Recognising the signs early to shorten the diagnostic journey
Pudendal neuralgia in women is one of the most under-diagnosed causes of chronic pelvic pain. On average, women wait more than four years and see five or more clinicians before receiving a correct diagnosis. Understanding the symptom pattern is the fastest way to shorten that journey.
The hallmark symptom: pain that worsens with sitting
The most consistent feature of pudendal neuralgia is neuropathic pain in the perineum, vulva, clitoris, vagina or rectum that intensifies when sitting and eases when standing or sitting on a toilet seat. Pain is typically described as burning, shooting, stabbing or a sensation of a foreign body inside the pelvis.
Urinary, bowel and sexual symptoms
Because the pudendal nerve carries motor, sensory and autonomic fibres to the pelvic floor, women often report urinary urgency and frequency without infection, painful bladder filling, constipation, painful bowel movements, dyspareunia (painful intercourse), reduced clitoral sensation or persistent genital arousal.
The Nantes criteria — the diagnostic gold standard
The internationally recognised Nantes criteria require: pain in the pudendal nerve territory, pain worsened by sitting, pain that does not wake the patient at night, no objective sensory loss on clinical exam, and positive response to a diagnostic pudendal nerve block. Meeting all five criteria strongly supports the diagnosis.
When to seek specialist assessment
If neuropathic perineal pain has persisted longer than three months, has not responded to pelvic floor physiotherapy, or is accompanied by sitting intolerance, a dedicated pudendal nerve evaluation — including MR neurography and diagnostic nerve block — should be arranged with a specialist centre.