Pudendal Nerve Block for Pelvic, Perineal, and Genital Pain
A pudendal nerve block is a fluoroscopy-guided (live X-ray) shot near the pudendal nerve. It may help evaluate or ease perineal, genital-region, rectal, or sitting-related pelvic pain. This page explains the Nantes criteria, fluoroscopy-guided technique, pulsed radiofrequency when relevant, risks, and how it differs from related nerve targets.
Quick Answer: Pudendal Nerve Block
- A fluoroscopy-guided (live X-ray) shot near the pudendal nerve (not a transvaginal route).
- May be used as a test, for short relief, or both.
- Nantes criteria are clinical clues for pudendal neuralgia. They are not proof of the diagnosis alone.
- Used for selected male and female patients when the exam fits.
- Different from a superior hypogastric plexus block (pelvic organ pain) and from a {a(COC,”coccyx / ganglion impar injection”)}.
- Sudden severe pelvic pain with fever, inability to urinate, or new saddle numbness needs emergency care.
What Is a Pudendal Nerve Block?
A pudendal nerve block is a fluoroscopy-guided (live X-ray) shot near the pudendal nerve. It can help test whether that nerve is driving perineal, genital-region, or sitting-related pain, and it may ease symptoms for a time.
The pudendal nerve arises from sacral nerve roots and travels through the pelvis toward the perineum. It passes near the sacrospinous and sacrotuberous ligaments and through Alcock canal. It helps supply the perineum, anus, genital region, and parts of the pelvic floor [Source].
Irritation along this path can cause sitting pain, perineal pain, or genital-region pain. Other problems can feel similar, so a careful exam matters.
Symptoms and the Nantes Criteria
Pudendal neuralgia is mainly a clinical diagnosis. A working group published the Nantes criteria as simple clues that support the diagnosis [Source]:
- Pain in the anatomical territory of the pudendal nerve.
- Pain worse with sitting.
- The pain does not wake the patient at night.
- No objective sensory loss on exam.
- A positive diagnostic pudendal nerve block.
These clues help. They do not prove nerve entrapment by themselves, and they do not replace a full exam [Source]. Pure coccyx pain, for example, may point more toward a coccyx injection or coccydynia care path.
Who May Benefit / Who May Not
Who may be considered
- Sitting-related perineal, genital-region, rectal, or pelvic-floor pain that fits a pudendal pattern.
- Pain that improves briefly with sitting changes or that tracks with cycling, childbirth, pelvic surgery, or pelvic floor spasm.
- People for whom a diagnostic block could clarify the next step.
Who may not be a good candidate
- Infection at the planned site, or a bleeding risk that cannot be managed safely.
- Pain that is clearly from the hip, SI joint, lumbar nerve roots, or pure tailbone pain alone.
- Expectation that one shot will permanently end all pelvic pain — that is not how this test or treatment works.
- Any case where your doctor judges the risks outweigh the possible benefit.
How the Block Is Done
The approach described here is external and fluoroscopy-guided (live X-ray). It is not transvaginal. At SpinePain Solutions, Dr. Sharma uses fluoroscopy for needle placement. You are usually face down. The skin is cleaned and numbed. Live X-ray helps guide a thin needle toward the pudendal nerve region near the ischial spine. Contrast may confirm spread before medicine is given.
Sedation is a range chosen with you:
- No sedation: local numbing only.
- Light sedation: midazolam (Versed); most people stay awake but calm.
- Monitored anesthesia care: propofol given by an anesthesia professional who watches breathing, heart rate, and oxygen.
If you get sedation, you will need a driver. Prep tips overlap with other nerve shots; see preparing for a spine injection.
Diagnostic vs Therapeutic Role
A clear short response can support that the pudendal nerve is part of the pain path. When relief lasts longer, that can also help day-to-day symptoms — but duration varies, and lasting relief is not expected for everyone. If relief is brief, the result can still guide care. If there is no relief, your doctor looks again at other sources such as pelvic floor issues, sacral roots, SI joint or hip disease, or visceral pelvic pain.
Possible next steps after a helpful block can include pelvic floor therapy, medicine changes, activity changes, a repeat block in selected cases, pulsed radiofrequency when short-lived block relief still pointed to that nerve, or other options case by case. A helpful block does not always mean the pudendal nerve is the only source.
Pulsed radiofrequency of the pudendal nerve
When a diagnostic pudendal block helped but relief was short, Dr. Sharma may offer pulsed radiofrequency (PRF) of the pudendal nerve. PRF uses short bursts of energy meant to keep tissue temperature low so the nerve is not intentionally destroyed, unlike conventional thermal radiofrequency [Source]. Evidence is still developing. A randomized trial using ultrasound guidance compared pudendal PRF plus a nerve block with a nerve block alone and reported lower pain scores in the PRF group at check-ins up to three months [Source]. A systematic review found mostly low-quality, mixed studies and no clearly superior approach [Source]. Results vary. Your doctor will discuss whether PRF fits you.
Pudendal vs Superior Hypogastric vs Coccyx / Ganglion Impar
- Pudendal nerve block: perineal, genital-region, or sitting pain along the pudendal nerve.
- Superior hypogastric plexus block: pelvic organ (visceral) pain [Source]. (Cross-link after that new page is live; see NOTES.)
- Coccyx / ganglion impar: midline tailbone or perineal pain. Related: coccydynia.
- Ilioinguinal / iliohypogastric: lower belly wall and groin nerves — a different target.
- Sympathetic nerve block hub: broader sympathetic targets such as stellate or lumbar sympathetic blocks.
Risks and Side Effects
Common short-term effects include soreness, bruising, and temporary numbness or changed feeling in the pelvic or perineal area. Less common risks include infection, bleeding, nerve irritation or injury, allergic reaction, and spread of medicine to nearby nerves with temporary leg numbness or weakness [Source] [Source].
Tell the team about blood thinners, allergies, infection, prior pelvic surgery, and pregnancy status when relevant.
Dr. Amit Sharma & our minimally invasive pain & spine team.
Aftercare and When to Call
You are watched until steady. Mild soreness is common. Track sitting tolerance and your usual pain if this was a test block. Temporary numbness or changed feeling in the pelvic or perineal area can happen and usually fades as the medicine wears off [Source].
Call the office for fever, chills, redness or drainage, or pain that keeps getting worse. Bring notes on how long any relief lasted so the next visit can use that information. Call 631-310-0000.
Call 911 or go to the emergency room now for inability to urinate, rapidly worsening swelling, new leg weakness, numbness in the groin or inner thighs, or new loss of bladder or bowel control (cauda equina syndrome warning signs).
Care at SpinePain Solutions
At SpinePain Solutions, Dr. Amit Sharma, Chief, Division of Pain Medicine at Good Samaritan University Hospital, sees patients at our Bay Shore, Commack and Farmingdale offices (see office locations). Care is shared with pelvic floor therapy, gynecology, urology, colorectal, and primary care teams when needed. If a pudendal nerve block fits, you will hear the goals, fluoroscopy plan, any pulsed radiofrequency option, sedation choices, and risks before the day. Call 631-310-0000.
Frequently Asked Questions
What is a pudendal nerve block?
A pudendal nerve block is a fluoroscopy-guided (live X-ray) shot near the pudendal nerve. That nerve helps supply the perineum, genital region, anus, and parts of the pelvic floor. The shot can be used as a test, for short relief, or both.
When should I seek emergency care for pelvic or perineal pain?
Call 911 or go to the ER for sudden severe pain with fever, rapidly worsening swelling, inability to urinate, numbness in the groin or inner thighs, or new loss of bladder or bowel control. Those can be emergency signs, including cauda equina syndrome.
What are the Nantes criteria for pudendal neuralgia?
Doctors use five clinical clues: pain in the pudendal nerve area; pain worse with sitting; pain that does not wake you at night; no clear loss of feeling on exam; and a helpful diagnostic pudendal block. These clues support the diagnosis. They do not prove nerve entrapment alone.
Is your pudendal nerve block transvaginal?
No. The approach described here is external and fluoroscopy-guided. It does not use a transvaginal route. That makes it usable for both male and female patients when the clinical picture fits.
Do you treat male and female patients?
Yes. Pudendal nerve pain can affect men and women. Symptom patterns can differ, but the external fluoroscopy-guided approach can be considered for either when the exam supports pudendal involvement.
Is the block diagnostic, therapeutic, or both?
It can be either or both. A clear short response can support the diagnosis. Longer relief can also help symptoms. If relief is brief or absent, your doctor rethinks the pain source or the next step.
How is fluoroscopy used, and what sedation is offered?
At SpinePain Solutions, Dr. Sharma uses fluoroscopy (live X-ray) so the needle can be placed near the pudendal nerve path, often near the ischial spine region. Sedation is a range chosen with you: local numbing only, light sedation with midazolam (Versed), or monitored anesthesia care with propofol by an anesthesia professional.
What are the risks?
Common short-term effects include soreness, bruising, and temporary numbness or changed feeling in the pelvic or perineal area. Less common risks include infection, bleeding, nerve irritation, and spread of medicine to nearby nerves. Your doctor reviews risks that apply to you.
How long does relief last?
It varies from hours to weeks or longer. Some people notice a change only while the numbing medicine is working. Others feel a longer change. Duration differs from person to person, and lasting relief is not expected for everyone. A short but clear response can still help as a test. If relief is brief or absent, your doctor rethinks the pain source or next steps such as pelvic floor therapy, medicine changes, or a different nerve or joint injection.
What is pulsed radiofrequency for the pudendal nerve?
Pulsed radiofrequency (PRF) uses short bursts of energy near the pudendal nerve. Unlike thermal radiofrequency, the pulses are meant to keep tissue temperature low so the nerve is not intentionally destroyed. Dr. Sharma may offer PRF when a diagnostic block helped but relief was short. Evidence is limited and developing. Response varies.
How is this different from a superior hypogastric plexus block or a coccyx / ganglion impar injection?
A pudendal nerve block targets the pudendal nerve for perineal, genital-region, or sitting pain. A superior hypogastric plexus block targets deeper nerves for pelvic organ pain. A coccyx or ganglion impar injection focuses on midline tailbone or perineal pain. See our coccyx injection page for that pattern.
Dr. Amit Sharma & our minimally invasive pain & spine team.
Medical References
- Labat JJ, Riant T, Robert R, Amorim D, Lefaucheur JP, Rambaud A, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27(4):306-310. doi:10.1002/nau.20505. PubMed.
- Leslie SW, Antolak S, Feloney MP, Soon-Sutton TL. Pudendal neuralgia. StatPearls. Treasure Island (FL): StatPearls Publishing. StatPearls. PMID: 32965917.
- Levesque A, Bautrant E, Quistrebert V, Valancogne G, Riant T, Beer Gabel M, et al. Recommendations on the management of pudendal nerve entrapment syndrome: a formalised expert consensus. Eur J Pain. 2022;26(1):7-21. doi:10.1002/ejp.1860. PubMed.
- Carr CM, Plastaras CT, Pingree MJ, Smuck M, Maus TP, Geske JR, et al. Immediate adverse events in interventional pain procedures: a multi-institutional study. Pain Med. 2016;17(12):2155-2161. doi:10.1093/pm/pnw051. PubMed.
- Vorenkamp K, Yi P, Kemp A. Sympathetic blocks for visceral pain. Phys Med Rehabil Clin N Am. 2022;33(2):519-539. doi:10.1016/j.pmr.2022.01.009. PubMed.
- Fang H, Zhang J, Yang Y, Ye L, Wang X. Clinical effect and safety of pulsed radiofrequency treatment for pudendal neuralgia: a prospective, randomized controlled clinical trial. J Pain Res. 2018;11:2367-2374. doi:10.2147/JPR.S167866. PubMed.
- Andiman S, Maron J, Dandolu V, et al. Impact of treatment of pudendal neuralgia on pain: a systematic review and meta-analysis. Int Urogynecol J. 2025;36(1):35-58. doi:10.1007/s00192-024-06004-x. PubMed.
These peer-reviewed and StatPearls sources support the Nantes criteria, anatomy, risk framing, comparisons, and pulsed RF notes above.
