Knowledge Base → Questions → What are the signs of pudendal neuralgiaPudendal neuralgiaNeuropathic pain in the territory of the pudendal nerve (perineum, external genitalia, anal region), often made worse by sitting.Read the full entry : Pudendal neuralgia?
What are the signs of pudendal neuralgia?
Burning, shooting or tingling pain in the area served by the pudendal nervePudendal nerveThe pudendal nerve arises mainly from the sacral roots S2 to S4. It provides a large share of the sensory and motor innervation of the perineum and the external genitalia.Read the full entry : Pudendal nerve (perineumPerineumThe perineum is the region at the lower part of the pelvis, between the thighs. It includes skin, muscle, fascial, vascular and nerve structures, and it is also an area that may bear load when sitting.Read the full entry : Perineum, anus, genitals), worse when sitting and eased by standing or lying down. The Nantes criteria require five essential criteria: pain in the territory of the pudendal nerve, worse when sitting, that does not wake you at night, with no objective loss of sensation on examination, and relieved by an anesthetic block of the pudendal nerve (Labat et al., 2008).
These signs do not allow you to diagnose yourself.
Where does the pudendal nerve run?
It arises from the sacral nerve roots S2 to S4, wraps around the ischial spine and runs through Alcock’s canal, which is formed by the fasciaFasciaFascia are connective tissue structures that envelop, connect or separate certain parts of the body. The "fascial system" refers to a broader set of connective tissues considered in their functional continuity.Read the full entry : Fascia of the obturator internusObturator internusThe obturator internus is a deep pelvic muscle involved in hip movement and stabilization. Its fascia is classically associated with the formation of Alcock's canal.Read the full entry : Obturator internus muscle. This is why contraction of this muscle can tighten around the nerve from the inside, in addition to seat pressure. → Anatomy of the pudendal nerve
What are the Nantes criteria?
| Essential criteria (all five are required) | Complementary signs (suggestive, not required) |
|---|---|
| Pain in the territory of the pudendal nerve | Burning, shooting, stabbing pain, numbness |
| Worse when sitting | Feeling of a foreign body in the rectum or vagina |
| Does not wake you at night | Pain that worsens during the day |
| No objective loss of sensation on examination | Pain on one side, or stronger on one side |
| Relieved by an anesthetic block of the pudendal nerve | Pain triggered by bowel movements; pain from light touch (allodyniaAllodyniaAllodynia is pain caused by a stimulus that is normally not painful: a light touch, the contact of clothing, gentle pressure. It is a descriptive clinical term: it describes what the person feels, without by itself designating a mechanism.Read the full entry : Allodynia); tenderness over the ischial spine on examination |
Many people also have less pain when sitting on a toilet seat, which leaves the perineum unsupported; this is not a Nantes criterion. In our files, 36 of the 58 people who answered this question have pain on one side, or stronger on one side.
What can cause similar signs?
Painful contraction of the pelvic floorPelvic floorThe pelvic floor is a deep group of muscles and connective tissues located in the lower part of the pelvis. It contributes to the support of the pelvic organs, to sphincter function and to the mechanical coordination of the abdominopelvic complex.Read the full entry : Pelvic floor, a fissure or an abscess, a urinary tract infection, prostatitis, vulvodynia, endometriosisEndometriosisEndometriosis is a chronic inflammatory disease in which tissue similar to the lining of the uterus grows outside the uterine cavity. It can cause severe pelvic pain and infertility.Read the full entry : Endometriosis, tailbone pain (coccydyniaCoccydyniaPain located in the tailbone (coccyx) region, often worse when sitting.Read the full entry : Coccydynia) or pain referred from the lower back. Each of these causes needs its own treatment.
How is it diagnosed?
Through the medical history, a clinical examination and an anesthetic block of the pudendal nerve, which is one of the five essential criteria; MRI is mainly used to rule out other causes. The path to diagnosis is often long: → The diagnostic odyssey and central sensitization
What about sitting?
Sitting makes it worse through pressure, protective contraction and immobility; this is where adjusting your seat acts, alongside medical care. → Why does sitting make perineal pain worse?, then Which cushion for pudendal neuralgia?
What other questions do people ask?
Can you have pudendal neuralgia without pain when sitting? It is atypical: pain that worsens when sitting is a central criterion.
Can a cushion cure pudendal neuralgia? No. It avoids sustaining the stresses of sitting.
Publisher: Blue Portance. Written by Gil Ayache, PhD (Mines Paris – PSL). Reviewed: October 19, 2026. Sources: Labat J.-J. et al., “Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria)”, Neurourology and Urodynamics, 2008; NHS; files from our online questionnaire (analysis of October 15, 2026). Aporia® cushions are not medical devices.
Note: this content explains mechanisms related to sitting. It is not a medical diagnosis or prescription, and it does not replace the advice of a healthcare professional.
