For men
Pudendal neuralgia in men.
Most men we see have taken three or more courses of antibiotics for 'chronic prostatitis' with negative cultures. The prostate was never the problem. Sitting-provoked perineal pain in men is, far more often than recognised, a pudendal nerve problem.
How it presents
The pattern is consistent and distinguishable from prostate disease once you look for it.
- Burning or aching pain in the perineum, scrotum, penis or rectum
- Pain that builds the longer you sit, relieved by standing
- Golf-ball or lump sensation in the rectum or perineum
- Urinary urgency, hesitancy, incomplete emptying
- Post-ejaculatory pain, sometimes lasting days
- Reduced penile sensation or erectile dysfunction
Why 'chronic prostatitis' is usually the wrong label
Category III prostatitis (CPPS) is defined by the absence of infection. It is a description of symptoms, not a cause. Repeated antibiotics for a sterile condition delay diagnosis by years.
If your cultures are negative, antibiotics have not helped, and pain is clearly worse when sitting, the pudendal nerve and pelvic floor should be assessed directly.
Common causes in men
Male cases are usually mechanical, athletic or post-surgical.
- Long-distance cycling and spinning (cyclist's syndrome)
- Prolonged sitting — driving, desk work, gaming
- Heavy squatting and deadlifting with pelvic floor bracing
- Hernia repair with mesh, prostatectomy, haemorrhoid or fistula surgery
- Falls onto the buttocks or coccyx
- Chronic constipation and straining
Getting an answer
A dedicated assessment applies the Nantes criteria, examines for tenderness at the ischial spine, orders MR neurography where indicated, and uses an image-guided pudendal nerve block to confirm the nerve as the pain generator.
Where entrapment is confirmed, decompression surgery addresses the cause. Where it is not, medical and physiotherapy management is the honest recommendation — and we give it.
Common questions
What does pudendal neuralgia feel like in men?
Men describe burning, aching or electric pain in the perineum, scrotum, penis or rectum that increases the longer they sit and settles on standing. A sensation of sitting on a golf ball, post-ejaculatory pain and urinary urgency are common.
Is chronic prostatitis actually pudendal neuralgia?
In many men, yes. True bacterial prostatitis is uncommon and responds to antibiotics. Men with negative cultures, repeated antibiotic courses and sitting-provoked perineal pain very often have pudendal neuralgia or pelvic floor dysfunction rather than prostate disease.
Can pudendal neuralgia cause erectile dysfunction?
Yes. The dorsal nerve of the penis is a pudendal branch, so compression can cause reduced sensation, weaker erections, altered or painful orgasm, and post-ejaculatory pain. These symptoms often improve as the nerve recovers.
Can it be caused by prostate surgery?
Pelvic surgery — prostatectomy, hernia repair with mesh, haemorrhoid or fistula surgery — can injure or entrap the pudendal nerve in scar tissue. Persistent new perineal pain after such surgery should be assessed as a possible nerve injury, not written off as normal healing.
What tests do men need?
Urine culture and prostate assessment to exclude infection, examination against the Nantes criteria, MR neurography when entrapment is suspected or surgery is planned, and an image-guided diagnostic pudendal nerve block.
Speak with a pudendal nerve specialist.
Dr Renaud Bollens leads a specialist practice dedicated to chronic pelvic pain, with centers in Dubai and Belgium.