Pudendal Nerve Block

Pudendal nerve pain is usually a burning, stabbing, aching or electric pain in the genitals, perineum or anus that is worst when sitting. It often eases when you stand or lie down and typically does not wake you at night^[2]. Some people feel as if there is swelling or an object in the rectum or vagina^[7]. Because these symptoms overlap with bladder, prostate, gynecologic and bowel conditions, many patients see several specialists before pudendal neuralgia is considered^[6].

For chronic pain, a pudendal nerve block is given through the buttock while you lie face down. After the skin is numbed, your physician uses live X-ray, ultrasound or CT to guide a thin needle to the nerve near the ischial spine and injects local anesthetic, sometimes with a steroid^[5][4]. It usually takes 20 to 30 minutes, and you go home the same day.

Most people describe a pudendal nerve block as uncomfortable but manageable. The skin is numbed first, so you mainly feel pressure and a deep ache as the needle is positioned, and sometimes a brief jolt of your familiar pain. Light sedation can be offered if you are anxious. The buttock may be sore for a day or two afterward.

Plan for a driver and come with your usual level of pain so the test is easier to read. Tell us about blood thinners, diabetes and allergies. Whether you should pause a blood thinner depends on the medicine and the procedure^[8] — never stop one without talking to the doctor who prescribed it. Eat lightly unless you have been told to fast for sedation.

Spend the rest of the day testing and resting. Sit and move as you normally would and record your pain every hour or so — that record shows whether the block worked. Pelvic numbness is expected, and the leg can feel weak if medicine reaches the sciatic nerve, so do not drive that day. Most people return to normal activities the next day.

The numbing effect lasts a few hours, which is enough to test whether the nerve is the source of pain. Longer relief varies widely. Some patients feel better for weeks or longer, but in a large randomized trial only about 12–14% of patients still had meaningful relief at three months^[4]. Relief tends to last longer when the block is used alongside pelvic floor physical therapy and other treatments.

Short-term success is common: across studies reviewed in 2025, pudendal blocks reduced pain in 68% to 94% of patients^[3]. Lasting success is lower, and in one large trial most patients no longer had meaningful relief at three months^[4]. A block that relieves your usual pain is still a success as a diagnostic test, because it points to the right treatment.

Yes. If a block clearly helps, it can be repeated, usually several weeks apart, while you continue physical therapy. If a steroid is included, your physician will limit the total amount. If blocks keep helping only briefly, pulsed radiofrequency, nerve stimulation or a surgical opinion may make more sense than repeating the same injection^[3].

Serious problems are uncommon. Expected effects include buttock soreness and temporary pelvic numbness, and the leg may feel numb or weak for a few hours if anesthetic spreads to the sciatic nerve. Because the pudendal artery and vein run beside the nerve, imaging is used to lower the chance of bleeding or injecting into a vessel^[5]. Infection and allergic reactions are rare.

Coverage is narrower than for most nerve blocks. Under Medicare’s New York policy, effective October 25, 2026, a diagnostic pudendal nerve block is covered to confirm or rule out pudendal neuralgia when the Nantes criteria point to it — usually a single block, occasionally a second — but repeated therapeutic pudendal blocks and pudendal radiofrequency ablation are non-covered^[1]. Commercial plans vary and often require prior authorization, and New York workers’ compensation and no-fault claims follow their own rules. Our staff will verify your benefits and explain any costs before scheduling.

If a well-placed block does not relieve your usual pain, the pudendal nerve is probably not the main cause, and your physician will look at other sources such as the pelvic floor muscles, the sacroiliac joint or the cluneal nerves. If blocks help but wear off, options include pelvic floor physical therapy, medicines such as gabapentin or amitriptyline, pulsed radiofrequency, nerve stimulation and decompression surgery^[7][3].