Pelvic Pain Misdiagnosis: When the Diagnosis Does Not Fit

Chronic pelvic pain is often given a label that does not lead to relief. Pudendal neuralgia is described as frequently misdiagnosed at first, and the conditions below are among those it is most often mistaken for. This page helps you check whether your pattern fits. It does not replace an examination.

Go to an emergency department now if pelvic pain comes with numbness around the genitals, anus or buttocks, not being able to pass urine, loss of bladder or bowel control, or new weakness in both legs. These can be signs of cauda equina syndrome, which needs urgent treatment.

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Why a diagnosis can be wrong for years

Pudendal neuralgia is nerve pain, and its symptoms overlap with several other conditions. Medical references list chronic prostatitis or chronic pelvic pain syndrome (the most common in men), interstitial cystitis, prostate conditions, endometriosis and other gynecological conditions, and vulvodynia among the conditions it is commonly mistaken for. The overlap runs both ways: these conditions are real, and they can also exist at the same time as a nerve problem.

Which diagnosis were you given?

Prostatitis or chronic pelvic pain syndrome (men): pain for months without infection. Antibiotics do not help unless an infection is proven. Read more about chronic prostatitis (CPPS)
Vulvodynia (women): vulvar pain for at least 3 months with no clearly identifiable cause. Read more in pudendal neuralgia in women
Interstitial cystitis or bladder pain syndrome: bladder pain and urgency with negative urine tests. Read more about urinary urgency with normal tests
Hemorrhoids, fissure or levator ani syndrome: rectal pain or pressure. Read more about rectal pain and pressure
Pelvic floor dysfunction: tight or poorly coordinated pelvic floor muscles. Read more about pelvic floor dysfunction
Piriformis syndrome or deep buttock pain: read more about piriformis syndrome

What points to a nerve cause

Doctors use the Nantes criteria. The essential ones are pain in the territory of the pudendal nerve (from the anus to the penis or clitoris), pain that is mainly felt when sitting, pain that does not wake you at night, no objective sensory loss on examination, and pain relief after a diagnostic pudendal nerve block. A block that gives an immediate reduction in pain of at least 50 percent is considered confirmatory. Scans, MRIs and nerve tests can be normal.

What to bring to a consultation

A list of the diagnoses you were given and when, the treatments you tried and what each one did, any scan or test reports, and a short note on when the pain is worse (sitting, standing, during the day, at night).

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Common questions

Can I have prostatitis or vulvodynia and pudendal neuralgia at the same time?

It is possible for more than one condition to be present. That is why a specialist assessment looks at the bladder, the prostate or the vulva, the pelvic floor muscles and the nerve together.

Why did antibiotics not help my prostatitis?

Chronic prostatitis or chronic pelvic pain syndrome is defined as pain without a urinary tract infection. In men without a proven infection, antibiotics are unhelpful.

Is vulvodynia the same as pudendal neuralgia?

No. Vulvodynia is vulvar pain of at least 3 months with no clearly identifiable cause. Pudendal neuralgia is nerve pain in a specific territory that is assessed with recognized criteria. They overlap and are frequently confused.

Does a normal MRI or nerve test rule out pudendal neuralgia?

No. Scans and nerve tests can be normal, and there is no single imaging test that confirms the diagnosis on its own.

Speak with a pudendal nerve specialist.

Dr Renaud Bollens leads a specialist practice dedicated to chronic pelvic pain, with centers in Dubai and Belgium.

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