Internal Pudendal Artery: Anatomy, Function & Location

The internal pudendal artery is a blood vessel located deep within the pelvic region that originates from the internal iliac artery. Its primary role is to transport oxygenated blood to the perineal region, which includes the external genitalia and structures in the anal and urogenital areas. While smaller in females, it serves as the principal blood supply to the perineum in both sexes.

Anatomical Pathway of the Artery

The internal pudendal artery branches from the anterior division of the internal iliac artery. It travels down and sideways along the lateral pelvic wall, in front of the piriformis muscle and the sacral plexus. It then leaves the pelvic cavity through the greater sciatic foramen, below the piriformis muscle, to enter the gluteal region.

It then curves around the sacrospinous ligament to re-enter the perineum by passing through the lesser sciatic foramen. The artery then travels through the pudendal canal (also known as Alcock’s canal), which is formed by pelvic muscle and membrane. Within this canal, it is accompanied by the internal pudendal veins and the pudendal nerve.

Primary Function and Areas of Supply

The internal pudendal artery distributes blood through several branches. One of its initial branches is the inferior rectal artery, which provides blood to the muscles and skin around the anal canal. Another branch is the perineal artery, which supplies the muscles of the superficial perineal pouch.

The perineal artery gives rise to the posterior scrotal arteries in males and the posterior labial arteries in females, supplying the skin of the scrotum or labia. The internal pudendal artery also gives off the artery of the bulb of the penis in males, which supplies the penile bulb and the bulbourethral gland. In females, the corresponding branch is the artery of the bulb of the vestibule, supplying its namesake and the greater vestibular gland.

Deeper in the perineum, the internal pudendal artery gives rise to the deep and dorsal arteries. The deep artery of the penis or clitoris penetrates the core erectile tissues (corpora cavernosa), providing the blood for tumescence. The dorsal artery of the penis or clitoris runs along the upper surface of these organs, supplying the surrounding skin and fascia.

Clinical Significance

The internal pudendal artery’s health is linked to several medical considerations. Its role in supplying the erectile tissues of the penis and clitoris means that reduced blood flow from arterial stenosis or atherosclerosis can be a direct cause of erectile dysfunction.

The artery’s close relationship with the pudendal nerve in the pudendal canal is clinically relevant. Compression of the artery and nerve in this canal can lead to pudendal neuralgia, or Alcock’s canal syndrome, which is characterized by chronic pain in the pelvic region, genitals, or rectum. Due to the shared pathway, any swelling or injury affecting the artery can also impact the nerve.

The artery’s consistent location makes it a landmark for medical procedures. Anesthesiologists use its position relative to the ischial spine to guide a pudendal nerve block. This procedure provides localized pain relief to the perineum and is used during childbirth to manage labor pain. Injury to this artery during pelvic fractures or other trauma can lead to severe bleeding.

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