Pudendal Nerve Pain versus Coccyx Pain, Tailbone Pain

I was recently asked how do physicians distinguish between pudendal nerve pain (also called “pudendal neuralgia”) and coccyx pain (also called tailbone pain, or coccydynia). Below is a very, very brief overview.

Genital involvement:
  • Pudendal nerve pain usually involves the genitalia region, whereas coccyx pain usually does not.
  • Genital symptoms may include pain, numbness or tingling. In males, these symptoms may occur at the scrotum and/or penis. In females, these symptoms may occur
Right, Left, or Midline:
  • Pudendal nerve pain is often unilateral, meaning that it often involves only one side of the pelvic. For example, it often involves only the right side or only the left side. (Still, some cases of pudendal nerve pain can be bilateral, meaning that both right and left are involved.
Tailbone tenderness on physical exam:
  • Pudendal nerve pain usually has no significant tenderness at the coccyx during coccyx palpation on physical exam, whereas coccyx pain usually does have focal tenderness at the coccyx during coccyx palpation on physical exam.
Location of the pain/symptoms compared with the location of the anus:
  • Tailbone pain is located slightly above/behind the anus.
  • Pudendal nerve pain is located in front of the anus. (Basically, pudendal nerve symptoms can involve the anus or forwards from there.)
Pain with sitting:
  • This is an area of similarity between coccyx pain and pudendal nerve pain. Both of these conditions are often worse with sitting, and especially they are usually worse with sitting on a bicycle seat. Both are usually less painful sitting on a toilet seat rather than on a bicycle seat.


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– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.


Patrick Foye, M.D.
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