Pudendal Nerve

What is the pudendal nerve?

The pudendal nerve is a major nerve in your pelvic region. This nerve sends movement (motor) and sensation information from your genital area. The pudendal nerve runs through .your pelvic floor muscles that support organs and ends at your external genitalia.

What is the purpose of the pudendal nerve?

The pudendal nerve is crucial for sensation and function in your pelvic region, including the genitals and anus. This nerve is part of your peripheral nervous system. Peripheral nerves send signals from your central nervous system (brain and spine) to your limbs and certain organs.

The pudendal nerve’s motor function controls the movement of your:

• Anal sphincter muscles, which help you hold in or release feces (poop).
• Urethral sphincter muscles, which help you hold in or release urine (pee).

The pudendal nerve also provides sensory information about touch, pleasure, pain and temperature to your:

• Penis (part of the male reproductive system).
• Vagina (part of the female reproductive system).
• Perineum (the skin between your anus and your vagina or penis).
• Anal canal and anus (part of your digestive system).

Where is the pudendal nerve?

You have a pudendal nerve for each side of your body (left and right). The pudendal nerve arises from the sacral plexus in the very lowest part of your spine. The sacral plexus is a bundle of nerves located on the back of your pelvis.

This sacral plexus is a complex network of nerves. These nerves give and receive feedback on movement and sensation to your thighs, lower legs, feet and part of your pelvis.

What is the pudendal nerve’s path?

The pudendal nerve:

• Connects to the S2 to S4 sacral spinal nerve roots in the sacral plexus.
• Runs through your pelvis and gluteal (buttock) region at the upper end of the thighbone (femur).
• Passes through an opening in the pelvic bone called the greater sciatic foramen.
• Exits the gluteal region through a smaller opening called the lesser sciatic foramen.
• Travels alongside the pudendal artery and vein into the pudendal canal (also called the Alcock canal), a narrow tunnel-like opening in your pelvis.
• Divides into smaller nerve branches.

What are the pudendal nerve branches?

After entering the pudendal canal, the pudendal nerve branches into:

• Inferior rectal nerve: Controls your anal sphincter muscle and sends sensory information to your anal sphincter and anal canal.
• Perineal nerve: Controls your pelvic floor muscles and your urethral sphincter. Provides sensory information to the perineum and the labia (the “lips” outside your vaginal opening) or scrotum (the sac that holds your testicles).
• Dorsal nerve: Sends sensory information (touch, pleasure, pain) to the skin of your penis or clitoris, allowing for sexual pleasure and assisting in erections.

What conditions and disorders affect the pudendal nerve?

Pressure on your pudendal nerve can cause pain or neuropathy (nerve damage).

Pudendal nerve entrapment syndrome is a rare type of nerve compression syndrome. With this condition, an injury or another problem puts pressure on your pudendal nerve. It causes pudendal neuralgia (chronic stabbing pain). This syndrome affects about 1 in 100,000 people.

What causes pudendal nerve problems?

Causes of pudendal nerve damage include:

• Accidents and trauma.
• Complications from pelvic surgeries like a prostatectomy, or surgery to correct pelvic organ prolapse.
• Diabetes and diabetes-related neuropathy.
• Difficult labor and delivery.
• Prolonged pressure on the nerve from activities like cycling.
• Radiation therapy.
• Tumors or cysts.

What is the role of pudendal nerve blocks during childbirth?

Healthcare providers sometimes use pudendal nerve blocks to provide pain relief during childbirth. Your provider may suggest the nerve block if you can’t have or don’t want an epidural (spinal anesthesia), or need extra pain relief during your repair.

A pudendal nerve block takes effect quickly. It reduces pain during the second (pushing) stage of childbirth or before an episiotomy. But it doesn’t relieve the pain from contractions.

How can I protect my pudendal nerves?

These steps can keep your nervous system healthy:

• Don’t sit for prolonged periods.
• Take breaks when cycling.
• Manage stress through meditation, walking or other healthful ways.
• Eat a nutritious diet and maintain a healthy weight.
• Manage conditions like diabetes and high blood pressure that can damage nerves.
• Seek help to quit smoking. Tobacco use slows blood flow to the nerves.

When should I talk to a doctor?

You should call your healthcare provider if you experience:

• Chronic pain in your pelvic region.
• Pain that worsens when seated.
• Sexual dysfunction.
• Urinary or fecal incontinence.

A note from Cleveland Clinic
The pudendal nerve provides most of the movement and sensations for your pelvic region, including your external genitals and anus. It plays a critical role in your ability to regulate when you pee and poop. Damage to the pudendal nerve can lead to pain and affect your ability to have or enjoy sex. Pressure on the nerve causes pudendal nerve entrapment syndrome. This condition causes severe, chronic pain (pudendal neuralgia) that can be disabling.