Clinical term
Pudendal neuralgia
Neuropathic pain in the territory of the pudendal nerve (perineum, external genitalia, anal region), often made worse by sitting.
Scientific basis
Pain may involve the perineum, the external genitalia or the anal region. The five Nantes criteria were proposed by an expert group to support the diagnosis of the form attributed to nerve entrapment: anatomical territory, worsening when sitting, no waking at night due to pain, no objective sensory deficit, and relief after an anesthetic block. Pudendal neuralgia does not automatically mean that entrapment has been established.
The pudendal nerve runs through Alcock's canal (pudendal canal), a split in the obturator internus fascia; anatomical studies locate several possible sites of conflict there, without implying systematic compression. Nerve gliding — the ability of a nerve to move relative to the surrounding tissues during movement — is an established principle in clinical neurodynamics, independent of any specific pathology. In addition, the distinction between densification (a reversible change in the viscosity of loose connective tissue) and fibrosis (a more structural change in collagen) has been proposed for fascia in general, and a concept of fascial entrapment neuropathy has been formulated to describe how an altered connective tissue environment could reduce a nerve's mechanical independence. These last two concepts are general and do not constitute a demonstration specific to the pudendal nerve.
Blue Portance / SBNFA™ reading
The Blue Portance doctrinal workbook V3.6 uses “functional pudendal neuralgia” to describe, within its model, pelvic-perineal pain linked to mechanical intolerance without proven lesional compression. SBNFA™ proposes that this intolerance results from reduced relative mobility between the nerve and its fascial environment (“densification” in SBNFA™ terminology) rather than from an isolated static pinching — a reading that connects the documented anatomical site (Alcock's canal), the principle of nerve gliding, and the general concepts of fascial densification and fascial entrapment neuropathy, but that remains a Blue Portance interpretive construct: it is not, as such, demonstrated by the sources cited here. This internal category is not a standardized medical diagnosis and does not replace clinical assessment.
Contribution to the analysis of sitting
Within the Blue Portance framework, the analysis focuses on tolerance to different positions, contact areas, and the options for modifying support so as to preserve postural variation rather than prolonged, fixed holding. It does not determine the cause of the pain and does not demonstrate the therapeutic efficacy of any device.
Not to be confused with
pudendal neuralgia attributed to entrapment, addressed by the Nantes criteria, and the internal operational category of SBNFA™.
Sources and scope
- Labat et al. (2008): Nantes criteria for pudendal neuralgia caused by entrapment
- Robert et al. (1998): anatomical basis of chronic perineal pain and the pudendal nerve
- Butler (2000): The Sensitive Nervous System — principle of nerve gliding
- Pavan et al. (2014): densification versus fibrosis of fascia
- Stecco et al. (2019): fascial entrapment neuropathy
Robert et al. (1998) document possible anatomical sites of conflict; Butler (2000) documents the general principle of nerve gliding; Pavan et al. (2014) document the densification/fibrosis distinction for fascia in general; Stecco et al. (2019) formulate the general concept of fascial entrapment neuropathy. None of these works directly validates the “fascial densification” mechanism as applied here to pudendal neuralgia — that connection belongs to the SBNFA™ reading. The “functional pudendal neuralgia” category comes from the Blue Portance doctrinal workbook V3.6, tab G05.
Further reading
- Learn more — Article: Pudendal Neuralgia: Why Can a Simple Sitting Position Become an Ordeal?
- Go further — Expert guide: Pudendal Neuralgia: Understanding the Mechanisms of a Neuropathic Pelvic Pain
