Pudendal neuralgia, also known as Alcock’s canal syndrome, is an irritation or injury of the pudendal nerve. This nerve becomes inflamed due to compression or trauma. Women are more affected than men, accounting for 6 out of 10 cases.

Still poorly understood and often difficult to diagnose, pudendal neuralgia causes pain in the perineal area, between the genitals and the anus.

The pudendal nerve (also called the shameful nerve) is located in the pelvis and innervates the area surrounding the anus and genital organs. Starting from the sacrum, it runs under the piriformis muscle, then through a space formed by the sacrotuberous and sacrospinous ligaments. It then travels through Alcock’s canal and innervates the scrotum and penis in men, or the labia majora and clitoris in women. The pudendal nerve also innervates part of the levator ani muscles.

Pudendal neuralgia can be triggered by compression or trauma to the pudendal nerve. Causes vary, making diagnosis particularly challenging. The nerve may be irritated during its passage through the space formed by the sacrotuberous and sacrospinous ligaments. Intense sports or an inflamed bladder may also compress or irritate the nerve. External factors such as surgery, childbirth, or a fall can also lead to pudendal syndrome.

Pudendal neuralgia causes pain in the perineal area (anus, rectum, genitals), which is why it is often mistaken for gynecological disorders.

People with Alcock’s syndrome frequently report burning sensations, electric shocks, stabbing pain, or the feeling of a foreign object in the rectum or vagina. Constipation or incontinence may also occur.

Because of the location of the pain, it is often difficult—if not impossible—to maintain a seated position.

The diagnosis of pudendal neuralgia is primarily clinical and based on symptoms, most often following the Nantes criteria:

• • Pain located in the perineal area (anus, penis/clitoris)
• • Pain worsens when sitting and is relieved on a toilet seat (due to decompression)
• • Pain does not wake the patient at night (though this is not always true)
• • No numbness in the affected area
• • Relief following an anesthetic nerve block test

The pudendal nerve cannot be fully cured in the conventional sense. However, it is possible to reduce compression and manage pain symptoms.

Medications and injections can help relieve pudendal neuralgia pain. Physical therapy and osteopathy sessions may also be beneficial, although some movements can exacerbate the nerve irritation.

Pudendal nerve decompression surgeries are occasionally considered. However, results are mixed—some patients report improvement, while others experience worsening pain.

Visiting a general practitioner can be a first step toward diagnosis, but it’s essential to see a pudendal neuralgia specialist to get a precise diagnosis and appropriate treatment plan.

The website pudendalsite.com lists specialists, pain management centers, physical therapists, and osteopaths experienced in treating pudendal neuralgia.

For over 12 years, we’ve been in daily contact with individuals living with pudendal neuralgia. This experience has helped us better understand the condition. Here are some regularly recommended tips for living with pudendal nerve syndrome:

• While seated, keep your knees slightly lower than your hips to maintain a “dynamic” posture. This position helps reduce pressure on the pudendal nerve. The only exception we’ve seen is among elderly patients, for whom this position can be difficult or painful to maintain.

• Avoid sitting for more than two hours at a time. Staying in one position too long creates muscular tension and can lead to shifting, which may cause friction on the pudendal nerve.

• You may practice sports, but with caution. Some doctors encourage physical activity, others advise against it. As always, listen to your body to avoid aggravating the nerve. Activities like walking or running may swell the gluteal muscles, increasing pressure and pain for some individuals.

Since pudendal neuralgia impacts both physical and mental health, it’s important to engage in enjoyable activities that reduce stress.

Due to the difficulties in diagnosis and treatment, many online forums and support groups have emerged. In addition to sharing experiences, these spaces offer psychological support for those who feel isolated by pudendal nerve issues.

Check Pudendalsite, where patients sharing research and personal stories.

Currently, pudendal neuralgia does not automatically qualify for recognition under Long-Term Illness (Affection de Longue Durée – ALD) status, although advocacy efforts have been ongoing to change this.

It is possible, however, to apply for official recognition as a Disabled Worker through the MDPH (Departmental House for Disabled Persons) to gain access to assistance and financial support.