Prognosis
Does pudendal neuralgia go away?
The honest answer depends almost entirely on why the nerve is irritated. Recent, removable provocation behaves very differently from years of anatomical entrapment — and the distinction determines whether waiting is reasonable or costly.
Cases that often resolve
Symptoms driven by a temporary load on the nerve frequently settle once the load is removed and the pelvic floor is retrained.
- Cycling-related irritation (cyclist's syndrome) caught early
- Post-partum pudendal stretch injury in the first year
- A period of extreme sitting — long-haul travel, exam periods, new desk job
- Post-infective or post-inflammatory irritation once the trigger is treated
Cases that usually do not
When the nerve is mechanically trapped between the sacrospinous and sacrotuberous ligaments or within the Alcock canal, the compression does not release itself. Physiotherapy and medication can reduce the muscular and central contribution, but the underlying entrapment persists.
The same applies to post-surgical scar or mesh involvement, where the structural cause is fixed in place.
Why waiting has a cost
Chronic nerve pain drives central sensitisation: the nervous system amplifies signalling, the pain map widens, sleep deteriorates and mood suffers. Patients with long-standing central sensitisation improve less after decompression than those treated earlier.
That does not mean surgery should be rushed. It means assessment should not be delayed while treatments that were never going to address entrapment are repeated.
A reasonable decision point
If symptoms have lasted more than six months, are clearly worse with sitting, and have not improved after competent pelvic-floor physiotherapy and neuropathic medication, that is the point to seek a dedicated pelvic nerve evaluation with a diagnostic block.
Common questions
Does pudendal neuralgia go away on its own?
Sometimes. When the trigger is recent and removable — a period of heavy cycling, a difficult delivery, months of extreme sitting — symptoms can settle over weeks to months once the provocation stops. Long-standing pain from true anatomical entrapment rarely resolves without an intervention.
Does pudendal neuralgia come and go?
Yes, especially early. Pain typically fluctuates with sitting load, stress, bowel habit, menstrual cycle and activity. Pain-free days early in the condition are a good prognostic sign; losing them is a signal to escalate assessment rather than wait.
Does pudendal neuralgia get worse over time?
Untreated mechanical entrapment tends to progress: pain-free windows shrink, sitting tolerance falls, and central sensitisation spreads the pain beyond the original nerve territory. That progression is the main argument against waiting years before assessment.
How long does pudendal neuralgia last?
Highly variable. Post-cycling or post-partum cases often improve within 3–12 months of removing the provocation. Entrapment cases can persist for years, but even after years of pain a correctly selected decompression frequently produces substantial improvement.
Can pudendal neuralgia heal on its own after surgery?
After decompression, the nerve heals gradually rather than instantly. Regeneration continues for 12–24 months, which is why outcomes are judged at one year rather than at six weeks.
Speak with a pudendal nerve specialist.
Dr Renaud Bollens leads a specialist practice dedicated to chronic pelvic pain, with centers in Dubai and Belgium.