A pudendal nerve block may help identify or temporarily reduce selected pelvic, perineal, genital, rectal, or sitting-related nerve pain.
Learn how Dr. Siefferman performs pudendal nerve blocks to diagnose and treat chronic pelvic pain by targeting irritation of the pudendal nerve.
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Hi, I’m Dr. Jason Siefferman, interventional pain specialist and medical director at Manhattan Pain Medicine. When we are considering pudendal neuralgia as a diagnosis, the definitive way to include or exclude that diagnosis is with a pudendal nerve block. Now, there are several ways pudendal nerve blocks are done.
The way we do them is with ultrasound guidance in the office and we target the nerve at the most proximal location, which is right where the nerve crosses over the sacrospinous ligament at the ischial spine. In the office, we’ll have the patient lie on their stomach. This is on the upper buttock. We use the ultrasound. Use alcohol to clean the skin. Cold spray to numb the skin. A little poke. We guide the needle next to the nerve along the sacrospinous ligament. We inject local anesthetic. We watch it spread around the nerve. And that’s it. It takes about 10 seconds. Pudendal nerve blocks don’t need to be difficult. And we know right away by turning the nerve off if that pain is pudendal neuralgia or not.
A pudendal nerve block is a targeted injection placed near the pudendal nerve to help evaluate or temporarily reduce selected pelvic nerve pain. It may be considered for patients with suspected pudendal neuralgia, pain worse with sitting, perineal pain, genital pain, rectal pain, pelvic floor dysfunction overlap, pelvic dystonia, or PGAD-related sensory symptoms.
At Manhattan Pain Medicine, pudendal nerve block NYC care begins with diagnosis-first evaluation. The goal is to determine whether the pudendal nerve is likely contributing to symptoms and whether a block may provide diagnostic information, temporary relief, or both.
MPM specialists evaluate whether a pudendal nerve block may be appropriate by carefully mapping pelvic pain symptoms to anatomy. Pudendal nerve pain may overlap with pelvic floor dysfunction, pelvic dystonia, endometriosis, PGAD-related symptoms, rectal pain, genital burning, urinary or bowel symptoms, spine-related referral, or central sensitization.
MPM reviews the pain pattern, sitting tolerance, pelvic floor history, prior pelvic therapy, gynecology or urology evaluation, neurologic symptoms, imaging, medications, and prior procedures. This helps determine whether a pudendal nerve block, nerve hydrodissection, peripheral nerve stimulation, neuromodulation, pelvic floor therapy, medication management, pain psychology, or specialist coordination may be appropriate.
Patients often search for a pudendal nerve block in Manhattan after months or years of pelvic pain, sitting pain, genital pain, rectal pain, burning, stabbing, electric sensations, pelvic floor dysfunction, or PGAD-related distress. Many have already seen gynecology, urology, colorectal specialists, pelvic floor physical therapy, neurology, or pain medicine.
MPM approaches pudendal nerve blocks as a precision tool, not a standalone cure. A block may help determine whether the pudendal nerve is meaningfully involved and may provide temporary relief for selected patients. Even short-lived relief can be clinically useful because it may guide next steps, such as nerve hydrodissection, peripheral nerve stimulation, neuromodulation, medication management, pelvic floor therapy, or pain psychology. If the block does not help, that result may suggest another pain generator or the need to reassess the diagnosis.
Pudendal nerve blocks fit within MPM’s Pelvic Pain expertise because pudendal symptoms rarely exist in isolation. A patient with suspected pudendal neuralgia may also have pelvic floor dysfunction, pelvic dystonia, endometriosis overlap, PGAD-related symptoms, urinary or bowel symptoms, hip or SI joint mechanics, autonomic symptoms, trauma-related pain, or central sensitization.
MPM uses pudendal nerve blocks as part of a broader pelvic pain framework. The block may provide important diagnostic information, but persistent pelvic pain often requires coordinated care. Treatment planning may include pelvic floor therapy, medication management, pain psychology, biofeedback, nerve hydrodissection, peripheral nerve stimulation, neuromodulation, gynecology, urology, colorectal care, neurology, or additional imaging when appropriate. The goal is to match the next step to the patient’s actual pain pattern.
Before a pudendal nerve block, MPM reviews the suspected nerve target, pelvic pain pattern, purpose of the block, medication being considered, risks, alternatives, and post-procedure instructions. The injection is directed near the pudendal nerve. Ultrasound guidance may be used when appropriate to support anatomical precision and help visualize nearby structures.
Patients may feel pressure, brief discomfort, numbness, warmth, heaviness, or temporary changes in pelvic sensation after the injection. Relief may last hours, days, or longer depending on the medication used and the patient’s condition. Some patients may have temporary soreness or a short pain flare. MPM reviews the response after the block to determine whether the pudendal nerve appears clinically meaningful and whether next steps should include additional nerve-focused care, pelvic floor treatment, medication management, pain psychology, or further diagnostic evaluation.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
A pudendal nerve block is an injection placed near the pudendal nerve to help diagnose or temporarily reduce selected pelvic nerve pain. It may involve local anesthetic, sometimes with corticosteroid when clinically appropriate. A pudendal nerve block may be considered for suspected pudendal neuralgia, pain worse with sitting, perineal pain, genital pain, rectal pain, pelvic floor dysfunction overlap, or PGAD-related sensory symptoms. At MPM, pudendal nerve block NYC care begins with diagnosis-first evaluation.
The pudendal nerve carries sensation from parts of the pelvis, perineum, external genital region, and rectal area. It also has relationships with pelvic floor function. When the pudendal nerve is irritated, compressed, inflamed, or sensitized, symptoms may include burning, stabbing, electric, raw, pressure-like, genital, rectal, or perineal pain. Symptoms may be worse with sitting. MPM evaluates whether the pudendal nerve territory matches the patient’s pain pattern before recommending a block.
A pudendal nerve block may help selected pelvic pain patients when the pudendal nerve appears to be contributing to symptoms. The block may provide temporary relief, diagnostic information, or both. Pelvic pain can also come from pelvic floor dysfunction, pelvic dystonia, endometriosis, bladder or bowel conditions, hip or SI joint mechanics, spine referral, other nerves, or central sensitization. A pudendal nerve block is not a cure for pelvic pain, but it may help guide next steps.
A pudendal nerve block may be considered when symptoms suggest pudendal neuralgia or pudendal nerve involvement. If pain improves after the block in the expected area, that response may support the pudendal nerve as a pain generator. Relief may be temporary, and response varies by patient. Pudendal neuralgia can overlap with pelvic floor dysfunction, pelvic dystonia, PGAD-related symptoms, endometriosis, spine-related pain, and other pelvic conditions. MPM interprets the response within the full clinical picture.
Pain that worsens with sitting can be associated with pudendal nerve involvement, but it is not specific to pudendal neuralgia. Sitting-related pelvic pain may also come from pelvic floor dysfunction, coccyx pain, hip or SI joint mechanics, hamstring or deep gluteal structures, spine referral, scar tissue, or central sensitization. A pudendal nerve block may help clarify whether the pudendal nerve is involved when the symptoms and exam support that target.
A pudendal nerve block may be considered for selected genital, rectal, or perineal pain when the pain pattern suggests pudendal nerve involvement. Symptoms may feel burning, electric, stabbing, raw, pressure-like, or hypersensitive. These symptoms can also overlap with pelvic floor dysfunction, infection, dermatologic conditions, endometriosis, bladder or bowel conditions, neuralgia, trauma, or central sensitization. MPM evaluates the full pattern before recommending a block.
A pudendal nerve block may help selected patients when pudendal nerve irritation overlaps with pelvic floor dysfunction. However, pelvic floor dysfunction can involve muscle overactivity, coordination problems, pelvic dystonia, myofascial pain, scar tissue, hip mechanics, spine referral, or autonomic symptoms. A nerve block does not replace pelvic floor therapy or broader pelvic pain care when those are needed. MPM may coordinate pudendal nerve blocks with pelvic floor therapy and other treatments when appropriate.
A pudendal nerve block may be considered in selected cases where PGAD-related sensory symptoms appear connected to pudendal nerve irritation or pelvic nerve sensitization. It is not a cure for PGAD and does not address every possible cause of persistent genital arousal symptoms. PGAD can overlap with pelvic floor dysfunction, pudendal neuralgia, spine-related issues, medication factors, vascular contributors, and central sensitization. MPM evaluates the full symptom pattern before recommending a block.
A pudendal nerve block can be diagnostic, therapeutic, or both. A diagnostic block helps determine whether the pudendal nerve is likely contributing to pain. A therapeutic block is intended to reduce symptoms for a period of time. Temporary relief can still be useful because it may guide future care. MPM reviews how much relief occurred, where relief occurred, and how long it lasted before recommending next steps.
The duration of relief varies by patient, medication used, diagnosis, and pain mechanism. Some patients may experience relief for hours, while others may have relief for days or longer. Some patients may not respond. Relief is often temporary. Even a short response can be clinically meaningful if it helps confirm pudendal nerve involvement. MPM uses the response to guide future treatment planning.
Ultrasound guidance may be used for selected pudendal nerve blocks when it supports anatomical precision and safety. Ultrasound can help identify relevant landmarks and nearby structures during certain procedures. Guidance does not guarantee relief, but it may help support accurate placement. MPM determines whether ultrasound guidance is appropriate based on the patient’s anatomy, symptoms, suspected target, and clinical goal.
Temporary relief may suggest that the pudendal nerve is contributing to the pain pattern. That information can help guide next steps, which may include repeat evaluation, medication management, pelvic floor therapy, pain psychology, nerve hydrodissection, peripheral nerve stimulation, neuromodulation, or specialist coordination. MPM also evaluates the quality and location of relief. If relief occurs in an unexpected pattern, the diagnosis may need to be refined.
Risks may include pain flare, soreness, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, urinary or bowel changes, nerve irritation, vascular injury, local anesthetic toxicity, steroid-related side effects when steroids are used, incomplete relief, temporary relief only, or no relief. Urgent evaluation is needed for fever, spreading redness, severe swelling, new weakness, new numbness, inability to urinate, new bowel or bladder dysfunction, severe pelvic or abdominal pain, heavy bleeding, severe allergic reaction, or rapidly worsening symptoms.
A pudendal nerve block may not be appropriate when symptoms do not suggest pudendal nerve involvement, when infection is suspected, when bleeding risk is unsafe, when pelvic pain requires urgent evaluation, or when another diagnosis should be addressed first. Severe pelvic or abdominal pain, heavy bleeding, pregnancy-related pain, blood in urine or stool, new bowel or bladder dysfunction, saddle anesthesia, fever, or rapidly worsening symptoms require prompt medical evaluation. MPM reviews these concerns before recommending treatment.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you are considering a pudendal nerve block in NYC for pelvic pain, pudendal neuralgia, pain worse with sitting, perineal pain, genital pain, rectal pain, pelvic floor dysfunction overlap, or PGAD-related symptoms, MPM can help determine whether this treatment may be appropriate. Your evaluation will consider your symptoms, anatomy, prior care, safety factors, and care goals before any recommendation is made.
A pudendal nerve block is a targeted injection placed near the pudendal nerve. It may be used to help diagnose or temporarily reduce selected pelvic nerve pain. The injection may include local anesthetic, with or without corticosteroid when clinically appropriate.
At Manhattan Pain Medicine (MPM), pudendal nerve block NYC care begins with diagnosis-first evaluation. The goal is to determine whether the pudendal nerve is likely contributing to symptoms and whether a block may provide diagnostic information, temporary relief, or both.
The pudendal nerve carries sensation from parts of the perineum, external genital region, and rectal area. It is also connected to pelvic floor function. When the pudendal nerve is irritated, compressed, inflamed, or sensitized, symptoms may include burning, stabbing, electric, raw, pressure-like, genital, rectal, or perineal pain. Pain may worsen with sitting and improve with standing or lying down in some patients.
These symptoms can be distressing and difficult to explain. They may also overlap with pelvic floor dysfunction, pelvic dystonia, endometriosis, bladder pain, bowel symptoms, hip or SI joint mechanics, spine-related referral, scar tissue, trauma, central sensitization, or PGAD-related sensory symptoms.
A pudendal nerve block may be diagnostic, therapeutic, or both. A diagnostic block helps answer whether the pudendal nerve is contributing to the pain. If the patient has temporary relief in the expected area after the injection, the response may support pudendal nerve involvement.
A therapeutic block may provide symptom reduction for a period of time. Relief may last hours, days, or longer, depending on the medication used and the patient’s condition. Some patients may not respond. MPM reviews the response carefully because the result may guide future treatment decisions.
Pudendal neuralgia is a condition in which the pudendal nerve is believed to contribute to pelvic, genital, rectal, or perineal pain. Pain may be worse with sitting and may feel burning, stabbing, electric, or hypersensitive. A pudendal nerve block may be considered as part of the diagnostic and treatment process when symptoms match the nerve territory.
A block does not cure pudendal neuralgia. It may help clarify whether the nerve is involved and may provide temporary relief. Persistent symptoms often require a broader plan that may include pelvic floor therapy, medication management, pain psychology, nerve hydrodissection, peripheral nerve stimulation, neuromodulation, or specialist coordination.
Many patients with suspected pudendal nerve pain also have pelvic floor dysfunction, pelvic dystonia, PGAD-related symptoms, endometriosis overlap, urinary or bowel symptoms, or medical trauma from years of unexplained pain. These factors can influence both symptoms and treatment response.
A pudendal nerve block may be considered when nerve involvement is suspected, but it should not replace evaluation of other pelvic pain contributors. MPM’s approach is to map the symptoms, identify overlapping drivers, and build a coordinated plan rather than treating the pudendal nerve as the only possible source.
Ultrasound guidance may be used for selected pudendal nerve blocks when it supports anatomical precision and safety. The procedure plan depends on the patient’s anatomy, symptoms, suspected target, and clinical goals. Before the injection, MPM reviews the expected benefits, limits, risks, alternatives, and what to monitor afterward.
After the block, patients may feel numbness, warmth, heaviness, soreness, temporary pelvic sensation changes, or a brief pain flare. MPM reviews the degree and location of relief, how long it lasted, and whether the response matches the expected pudendal nerve distribution.
If a pudendal nerve block provides meaningful temporary relief, it may suggest that the pudendal nerve is contributing to the pain. This may guide next steps such as pelvic floor therapy, nerve hydrodissection, peripheral nerve stimulation, medication management, pain psychology, or neuromodulation.
If the block does not help, it does not mean the pain is not real. It may mean the pudendal nerve is not the main pain generator, the target needs reassessment, or another condition is contributing. MPM may then evaluate other pelvic nerves, pelvic floor muscles, spine-related pain, hip or SI joint mechanics, gynecologic or urologic issues, or central pain mechanisms.
Risks may include pain flare, bruising, bleeding, infection, allergic reaction, temporary numbness or weakness, urinary or bowel changes, nerve irritation, vascular injury, local anesthetic toxicity, steroid-related side effects when steroids are used, incomplete relief, temporary relief only, or no relief.
Patients should seek urgent evaluation for fever, spreading redness, severe swelling, new weakness, new numbness, inability to urinate, new bowel or bladder dysfunction, saddle anesthesia, severe pelvic or abdominal pain, heavy bleeding, pregnancy-related pain, blood in urine or stool, severe allergic reaction, or rapidly worsening symptoms.
For selected patients, a pudendal nerve block may be an important step in understanding pelvic nerve pain. MPM’s role is to determine whether the pudendal nerve is the right target and how the block fits within a coordinated, medically responsible pelvic pain plan.
