Health Organization for Pudendal Education

I have read most of Isa Herrera's book Ending Female Pain. She is a New York City PT who specializes in pelvic pain and pelvic floor dysfunction. Some of the exercises in her book are yoga-based and involve squatting and yoga-like "hip openers."

Amy Stein's exercises (another NYC PT) are very similar and include lunges.

My question: are these types of exercises okay for pudendal neuralgia?

Also, if you've had a problem with these exercises (or yoga), how long after squatting or lunging do you notice a worsening in your pain?

Thanks so much for any comments!

Hi Susibee,
If it were me, I'd hold off on the lunging and squatting for a little while.
Warm regards,
Karyn

Squatting/lunging definitely flares me up. I probably squat 20 times a day picking up a 30 lb 18 month old and it increases my pain (especially in the sacral/rectal area). I think a lot of it probably depends on if you have pelvic instability issues and where your pain is. But in general I would think squatting and lunging are not good for PN. These books are written for people with a wide variety of pelvic pain issues and I think the authors need to be a little more careful about making broad blanket statements like everyone with pelvic pain needs to do this exercise "program". I do some yoga. I use a viniyoga DVD I found on Amazon for the low back, sacrum, and hips. I can't do all the exercises, but I do what doesn't increase my pain if that makes sense.

Susibee,

Lunges are what got me into trouble in the first place. Then my PT had me start doing hip openers/squats and while it didn't bother me while I was doing them, over several months I think they are what pushed me over the edge into serious PNE. Each person may be different but if you have a nerve entrapment I think these exercises can be problematic because they can cause a stretch injury to the nerve and also the repetitive hip flexion has been listed as one of the culprits in causing PNE.

Hi, ladies! Thanks for the advice. Sounds like the concensus is "no" to the lunges and squatting.

I'm still not 100% sure, because my trigger has always been touch, not exercise, and I've been going to yoga classes for years when I was without symptoms. But I'm just so AFRAID at this point of making anything worse. (I'm currently in the worse flare I've ever experienced with buttock pain and inner thigh burning, making me feel I have PN, not just nonspecific vulvodynia with my usual, short-lived vulvar burning.) I don't know. I might wait this out now -- hopefully it will calm down -- and then slowly go back to yoga and see what happens.

If it's my dorsal nerve that's the problem, I feel like that would be less likely to be bothered by yoga since it's more superficial and not so deep in the pelvis. Does that make sense?

Oh -- my other concern with PT, specifically, is myofacial release or trigger point release internally. I feel like, since my trigger is definitely touch (clitoral/vulvar touch, not inside touch, but still...), would it be stupid to allow a PT to touch me?

Yoga is good for fitness and removing the pain.
It is good exercises for both physical and mental health.
It is good for getting rid of body pain and stress.

I have to comment on this because i have wondered the same thing. Isa Herrera (PT mentioned above) is my physical therapist and she told me NOT to do any forward bends/hip flexion as it "stretches" the pudendal nerve and irritates it. I am a yoga teacher and have found that yoga can both help alleviate some of the PNE symptoms and make them worse. In fact, i think yoga caused some of the SIJD that i have and possibly cause my PNE. Based on my experience, i would proceed with caution and only work with someone who knows a lot about PNE -- not just pelvic floor disorders!!