The internal pudendal artery is the terminal branch of the anterior division of the internal iliac artery, exiting the pelvis through the greater sciatic foramen below the piriformis, hooking around the ischial spine, and re-entering the perineum through the lesser sciatic foramen to run in Alcock's canal (the pudendal canal in the obturator internus fascia) on the lateral wall of the ischioanal fossa. It supplies all the perineal structures: the clitoris/penis, the external urethral sphincter, the external anal sphincter, and the perineal skin.
The internal pudendal artery and pudendal nerve in Alcock's canal are the targets for pudendal nerve block and for interventional treatment of pudendal neuralgia. Pudendal nerve entrapment in Alcock's canal produces perineal pain, dyspareunia, and dysuria. Image-guided pudendal nerve block at the ischial spine provides diagnostic confirmation and therapeutic relief. The internal pudendal artery is the pedicle for penile and clitoral reconstruction flaps and for inferior rectal flaps in perineal wound closure after abdomino-perineal resection.
Cycling-induced compression of Alcock's canal traps the pudendal nerve and artery between the bicycle seat and the ischial spine, producing perineal pain, sexual dysfunction, and urinary symptoms in cyclists and triathletes; CT-guided pudendal nerve block confirms the diagnosis and surgical decompression of Alcock's canal releases the entrapment.
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