Pudendal neuralgia is posturally induced and, therefore, intermittent, making its assessment particularly difficult. It is nonetheless central to have a quantitative assessment to develop therapeutic indications and determine the impact of the disorder. We have developed a self-administered questionnaire for this type of pain. Most importantly, the goal was to create a personal assessment form that makes it possible to understand the evolution of pain at various stages of therapeutic treatment (medications, physical therapy, infiltration, and surgery). This form does not aim to assist in the clinical process. It can possibly be used within the framework of later therapeutic protocols associated with other more traditional scales (depression, quality of life, etc.).