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My perineum hurts when I sit: what could it be?

Perineal pain that gets worse when sitting can come from irritation of the pudendal nerve, painful contraction of the pelvic floor muscles, a local cause (anal, urinary or gynecological) or pain referred from the tailbone, the sacrum or the lower back. Burning or electric-shock pain that worsens when sitting and eases when standing or lying down suggests pudendal neuralgia (NHS). Only a doctor can make this diagnosis.

This page helps you understand; it does not make a diagnosis. Blue Portance designs and sells Aporia® seating.

Where is the pain?

Between the anus and the genitals, but it can be centered, further forward, further back, or on one side. In our pudendal neuralgia files, 36 of the 58 people who answered this question have pain on one side, or stronger on one side. The location guides the assessment and the choice of seat; on its own, it does not identify the cause.

Why does sitting make it worse?

Because sitting combines several stresses: seat pressure, compression of the nerve by contracted muscles (hypertonia), immobility and, often, an imbalance between the right and left sides. In the pudendal neuralgia cases we have personally assessed, pelvic floor hypertonia has been a consistent clinical observation. The full explanation is on the page Why does sitting make perineal pain worse?

When should you seek medical advice?

Perineal pain can have different causes, some of which require medical evaluation. If your symptoms are new, persistent, worsening, or accompanied by unusual changes in sensation, urinary or bowel function, consult a qualified healthcare professional.

What can you do in the meantime?

Break up your sitting time and note what makes it worse or better: type of seat, how long you can sit, which side, car trips. These notes help your doctor and help you choose your seat.

Can a cushion help?

A suitable cushion reduces pressure on the sensitive area and does not force you to hold yourself up, an effort that sustains muscle contraction; it does not treat the cause. Offloading removes the contact of the seat; it does not relax contracted muscles and does not make tissues move. The selection criteria are detailed in the guide Which cushion for pudendal neuralgia?, which compares U-shaped cushions, donuts, foam cushions and Aporia® seats with the same questions.

What other questions do people ask?

Is it necessarily pudendal neuralgia? No: pelvic floor muscle contraction, a local cause or referred pain can produce similar signs.

Why does the pain build up during the day? Pressure, immobility and contraction add up; pain that is bearable in the morning can become overwhelming after a few hours of sitting.

Publisher: Blue Portance. Written by Gil Ayache, PhD (Mines Paris – PSL). Reviewed: October 19, 2026. Sources: NHS, “Pudendal neuralgia”; files from our online questionnaire (69 pudendal neuralgia cases out of about 100 case files, analysis of October 15, 2026). Aporia® cushions are not medical devices.

Note: this content explains mechanisms related to sitting. It is not a medical diagnosis or prescription, and it does not replace the advice of a healthcare professional.