Why do I feel something crawling down there? Understanding the Causes

September 23, 2025 •

4 min read

Did you know that phantom crawling sensations are a real neurological phenomenon known as paresthesia or formication? For those asking, "Why do I feel something crawling down there?", understanding the root cause is the first step toward finding relief from this unsettling experience.

Quick Summary

A crawling feeling in the pelvic or perineal region can be caused by nerve irritation (like pudendal neuralgia), skin infections (such as pinworms), hormonal changes, or anxiety. The symptom, while disturbing, can often be managed once the underlying cause is identified.

Key Points

Formication is a Symptom: A crawling sensation, known as formication or paresthesia, is a neurological symptom, not necessarily caused by actual insects.
Diverse Causes Exist: Causes range from physical issues like pinworm infections and nerve entrapment to psychological factors like anxiety and stress.
Nerve Irritation is Common: Pudendal neuralgia, a condition where the pelvic nerve is compressed, is a significant cause of perineal crawling, burning, and pain.
Skin Conditions Can Be the Culprit: Parasites like pinworms and pubic lice, as well as fungal infections, can cause itching that mimics a crawling sensation.
Consider Systemic and Psychological Factors: Hormonal changes, systemic diseases, substance withdrawal, and mental health conditions like anxiety can all trigger this unsettling symptom.
Diagnosis is Key to Treatment: A proper medical evaluation is essential to identify the root cause, which then dictates the most effective treatment approach.
Seek Medical Advice for Persistent Issues: If the sensation is persistent, painful, or accompanied by other symptoms, a healthcare provider should be consulted for a definitive diagnosis.

Understanding the Crawling Sensation

The feeling of something crawling on or under your skin, known medically as formication or paresthesia, is a tactile hallucination. It can be particularly distressing when it occurs in a sensitive area like the perineum or genitals. This sensation arises from a misfiring of nerves, which can be triggered by a wide array of physical and psychological conditions. While the feeling of insects is often not a reality, the symptom is real and points to an underlying issue that needs investigation.

Potential Causes of Perineal Paresthesia

Many different conditions can lead to this specific type of nerve-related sensation. It is crucial to consider all potential origins to arrive at an accurate diagnosis and treatment plan.

Skin and Parasitic Conditions

Pinworm Infections: One of the most common causes, particularly in children and caregivers. Female pinworms lay eggs around the anus, typically at night, causing intense itching and a crawling sensation.
Yeast or Fungal Infections: Overgrowth of Candida fungus can occur in warm, moist areas, leading to intense itching, burning, and a crawling-like feeling. This can affect both men and women.
Pubic Lice (Crabs): These tiny parasites infest the pubic hair and surrounding skin, feeding on blood. The bites and movement of the lice and their eggs can create a distinct crawling or tickling sensation.
Dermatitis: Contact dermatitis from soaps, detergents, or other irritants can cause local skin inflammation and itching that feels like something is moving.

Neurological and Nerve-Related Issues

Pudendal Neuralgia: This is a condition where the pudendal nerve, which supplies the genitals, perineum, and rectum, becomes irritated or compressed. It can cause chronic pain, numbness, and sensory changes like a crawling or tingling feeling, often worsened by sitting.
Peripheral Neuropathy: Nerve damage from conditions like diabetes, vitamin deficiencies (especially B12), or autoimmune disorders can lead to abnormal sensations, including tingling and crawling, in the extremities and pelvic area.
Sciatica: While known for leg pain, severe sciatica affecting the lower sacral nerves can sometimes cause referred sensations in the genital or perineal region.

Hormonal and Systemic Factors

Hormonal Changes: Fluctuations in hormones, such as during perimenopause, menopause, or from certain hormonal medications, can affect nerve sensitivity and moisture levels in delicate tissues, leading to irritation and odd sensations.
Systemic Diseases: Liver and kidney diseases can cause general itching (pruritus), which might be perceived as a crawling feeling. Thyroid problems can also impact nerve function.

Psychological and Drug-Related Causes

Anxiety and Stress: Psychological factors can significantly alter nerve perception. Intense anxiety and stress can increase nerve sensitivity, leading to somatic symptoms like tactile hallucinations or paresthesia.
Substance Use and Withdrawal: The use or withdrawal from certain substances, including stimulants like cocaine and amphetamines, or even alcohol, can trigger formication.
Obsessive-Compulsive Disorder (OCD): A subtype of OCD can lead to hyperawareness of benign physical sensations, sometimes misinterpreting normal bodily feelings as a threat or infection.

Diagnosing the Cause of Perineal Paresthesia

Because the causes are so varied, your doctor will likely use a combination of methods to determine the source of your symptoms. A thorough medical history, physical examination, and potentially further tests will be necessary.

Detailed Medical History: Your doctor will ask about the sensation itself (e.g., is it constant, does it come and go?), any related symptoms (pain, discharge, urinary changes), and your overall health.
Physical Examination: A visual and physical inspection can reveal signs of infection, irritation, or nerve compression.
Diagnostic Tests: This might include a "tape test" to check for pinworm eggs, blood work to check for vitamin deficiencies or other systemic diseases, or nerve studies to assess for neuropathy.

Comparison of Common Causes


Feature	Pudendal Neuralgia	Pinworm Infection	Yeast Infection	Anxiety-Related Formication
Sensation	Tingling, burning, shooting pain, often like sitting on an object	Intense, localized anal itching, especially at night	Itching, burning, redness, with possible discharge	Phantom crawling sensation, no visible physical cause
Location	Genitals, perineum, anus, buttocks	Primarily around the anus	Genital and perineal areas	Can be focused or generalized, no physical origin
Aggravating Factor	Sitting for long periods	Nighttime (when worms lay eggs)	Warm, moist environment	High stress or panic
Key Accompaniments	Urinary/bowel changes, sexual dysfunction	Restlessness, sleep disturbance	Redness, swelling, possible discharge	Other anxiety symptoms (racing heart, panic attacks)

Finding Relief and When to See a Doctor

Immediate relief strategies often depend on the suspected cause. For skin irritation, cool compresses or a topical anti-itch cream may help temporarily. For nerve-related pain, adjusting posture or using a specialized cushion can reduce pressure. However, as the underlying cause could be complex, self-treatment is often insufficient. It is strongly recommended to consult a healthcare professional for a proper diagnosis.

When to Seek Medical Attention

You should see a doctor if the crawling sensation is persistent, painful, or accompanied by other concerning symptoms, such as:

Severe pain
Changes in urination or bowel movements
Unusual discharge
Fever or chills
Visible rash, blisters, or sores

Conclusion

The feeling of something crawling "down there" can be both mysterious and concerning, but it is a symptom with identifiable causes. Ranging from simple parasitic infections to more complex neurological or psychological issues, understanding the possible triggers is the first step toward effective relief. By working with a healthcare provider, you can pinpoint the root cause and receive the appropriate treatment, putting your mind at ease and your discomfort behind you. For more information on pelvic pain, visit this guide from the Cleveland Clinic.

Frequently Asked Questions

Yes, high levels of anxiety and stress can increase nerve sensitivity, leading to tactile hallucinations known as formication, which can manifest as a crawling or tingling feeling in various parts of the body, including the pelvic region.

Pudendal neuralgia is a condition resulting from the irritation or compression of the pudendal nerve in the pelvis. This can cause a range of sensations, including burning, numbness, and crawling, particularly when sitting down.

Yes, pinworm infection is a common cause, especially around the anus. Female pinworms lay eggs around the opening at night, causing intense itching and a distinct, localized crawling feeling.

It is advisable to see a doctor if the crawling sensation is persistent, painful, worsening, or accompanied by other symptoms like pelvic pain, urinary changes, fever, or visible sores.

Yes, declining estrogen levels during perimenopause and menopause can affect nerve sensitivity and tissue health, potentially leading to discomfort, dryness, and phantom crawling sensations.

While often related, a crawling sensation (paresthesia) is a nerve-based feeling, whereas an itch (pruritus) is typically a skin response. However, many underlying conditions can cause both, and the two can feel similar.

Yes, chronic pressure on the pelvic area from prolonged sitting can compress or irritate nerves like the pudendal nerve, triggering crawling, tingling, or pain.