I have pelvic pain for many years. I think they originally thought it was prostatais, then someone said pudendal nerve but I have some of your symptoms. The book a headache in thePelvis by Dave Wise discusses this and how it is diagnosed many ways. I have trouble sitting due to pain and have to sit on a doughnut. This is one of the symptoms of pudendal nerve issues. One thing they say can cause pudendal neuralgia is cycling.
My pelvic pain of sitting was much worse after I had a prostatectomy( I would not sit) and I had pains from the sphincter muscles and had incontinence. The urologist told me to go to a pelvic therapist. I did and they were able to find trigger points to my sitting pain and I felt better after the therapy but the pain came back. They stopped me from doing Kegels and had me do pelvic stretch exercises. My sitting pelvic pain got better. I do not know if this is what caused it to get better, but it might have helped. I still have sitting pain and my external sphincter muscle has pain making me feel I have to go all the time. The urinary incontinence is secondary to me, I can manage the incontinence by using protection but the pain I can not manage.
I have learned stress can contribute to pain also since it makes you tense your pelvic area causes muscle tension. When I was diagnosed with prostate cancer last year I was extremely stressed and the pelvic pains became very bad. It appears I may need to get less stress to help also
My pains in the pelvic area comes in waves and can radiate out.
I take Cymbalta for pain and when I take it I can not get to orgasm. I am almost 70 now and after the prostatectomy last September this is less of an issue since I have errecticle dysfunction too and shrinkage.
I have had heavy antibiotics, blood test, surgery in the pubic area for the pelvic pain in the past with no success. I learned to accept the pain and live with it(I had no choice). The problem is that it has now progressed and given me more pain and incontinence. I am at the point that I am going the route of continuing pelvic stretching and try to lower my stress. The book I referenced above has a Wise protocol which can be taken to teach you how do trigger points and relaxation if you take their course. I am looking t it but it s expensive and I would like to hear from other people who have taken it. The pelvic pain you have is not easy to get rid of, I wish you luck, I have read how many people have tried many things with few successes
Wishing everyone happiness
Tim