Pudendal nerve damage after surgery: signs, causes and what can help
Some people develop new pain, burning or numbness between the anus and the genitals after an operation. When this happens, the pudendal nerve may have been stretched, compressed or caught during or after the procedure. It is not common, but it is real, and it is often missed because the symptoms can seem unrelated to the original surgery. This page explains which operations are most often involved, what the symptoms look like, how the problem is assessed and what treatment options exist.
What the pudendal nerve does
The pudendal nerve carries sensation from the skin around the anus, perineum and genitals, and controls some of the muscles that help with continence and sexual function. It runs deep in the pelvis, close to ligaments and muscles that are handled during several types of surgery.
Which operations can affect the pudendal nerve
Hip arthroscopy
During some hip arthroscopy procedures, the leg is pulled (traction) against a padded post placed in the groin. Pressure from the post can affect the pudendal nerve. Symptoms are often numbness or tingling in the genital area, and in many cases they settle over weeks to months. Newer "postless" techniques are designed to reduce this risk.
Pelvic floor and prolapse surgery
In sacrospinous ligament fixation, a common operation for vaginal prolapse, stitches are placed in a ligament that lies very close to the pudendal nerve. A stitch can occasionally trap or irritate the nerve, causing sharp pain in the buttock, perineum or vagina, often worse when sitting. Other procedures involving pelvic mesh or deep pelvic stitches can do the same.
Other pelvic and anal surgery
Gynaecological, urological and colorectal operations in the deep pelvis can sometimes involve the nerve, through direct injury, scar tissue that forms afterwards, or positioning during long procedures.
Childbirth
Childbirth is not surgery, but a long or difficult vaginal delivery can stretch the pudendal nerve. Some women notice symptoms soon after birth. See our guide to postpartum pelvic pain and pudendal neuralgia.
Signs that the pudendal nerve may be involved
- Burning, stabbing or electric pain in the perineum, anus, vulva, penis or scrotum.
- Pain that is worse when sitting and easier when standing or lying down.
- Numbness or altered sensation in the same area.
- A feeling of a foreign body in the rectum or vagina.
- Changes in bladder, bowel or sexual function.
Symptoms may start immediately after surgery or appear over the following weeks as swelling and scar tissue develop.
Seek urgent medical care if you develop sudden loss of bladder or bowel control, or numbness around the genitals and anus that is spreading.
Temporary irritation or lasting damage?
Not every symptom after surgery means permanent damage. Nerves that have been stretched or compressed for a short time often recover, though this can take months.
Symptoms that are more likely to need specialist assessment include pain that is getting worse rather than better, pain clearly linked to sitting, and symptoms that have not improved after a few months.
If you have had pudendal nerve decompression surgery, a temporary rise in nerve pain in the weeks afterwards is expected. In Dr Bollens' clinical experience, worsening during recovery can reflect the nerve reactivating rather than failure of the operation. Read more about recovery after pudendal nerve decompression.
How it is assessed
A specialist will usually:
- Take a detailed history, including the exact operation, the timing of symptoms and what makes them worse.
- Examine you, including the areas of altered sensation and tenderness along the nerve.
- Compare your symptoms with the Nantes criteria, the standard checklist for pudendal nerve entrapment.
- Arrange imaging to look for stitches, mesh, scar tissue or other causes. MR neurography can sometimes show the nerve and possible compression points.
- **Consider a diagnostic pudendal nerve block** to confirm whether the nerve is the source of pain.
Bring the operation report if you can. Details such as where stitches or mesh were placed can change the plan.
Treatment options
Treatment depends on the cause, how long symptoms have lasted and how severe they are.
- Time and protection: avoiding prolonged sitting, using a cut-out cushion and adjusting activity while the nerve settles.
- Medication for nerve pain.
- Pelvic floor physical therapy, focused on relaxation and nerve mobility rather than strengthening.
- Image-guided nerve blocks, which can be both diagnostic and therapeutic.
- Surgery to free the nerve when a stitch, mesh or scar tissue is clearly compressing it and conservative care has not helped. This may involve removing the material and releasing the nerve.
In Dr Bollens' practice, decompression surgery is considered only after a full assessment, a response to diagnostic nerve blocks and a fair trial of conservative treatment. Surgery is carried out at partner hospitals in Dubai and Belgium, and the first consultation can take place online. See pudendal nerve decompression.
No treatment can guarantee a full recovery. A specialist should discuss realistic expectations with you.
Sources
- Hoit G, Dwyer T, Chahal J, et al. The incidence and breadth of postoperative pudendal nerve palsy and its relationship to table traction during hip arthroscopy with a perineal post. Am J Sports Med. 2026. PubMed
- Vodegel EV, van Delft KWM, Nuboer CHC, et al. Surgical management of pudendal nerve entrapment after sacrospinous ligament fixation. BJOG. 2022;129(11):1908-1915. PubMed
- Kaur J, Leslie SW, Singh P. Pudendal Nerve Entrapment Syndrome. StatPearls. NCBI Bookshelf
- Labat JJ, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27(4):306-10. PubMed
- Levesque A, Bautrant E, Quistrebert V, et al. Recommendations on the management of pudendal nerve entrapment syndrome: a formalised expert consensus. Eur J Pain. 2022;26(1):7-17. PubMed
Common questions
Can pudendal nerve damage after surgery heal on its own?
Mild stretch or pressure injuries often improve over weeks to months. Ongoing compression, for example by a stitch, is less likely to settle without treatment.
How long after surgery can symptoms start?
Some people notice symptoms straight away. Others develop them over weeks as scar tissue forms.
Which surgeon should I see?
A specialist in pelvic nerve pain. Your original surgeon should also be told, as they know the details of the operation.
Will a scan show the damage?
Not always. Imaging is useful to look for stitches, mesh or scar tissue, but the diagnosis also relies on symptoms, examination and nerve blocks.
Is numbness the same as nerve pain?
No. Numbness is reduced feeling. Nerve pain is burning, stabbing or electric pain. They can occur together and have different implications.
Speak with a pudendal nerve specialist.
Dr Renaud Bollens leads a specialist practice dedicated to chronic pelvic pain, with centers in Dubai and Belgium.