Consult a pain-management specialist or pelvic-pain specialist experienced with pudendal neuralgia/pudendal nerve blocks. Assessment may include a neurological and pelvic examination and, when indicated, imaging to exclude other causes. Treatment is generally stepwise and may include reducing activities that aggravate the nerve, medication for neuropathic pain, appropriately selected pelvic-floor rehabilitation, and an image-guided diagnostic/therapeutic pudendal nerve block. Surgery or neuromodulation is generally considered only for carefully selected patients with persistent symptoms despite conservative treatment.

Until evaluated, minimize prolonged sitting and activities that clearly worsen the pain, such as long periods of cycling; a pressure-relieving seat cushion may help some patients. Seek urgent medical assessment if you develop new leg weakness, numbness around the saddle area, difficulty passing urine, urinary retention/incontinence, or loss of bowel control, as these symptoms require evaluation for other neurological causes.

Since you have already consulted a urologist, gastroenterologist and neurologist, I would suggest evaluation by a doctor experienced in pelvic floor disorders and pudendal neuralgia. Pelvic floor physiotherapy can be very helpful if muscle tightness or spasm is contributing to your symptoms.

Avoid prolonged sitting and consider using a cushion that reduces pressure on the perineum. Maintaining a healthy body weight can also help reduce pelvic pressure, particularly if you are overweight.