Hi, welcome to the forum. It's hard to predict a prognosis with 100% certainty because the question is - what is causing the nerve irritation and can the underlying cause be corrected. Many people with PN get better, and with the right treatments, you have a good chance of getting better, especially since you are young, and younger people tend to heal better. But it seems like you need more information to figure out the underlying cause, and where to go from here.
I am curious how the physician determined that it is unlikely an entrapment, and if it's not an entrapment, what might be causing the muscles to tense up. There are some questions to ask yourself based on the Nantes Criteria for determining an entrapment. (
https://www.pudendalhope.info/wpcontent ... iteria.pdf)
They aren't 100% accurate in every case but can be very helpful in determining what might be going on.
Do you have any idea what might have initially caused your pelvic floor to tighten up? Were there any injuries or incidents that you can point to, or did it just start out of the blue with sitting? Any exercising associated with it? Is your pain bilateral or unilateral? (unilateral could indicate an entrapment)
Have you had any MRI's to rule out anything obvious that could be the culprit?
Does pelvic floor PT seem to help at all, or does it seem to make you worse? When the PT presses on your pudendal nerve via the rectum, is your pudendal nerve tender to pressure? (Could indicate an entrapment)
Did the PT evaluate you for any musculoskeletal anomalies such as pelvic floor misalignment or SI joint dysfunction that could be contributing to the problem? Any ligament strain or hip issues?
Have you had any pudendal nerve blocks for diagnostic purposes yet? In years past, steroids were used in pudendal nerve blocks, but some major medical organizations have developed new guidelines that state there is little evidence that steroid pudendal nerve blocks are beneficial. However, nerve blocks containing an anesthetic such as marcaine can be helpful in determining a diagnosis. (Positive nerve block could indicate an entrapment)
Sorry for the list of questions but when you are dealing with PN, you have to be a Sherlock Holmes to figure out what the underlying cause of the problem might be. There is always the chicken and the egg question -- did the muscles just tense up and start irritating the nerve (and if so, why?) or is something else irritating the nerve, and is the irritated nerve causing the muscles to tense up?
While you are figuring this out there are some strategies for helping to lower your pain levels. Things like a heating pads, gel ice packs, alternating hot/cold sitz baths, TENS unit to calm down the muscles, lidocaine or icy hot patches, pain relieving creams, avoiding sitting as much as possible while the nerve heals and avoiding anything that causes a flare-up, and oral medications can be helpful such as gabapentin, lyrica, baclofen, SSRI's, SNRI's such as duloxetine. If you are like most people, you want to avoid medication but if the pain is severe, they can really help you get through the worst of the journey and once you start to improve, you can slowly wean off of them. Being able to sleep at night is really important.
If you try a TENS unit, your PT should be able to tell you where to place the electrodes for maximum benefit. I was not able to use a TENS unit prior to pudendal nerve release surgery because it increased the pain, but later after surgery it helped calm down the muscles.
I'm not asking you to answer all these questions here. Just brainstorming things for you to consider that might help you figure this out. Wishing you the best as you figure this out.
Violet
