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.
A common symptom pattern: pain that worsens with sitting
A frequent 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.
How the diagnosis is confirmed
We look for a recognisable clinical picture: pain in the pudendal nerve territory, worsened by sitting, not waking the patient at night, no objective sensory loss on clinical exam, and a positive response to a diagnostic pudendal nerve block. Meeting these features 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.