The internal pudendal artery is the primary blood supply to the perineum, external genitalia, and external sphincters. Its course around the ischial spine (with the pudendal nerve) and through Alcock canal is clinically important for pudendal nerve blocks and for understanding the vascular anatomy of erectile function. The dorsal and deep arteries of the penis from the internal pudendal are the primary erectile arteries.
| Origin | Anterior division of the internal iliac artery |
|---|---|
| Course | Exits the pelvis through the greater sciatic foramen below the piriformis, crosses the ischial spine, re-enters through the lesser sciatic foramen, and runs through Alcock canal on the lateral wall of the ischiorectal fossa |
| Branches |
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The internal pudendal artery runs with the pudendal nerve around the ischial spine and through the pudendal (Alcock) canal, which is where a pudendal nerve block is placed and where the nerve can be compressed in pudendal neuralgia, for example in long-distance cyclists. Angiographic embolisation of the artery treats high-flow priapism from an arteriovenous fistula after perineal trauma. Injury in high-energy pelvic fractures, or narrowing from atherosclerosis, can cause vascular erectile dysfunction. Its perineal branches supply flaps used to close perineal wounds after abdominoperineal resection and in genital reconstruction.
Internal pudendal artery injury in high-energy pelvic fractures producing vascular erectile dysfunction managed with PDE-5 inhibitors and vascular assessment.
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