tear repair, but biggest fear is not that it won't work but that it could make me worse off. Anyone else out there have any connection to hip problems, hip labral tear surgery and/or hip joint injections helping pudendal nerve pain?
Hip Labral Tears and Pudendal Neuralgia - Pelvic Pain Suppo...
Hip Labral Tears and Pudendal Neuralgia
Hi, interesting to hear about the hip injection improving your symptoms. I have read that some get better but some get worse after surgery of labral tear. I do not have a labral tear (or at least no diagnosis have shown that) but I am quite convinced that my hips are not balanced which has contributed to my PN. The thing that gave me PN was too intense stretching of my hips and hamstring. My theory is that my pudendal nerve was slightly compressed on my right side and it got stretched out too far because of compression by my hip rotator obturator internus.
I think a labral tear, uneven hips will impact your walking gait and in turn put unnecessary forces on muscles that should not be very active when walking/running. In my case I also get a delayed of the symptoms (12-24 hours). My pain is only located on the right side of the inside of the sitbone. Where is you pain located? Do you know which movements trigger your pain?
Running, cycling, pilates, sex and yoga all seem to be potential triggers, I eventually stopped all (I was highly active) after about 1-2 years of constant pain. It did seem to be less intense once I stopped trying to be so active. After injections worked, these things were still triggers but I could walk for exercise. It still would occassionally flare, but not nearly as bad or long. Sadly, intercourse or even external stimulation often (but not always) would flare me the next day 
. My pain moves, but a primary location is where you describe, but I will also feel burning anywhere from the 7pm (on a clock, my right if facing me) position near vaginal opening all the way up through labia and into clitoris at times. Higher up is less frequent but does happen. After I posted this, another suggested post came up that referenced this blog (mermaidsreel.blogspot.com/). My PT also agrees that due to tear, no matter how small, my femur head does not sit tight enough in the socket, so yes, the Obturator Internus muscle is either always in spasm thus pressing on nerve. That muscle is typically tight on internal exam which corresponds with inside the sit bone/7pm position. I remember asking the hip surgeon 4 years ago about this dynamic of another muscle compensating and he did not really answer the question on that being possible (eyes rolling). Fast forward 4 years, and his PA, who has done my injections, says he has now seen a few patients with PN/Pelvic pain that improved post hip labral tear repair. Also, regarding making it worse, they put you in traction with this massive pole between your legs, which has caused some PN issues in some patients that did not even have this before. I spoke with PA about this recently and he said this surgeon now uses this table (Guardian, by Stryker) that tilts you head down to a degree which no longer requires that pole, so this probably minimizes a lot of the risk of stretching/pressing the PN.
How long have you had your condition and what has helped or made worse?
Ok, yes the Guardian table sounds as a good way of minimizing the risk of stretch injury. The picture of traction and the pole between the legs looks terrible. I remember I read somewhere that prolotherapy could be an option for labral tear. Have you thought about that?
I guess I should feel lucky in the sense that so far I have no genital pain (should mention that I’m a male) but I am sorry you are suffering that kind of pain:(.
Thanks for the blog reference, really shows the evidence between dysfunctional hips and PN. Just so annoying that you have to do all research yourself. I have tried several physiotherapists and chiropractors but all have made me worse unfortunately.
I have ’only’ suffered for 1 year, but before PN I had sacrum and lumbar pain for several years. Also had problems with my knee. The interesting thing is that all my pain has always been located on my right side. That’s why I think it must be a biomechanical issue and perhaps a dysfunctional hip. I love exercising so PN is tough but basically what triggers my pain is sitting, flexing my hip, stretching my glutes. I read about several people who prefer doing pelvic floor stretching but all those exercises would give me a big flare. What helps me is actually resting and time and listened to the body. Initially I ignored the pain and exercised as I used to but it just got worse. I am also trying to change my walking gait so my glutes are working instead of piriformis and obturator.
Yes, the lack of doctors knowing about PN is incredible really, because it does not seem like rocket science to make the connection of an unstable hip joint and how that could cause PN pain do to gait mechanics, but the more you read, hip surgeons still don't seem to know about it. Thanks for the suggestion about Prolotherapy, a friend had that for a hamstring issue, but no one had mentioned this as a possibility for labral tear. The PA for the surgeon I see is with Duke which is known for leading edge medicine, so I am surprised this hasn't been mentioned as an option, esp. since my tear is deemed 'small'. I will definitely be asking, because avoiding surgery would be preferable since it is theory and anecdotal data on hoping labral tear repair would address the PN pain, I have really barely any actual hip pain, except tender to palpate the joint by the PA. I am also trying orthotics to see if shifting gait might help.
Exactly, this is not rocket science, it seems that many doctors have their area and are not willing to think out of the box and the bigger connection of body mechanics. It’s frustrating to realize that many times we as patients have more knowledge but can be neglected because we are ’just’ patients.
Yes, that sounds like a good strategy to check out the prolotherapy before jumping into a surgery. I hope it goes well and would be nice to hear how it goes, good luck!
Hi PnJadi, my pain started on the inner side of my left sit bone. It started 5 months after I fell and fractured my left femur. They put 3 screws in the fractured bone. Nine months later the pain radiates to my left butt crack. I had an mri of my left hip which shows labral cysts, but due to the metal screws they cannot get a complete view of my hip joint so I may have tears. I'm wondering if I had hip surgery if it would take my sit bone and butt crack pain away? It's all such a gamble, hard to know the right thing to do. Did you read the article at mermaidsreel.blogspot ?
Four years ago after a fall off a 8 ft ladder onto my back side, I started having bladder pain that wasn't related to an infection. I also fractured my t12 vertabre which was repaired with kyphoplasty. Many doctors later, I was diagnosed with PN. I started PT and also gabapentin. I was already taking amitrypyline for mild depression. The drugs helped but I continued to have pain in my hip that no one could diagnosis. Finally after seeing a second pelvic pain expert, I had a MRI of right hip and a labral tear was diagnosed. After having a lidocaine/steroid hip injection, it was concluded that hip pain caused by labral tear. I had hip arthroscopy where they cut away frayed labrum. The tear was worse than thought and I had lots of inflammation. Unfortunately, I didn't really improve after surgery, despite lots of time and PT. Another MRI several years later revealed another tear. I consulted 2 hip doctors and they said basically my options were to manage the pain or to get a hip replacement. I have been trying, along with help from my hip doctor and pelvic dr and PT, to manage pain. I want to be much more active and travel than I have been able to be so I am considering a hip replacement. I can walk a mile or swim 25 minutes every other day but do it with some pain afterword. FYI, I am 62 and have been diagnosed with borderline osteoporosis. So walking is important. I plan to get a 2nd opinion from another hip doctor, due to osteoporosis before making a decision. FYI, most doctors, including a urologist, I consulted early in the process do not understand PN at all.
If pain is unbearable, I'd strongly considering trying hip arthroscopy to repair tear. In my case, it didn't work because tearing was very extensive from the fall.
Good luck and let us all know what you decide to do.
Are you going to get a hip replacement? I wonder if that would help my pain.
I’ve had ongoing issues for two years now. The thing that stuck out from your post was how similar our pain issues are. I had to give up everything I love doing Sportswise. Haven’t been able to sit comfortably for two years now. But the thing that struck me is the pain pattern. I too get delayed pain. Never while I’m doing an activity but 12-24 hours after. I have pain that swaps sides of my butt. Had MRI’s of lower back and hips that don’t show anything. Had hip injection that did nothing. An ultrasound diagnosed gluteal tendinopathy one side and high hamstring tendinopathy the other. One thing I have noticed is that it is activation of my glute muscles that trigger the pain. I too had pain in my undercarriage but this has subsided and only flares occasionally now. I think I have major instability in my pelvis. I think the nerves in that area have become hypersensitive so just squeezing my butt triggers it. I have no idea why it doesn’t trigger pain straight away. At the moment I’m focusing on core exercises only.
No glute or hip work to see if that helps.
Hi there I suffer from PNE and can tell you after my two years of agony that almost any pain in that area is origenated in the entrapment of the pudendal nerve(mainly)which as a consequence will trigger the muscles in the surrounding area to go into spasm and subsequently they will unbalance the pelvis because the affected side muscles will stronger than the ones from the unaffected side plus backbone will inevitably get askew
having in this process pain in different places or areas of mainly pelvic floor and of course genitalia area.
I'm going now to explore osteopathy because the assistance received by doctor has been very much like the first page from the search engine on the internet because the solution are always the same kind of "copy and paste"
I think one of the biggest mysteries in life is why doctors have no idea of this problem ? They don't really know what to do with this condition.
I'm going to follow a Spanish oestheo path that been researching for about a decade on PNE, he has recently published a book with his osteopathic approach.
After 2years and all the medicine i have taken I'm still seating at the starting point, don't consider a surgical solution it will possibly get you worse.
Best of luck !!!
Hi paine321, I hope that you will get relief from the osteopath. Indeed it is a huge mystery how come doctors have no idea about this condition.
Did you get your PNE from a specific trauma or did it just occur randomly?
Hi
Wondered if you'd mind sharing the name/ details of the Spanish osteopath. I'm very interested to read up. I've been suffering for 6 years now. Please PM me if you'd prefer.
Thank you
Of couse not his name is José Enrique Garcia González "José Garcia "
The little of the book is "síndrome de atrapamiento del nervio pudendo" (abordaje osteopatico)
{ pudendal nerve entrapment syndrome (osteopathic approach) }.
Everything is in Spanish so get a Spanish bilingual dictionary beforehand.
Hopefully it will help you in any way.
Best of luck
Paine321.
Hi all who've responded to this post. I wanted to share that I've had a huge shift in my thinking after subscribing to Curable. It is a chronic pain management app and the newest theories and proven research on pain science are a bit mind-blowing. I decided trying this out with pelvic floor and hip PT (one more time) was way better than trying a surgery that may or may not resolve my pain. So far I am pretty blown away and while it has not been long, I am experiencing less pain after just a few weeks (everyone's length of time is different). It is about how the brain signals pain even after an injury has healed, if nothing else, it is very interesting and certainly can not result in negative effects. I am hopeful that it will continue to improve.
PN is so hard to deal with. I fractured my upper femur and 3 screws were put in, then 5 months later I started having signs of PN/PNE at my inner left sitz bone which has now spread to my butt crack. Pain started only when sitting, but now is there continuously and tramadol just takes the edge off. I've also developed sciatic symptoms and am currently seeing a chiropractor. I wish I could figure out a way to fix myself. 🤔 Good luck to you!
PN is really miserable and hard to deal with and the worst since unlike a back or neck issue, is not easily talked about for most. I don't know if you saw my earlier post, I am using the Curable app. It provides tools and techniques for reducing and/or eliminating chronic pain of various types regardless of the initial cause and is based on the latest 'pain science' research. I highly recommend, just learning about the latest research plus meditating helped me push the pain to the background for me so far. Also, really nothing to lose - since it is based on the brain vs any type of medication or procedure which can create negative effects. Good Luck!
I understand the mind thing, but I would really like to find a physical solution to fix whatever is causing the pain. I am glad the app is working for you. Thank you for responding!
Just fyi...if you listen to some of the free podcasts on Curable (before you pay for the app), the pain science and research highly indicates that what may have been initially a physical/structural reason for the pain, when it becomes chronic (>3 months) it is very often a result of where the physical healing has taken place, but the neural pathways in the nervous system are still detecting a threat thus sending pain signals. When I first ran across this about 6 months ago, I thought it sounded a little hoaky, but then separately I decided to start meditating (just 10 mins a day, every day) and I noticed a shift, so then I went back to Curable and started listening to more and once I got into it, realized it makes so much sense. Also, I can't explain how for the first time in 9 years, I feel like I have control to change this pain and have already seen pretty significant results. There are many success stories of people and a private fb group that is very positive, supportive and 'know the misery' of chronic pain. Just saying...I was totally convinced my pain was due to something physical and wanted to find that answer when I first posted here too. Don't know how long you've had your PN pain to know if it is considered chronic (> 3 months)?
My pain is chronic. Have had it for a year. If I do have PN/PNE and I use this mind over matter approach and start sitting more won't I do more damage to the nerve and eventually become incontinent? That is something I am trying to avoid.
I'm just suggesting it is something you might want to explore and listen to some of the free podcasts/content and see if any of it resonates with you in a way that would make you want to explore further. It is not a mind over matter approach (i.e. I broke my foot but I'm going to will the pain away ) and you go at your own pace with it. It is education on pain science research, meditations, reframing how you think, etc. There isn't anything that suggests you go do physical things that you think will make something worse. Anyway, it has just been so helpful for me, I wanted to share. Best wishes.
Thank you for sharing this information.
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