Have you read the threads about saddle fitting? If the saddle is too narrow for you - or if it's the wrong shape so that it forces you to ride on the nose - it can cause a lot of grief.

Even though the saddle worked on your MTB, you're on a different part of your sitbones in road bike riding position. So what fits you for one might not for the other.

Tilt is definitely a possibility - especially if you're getting pressure that far forward, unless you're in an extreme aero tuck. You can cut a piece of metal out of a steel can to shim your seatpost if you need a tilt that's between what the grooves allow you, if you don't want to spring for a micro-adjustable seatpost.

IME most cut-outs don't extend far enough forward to relieve pressure on the clitoris, anyway. They're mainly made to accommodate large labia. Selle SMP models have a very long cut-out, so that might be something for you to try if tilt and rear size don't solve your problem.

Good luck - saddle issues are miserable.