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PubMed This is a summary of 65 peer-reviewed journal articles Updated
Neurology

Understanding Pudendal Nerve Entrapment Syndrome

At a Glance

Pudendal Nerve Entrapment Syndrome (PNES) is a physical condition where the main nerve in the pelvis becomes compressed, causing chronic pain that typically worsens when sitting. It is a highly treatable mechanical issue diagnosed using specific medical guidelines known as the Nantes criteria.

If you have been struggling with unexplained pelvic pain, you may have felt dismissed or confused by previous medical appointments. Understanding Pudendal Nerve Entrapment Syndrome (PNES) starts with a vital realization: your pain is real, it has a physical cause, and there is a defined path forward for diagnosis and care [1][2].

PNES occurs when the pudendal nerve—the main nerve responsible for sensation in your pelvic area, including the perineum and genitals—becomes compressed or “pinched” [1][3]. This is a mechanical issue, much like a garden hose being stepped on, which prevents the nerve from functioning correctly and causes it to send constant pain signals to the brain [4][5].

Three Stabilizing Facts

When facing a complex diagnosis like PNES, these three facts can help ground your experience:

01

The Biology of PNES and Ruling Out Look-Alikes

Understand the biology of Pudendal Nerve Entrapment Syndrome (PNES). Learn where the nerve gets compressed and how to rule out similar pelvic pain conditions.

02

Getting an Accurate Diagnosis: The Nantes Criteria

Learn how Pudendal Nerve Entrapment Syndrome (PNES) is diagnosed using the Nantes criteria. Understand the 5 key signs, diagnostic nerve blocks, and red flags.

03

Treatment Strategies: From Conservative to Surgical Care

Explore treatment options for Pudendal Nerve Entrapment Syndrome (PNES). Learn about specialized pelvic floor therapy, nerve blocks, and surgical release.

Why It Is Often Missed

You may find that some local doctors are unfamiliar with PNES. This is often because the condition is considered rare and its symptoms—such as burning, aching, or a feeling of a foreign object in the rectum or vagina—overlap with many other conditions [2][6].

Because the nerve’s path is deep within the pelvis and varies slightly from person to person, it can be difficult to assess during a standard physical exam [7][8]. Many patients are initially misdiagnosed with urinary tract infections, prostate issues, or general “pelvic pain” before the pudendal nerve is correctly identified as the source [2][9]. For a full list of potential symptoms, explore Symptoms and Patterns of Pudendal Neuralgia.

Navigating the Journey

Addressing PNES requires a targeted approach. Key elements of your journey will involve:

01

Building Your Pelvic Pain Care Team

Learn how to build a multidisciplinary care team for pudendal nerve entrapment syndrome (PNES). Find the right specialists, what to ask, and how to prepare.

02

Living with PNES: Management and Quality of Life

Learn how to manage daily life with Pudendal Nerve Entrapment Syndrome (PNES). Discover tips for sitting, intimacy, mental health, and navigating flare-ups.

Recognizing these patterns is the first step toward reclaiming your quality of life and working with a specialist who understands the mechanical nature of your pain.

Common questions in this guide

What is Pudendal Nerve Entrapment Syndrome (PNES)?
PNES is a physical condition where the pudendal nerve becomes pinched or compressed by surrounding muscles and ligaments in the pelvis. This entrapment causes the nerve to send constant pain signals to the brain, often felt in the perineum and genitals.
Why is my pelvic pain worse when I sit down?
Pain that worsens when sitting and improves when standing or lying down is a classic symptom of pudendal nerve entrapment. Sitting increases the mechanical pressure on the already compressed pudendal nerve deep within your pelvis.
How do doctors diagnose pudendal nerve entrapment?
Doctors use a standardized set of five rules called the Nantes criteria to diagnose pudendal neuralgia. Your doctor will assess your symptom patterns, perform a specialized physical exam, and may use a diagnostic nerve block to confirm the source of the pain.
Can physical therapy help with pudendal nerve pain?
Yes, specialized pelvic floor physical therapy is a common treatment. However, it is crucial to work with a physical therapist who is specifically trained in treating nerve entrapment, as standard pelvic strengthening exercises can sometimes worsen the pain.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do my symptoms align with the five mandatory Nantes criteria for pudendal neuralgia?
  2. 2.Is there a specific anatomical site, like Alcock’s canal or the ischial spine, where you suspect my nerve is being compressed?
  3. 3.How much experience do you or the specialists you refer to have in diagnosing and treating PNES specifically?
  4. 4.If we move forward with a diagnostic nerve block, what are the next steps if it provides temporary relief versus no relief at all?
  5. 5.Can you recommend a pelvic floor physical therapist who is trained specifically in nerve entrapment rather than general pelvic strengthening?

Questions For You

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References

References (9)
  1. 1

    [Intraoperative neurophysiological monitoring in radical prostatectomy and pudendal nerve surgical releasing.]

    Sánchez-Guerrero C, López-Fando L, Martín-Palomeque G, et al.

    Archivos espanoles de urologia 2019; (72(8)):857-866.

    PMID: 31579045
  2. 2

    [Mechanisms of formation and diagnosis of tunnel pudendal neuropathy].

    Izvozchikov SB

    Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2019; (119(11)):98-102 doi:10.17116/jnevro201911911198.

    PMID: 31851179
  3. 3

    Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome.

    Luesma MJ, Galé I, Fernando J

    Medicina clinica 2021; (157(2)):71-78 doi:10.1016/j.medcli.2021.02.012.

    PMID: 33836860
  4. 4

    Robot-Assisted Exploration of the Alcock Canal: A Novel Surgical Technique.

    Shakiba K, Kolesnikova K

    Journal of minimally invasive gynecology 2024; (31(12)):985 doi:10.1016/j.jmig.2024.07.004.

    PMID: 38972571
  5. 5

    Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study.

    Aoun F, Mjaess G, Assaf J, et al.

    Scandinavian journal of urology 2020; (54(3)):258-262 doi:10.1080/21681805.2020.1770855.

    PMID: 32476566
  6. 6

    Sexual dysfunction due to pudendal neuralgia: a systematic review.

    Aoun F, Alkassis M, Tayeh GA, et al.

    Translational andrology and urology 2021; (10(6)):2500-2511 doi:10.21037/tau-21-13.

    PMID: 34295736
  7. 7

    Anatomic variations of pudendal nerve within pelvis and pudendal canal: clinical applications.

    Maldonado PA, Chin K, Garcia AA, Corton MM

    American journal of obstetrics and gynecology 2015; (213(5)):727.e1-6.

    PMID: 26070708
  8. 8

    Anatomical Variation of the Pudendal Nerve and Related Structures.

    Yang J, Webb KE, Carrington EV, et al.

    European urology open science 2026; (85()):71-81 doi:10.1016/j.euros.2026.01.015.

    PMID: 41705166
  9. 9

    Intrapelvic Nerve Entrapment Syndrome Caused by a Variation of the Intrapelvic Piriformis Muscle and Abnormal Varicose Vessels: A Case Report.

    Kale A, Basol G, Topcu AC, et al.

    International neurourology journal 2021; (25(2)):177-180 doi:10.5213/inj.2040232.116.

    PMID: 33504131

This page provides an educational overview of Pudendal Nerve Entrapment Syndrome (PNES). It is not a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.

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