Internal pudendal artery !

The internal pudendal artery runs along the side of the pelvic outlet to the perineum; it feeds the anal canal, perineal muscles, vulva and clitoris.

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What it is

The artery of the perineum, which leaves the pelvis and runs forward along the side wall below the pelvic floor.

What it does

Feeds the anal canal, the perineal muscles, the vulva and the erectile tissue of the clitoris.

Key facts

Origin: Anterior division of internal iliac artery
Branches: Inferior rectal, perineal (posterior labial), artery of bulb of vestibule, deep and dorsal arteries of clitoris
Supplies: Perineum, anal canal, vulva and erectile tissue; leaves through the greater and re-enters through the lesser sciatic foramen into the pudendal canal

Relations

Course: Internal iliac artery → down in front of the piriformis and sacral plexus → greater sciatic foramen → over the back of the ischial spine → lesser sciatic foramen → forward in the pudendal canal on the lateral wall of the ischioanal fossa → deep perineal pouch
Medial: Pudendal nerve at the ischial spine; in the canal the nerve and its branches run with it
Lateral: Nerve to obturator internus at the ischial spine; in the canal, the obturator internus and its fascia
Superficial: Sacrotuberous ligament and gluteus maximus cover it where it crosses the ischial spine

How to find it

It cannot be felt from outside. On vaginal or rectal examination the ischial spine is felt on the side wall; the pudendal vessels and nerve pass just behind its tip. In the gluteal region it appears below the piriformis, medial to the sciatic nerve.

On imaging

Followed on CT or catheter angiography from the anterior division of the internal iliac artery through the greater sciatic foramen, around the ischial spine and into the perineum. It is a common target for embolisation when angiography shows contrast leaking after a pelvic fracture or postpartum. Penile Doppler ultrasound and angiography assess inflow through it in vascular erectile dysfunction.

Treatment

Tied or blocked (embolised) to control severe bleeding after birth when other measures fail.

Clinical notes

Transvaginal pudendal block: the needle passes through the sacrospinous ligament just medial and posterior to the ischial spine; aspiration comes first because the artery lies beside the nerve
In pelvic fractures it is one of the internal iliac branches most often found bleeding on angiography and treated by embolisation
Its perineal branches can bleed into a vulvar or perineal haematoma after vaginal birth
Accessory pudendal arteries running above the pelvic floor beside the prostate can supply much of the penis and may be injured in radical prostatectomy

Anatomical variants

Internal iliac branching varies widely; it may arise from a common trunk with the inferior gluteal artery
Accessory pudendal arteries (from the obturator, inferior vesical or other branches) are a recognised variant

Memory aid

PIN at the ischial spine, medial to lateral: Pudendal nerve, Internal pudendal vessels, Nerve to obturator internus.

Test yourself

Think of the answer, then tap the question to see it.

What is the course of the internal pudendal artery out of and back into the pelvis?

Out through the greater sciatic foramen below piriformis, around the ischial spine, back through the lesser sciatic foramen into the pudendal (Alcock's) canal.

What is the medial-to-lateral order of structures at the ischial spine?

PIN: Pudendal nerve, Internal pudendal vessels, Nerve to obturator internus.

Why is aspiration done before injection in a pudendal block?

The internal pudendal artery lies beside the pudendal nerve at the ischial spine.

What is the role of the internal pudendal artery in pelvic fractures?

It is one of the internal iliac branches most often found bleeding on angiography and treated by embolisation.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): arteria pudendalis interna TA2 4341
Official Spanish (DeCS): Arteria pudenda interna
English (TA2): Internal pudendal artery
Also called: arteria pudenda interna

Sources: Terminologia Anatomica (TA2); Anatomy, Abdomen and Pelvis: Internal Iliac Arteries; Anatomy, Abdomen and Pelvis, Pudendal Nerve.

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Representative model, for educational purposes only.

Internal pudendal artery highlighted on the Durgical 3D model