Pain that gets worse sitting
Car seats, office chairs and bike saddles are the worst, and many people know exactly how many minutes they can sit.
The pudendal nerve runs through the pelvic floor and carries sensation from the perineum, rectum, and genitals. When it’s irritated, pain shows up anywhere along that territory: the vulva, penis, scrotum, rectum or tailbone. It’s often worse sitting, better standing, and nearly gone lying down.
In most people I see, the nerve isn’t pinched by one fixed structure. It’s being squeezed and tugged by the muscles around it, mainly the pelvic floor and obturator internus, which have tightened and stopped relaxing. Sitting adds pressure on top of that. Imaging usually comes back normal because it shows anatomy, not a nerve that’s become sensitive to ordinary pressure.
For pudendal neuralgia I rely on dry needling, a form of acupuncture, along with electroacupuncture. A tight obturator internus and levator ani can crowd the pudendal nerve, so I needle those muscles to give it room. If the pudendal nerve itself is irritable, I use electroacupuncture: fine needles near it with a gentle current to help change its signaling. And if the whole system is turning pain up, I treat at the sacral segments, S2 to S4, where the pudendal nerve begins.
Most people have had normal imaging, a course of nerve pain medication, and sometimes a nerve block. Medication can turn the volume down without changing why the nerve is irritated. A block can confirm the nerve is involved but often wears off. Pelvic floor PT may also be on your list. Needling isn’t part of it here, because New York doesn’t allow PTs or chiropractors to dry needle.
I start with how long you can sit, where the pain goes, and what reliably calms it. Then the exam:
I work alongside urology, urogynecology, pain medicine and pelvic floor PT. Should something in the exam point back toward one of them, I’ll tell you and pass along my findings.
Not always. Entrapment means a fixed structure is pinching the nerve. Many people have the same symptoms from tight pelvic floor and hip muscles and an irritable nerve, with no structural lesion. Your doctors can look for structural causes, and I focus on what keeps the nerve irritated.
Yes. MRI shows structure. It doesn’t show a nerve that’s become sensitive to pressure, and that’s the usual problem.
Usually it’s a mix of approaches, since more than one thing tends to be going on. Releasing the obturator internus and levator ani relieves the squeeze on the pudendal nerve during sitting. Current near the nerve and work over the sacrum address the nerve’s own sensitivity.
Yes. Pudendal symptoms often respond best to coordinated care. PT can focus on coordination and a gradual return to sitting and activity, while I work on muscle tone and the nerve. I’m glad to share what I find with your therapist.
Some soreness or a short increase in symptoms can happen when tissue is very sensitive. I adjust where I needle, how many needles I use and how strong the current is. The goal is a response you can manage, not pushing past what your body tolerates right now.
Get prompt medical care for worsening numbness or weakness, numbness in the saddle area, or suddenly being unable to urinate. Fever, unexplained weight loss or signs of infection also call for a doctor. These point to problems that need medical evaluation before needling.
Adults with pelvic floor, nerve and orthopedic pain, along with neurological conditions. Most of my patients come to me after other care hasn't fully settled things. If you're looking for general wellness acupuncture, I'm not the right fit.
We review your history and what you've already tried. I assess the muscles and nerves involved, and you're treated the same day.
It depends on the condition. Pelvic and orthopedic plans usually run 4 to 6 weeks. Neurological plans are usually 2 visits a week for 6 weeks or 3 a week for 4. After that, visits space out so the changes hold. These are typical timelines, not promises.
Yes. I work alongside doctors, physical therapists and specialists. If something I find needs a closer look from one of them, I'll tell you.
I'm an out-of-network provider. You pay at the time of your visit, and my office submits the claim so any reimbursement comes to you. Free benefit checks are available before your first visit through the verification form, and HSA and FSA cards work. I don't take Medicare or Medicaid, though some Medicare Advantage plans reimburse out-of-network care. Full insurance details
Yes. I treat adults, teens and children, though I don't specialize in infants or toddlers.
Yes. Book a free discovery call to ask your questions and see whether we're a good fit.
Dry needling is a form of acupuncture. Fine needles go into tight bands of muscle and trigger points to lower muscle tension and change how the area is signaling.
You may feel a brief twitch or a deep ache as the needle reaches tight muscle. It passes quickly, and any soreness afterward usually fades within a day or two.
It's generally safe with a properly trained practitioner. Needles are sterile and single-use, and I check your health history first, including blood thinners. In New York, dry needling can only be performed by licensed acupuncturists, MDs and DOs. Physical therapists and chiropractors aren't permitted to perform it.
Eat something light beforehand and wear loose clothing that lets me reach the area being treated.
Usually not. Ultrasound helps in a few specific cases, but it hasn't been shown to improve results for common trigger points. A careful hands-on exam is what guides the needle. More on ultrasound-guided dry needling
Dry needling aimed at the pelvic floor and the hip and abdominal muscles around it, for pain, tension and urinary symptoms driven by those muscles and their nerves. More on pelvic floor dry needling
Sometimes, depending on the muscles involved, and you'll be draped throughout. Treatment always follows your consent and comfort. I don't do internal exams or internal treatment.
No, though it helps if you've already seen a doctor or pelvic floor physical therapist. Bring any notes or imaging you have.
Completely. I've heard it all, and there's no judgment here, just a straightforward conversation so we can treat what's going on.
Yes, I treat adults of every gender and identity. After gender-affirming surgery involving the pelvis, bring your surgical notes and we'll decide together what fits.
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118 W. 72nd St, Rear Lobby, New York, NY 10023
Evidence-based acupuncture and dry needling on the Upper West Side. From chronic pain and headaches to pelvic floor dysfunction, Dr. Jordan Barber pairs the highest level of training with care that actually listens.
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