Internal pudendal artery

The internal pudendal artery is the smaller of the two terminal branches of the anterior trunk of the internal iliac artery, and supplies the external genital organs. Though the course of the artery is the same in the two sexes, the vessel is smaller in the female than in the male, and the distribution of its branches somewhat different. The description of its arrangement in the male will first be given, and subsequently the differences which it presents in the female will be mentioned.

The internal pudendal artery in the male passes downward and outward to the lower border of the greater sciatic foramen, and emerges from the pelvis between the Piriformis and Coccygeus; it then crosses the ischial spine, and enters the perineum through the lesser sciatic foramen. The artery now crosses the Obturator internus, along the lateral wall of the ischiorectal fossa, being situated about 4 cm above the lower margin of the ischial tuberosity. It gradually approaches the margin of the inferior ramus of the ischium and passes forward between the two layers of the fascia of the urogenital diaphragm; it then runs forward along the medial margin of the inferior ramus of the pubis, and about 1.25 cm behind the pubic arcuate ligament it pierces the inferior fascia of the urogenital diaphragm and divides into the dorsal and deep arteries of the penis.

• Relations.—Within the pelvis, it lies in front of the Piriformis muscle, the sacral plexus of nerves, and the inferior gluteal artery. As it crosses the ischial spine, it is covered by the Gluteus maximus and overlapped by the sacrotuberous ligament. Here the pudendal nerve lies to the medial side and the nerve to the Obturator internus to the lateral side of the vessel. In the perineum it lies on the lateral wall of the ischiorectal fossa, in the pudendal canal (Alcock’s canal) formed by the splitting of the obturator fascia. It is accompanied by a pair of venæ comitantes and the pudendal nerve.   

• Peculiarities.—The internal pudendal artery is sometimes smaller than usual, or fails to give off one or two of its usual branches; in such cases the deficiency is supplied by branches derived from an additional vessel, the accessory pudendal, which generally arises from the internal pudendal artery before its exit from the greater sciatic foramen. It passes forward along the lower part of the bladder and across the side of the prostate to the root of the penis, where it perforates the urogenital diaphragm, and gives off the branches usually derived from the internal pudendal artery. The deficiency most frequently met with is that in which the internal pudendal ends as the artery of the urethral bulb, the dorsal and deep arteries of the penis being derived from the accessory pudendal. The internal pudendal artery may also end as the perineal, the artery of the urethral bulb being derived, with the other two branches, from the accessory vessel. Occasionally the accessory pudendal artery is derived from one of the other branches of the internal iliac artery, most frequently the inferior vesical or the obturator

• Branches.—The branches of the internal pudendal artery are:

  • The muscular branches consist of two sets: one given off in the pelvis; the other, as the vessel crosses the ischial spine. The former consists of several small offsets which supply the Levator ani, the Obturator internus, the Piriformis, and the Coccygeus. The branches given off outside the pelvis are distributed to the adjacent parts of the Gluteus maximus and external rotator muscles. They anastomose with branches of the inferior gluteal artery. 

  • The inferior anorectal artery arises from the internal pudendal artery as it passes above the ischial tuberosity. Piercing the wall of Alcock’s canal it divides into two or three branches which cross the ischiorectal fossa, and are distributed to the muscles and integument of the anal region, and send offshoots around the lower edge of the Gluteus maximus to the skin of the buttock. They anastomose with the corresponding vessels of the opposite side, with the superior and middle anorectal arteries, and with the perineal artery.   

  • The perineal artery arises from the internal pudendal artery, in front of the preceding branches, and turns upward, crossing either over or under the Transversus perinæi superficialis, and runs forward, parallel to the pubic arch, in the interspace between the Bulbocavernosus and Ischiocavernosus, both of which it supplies, and finally divides into several posterior scrotal branches which are distributed to the skin and dartos tunic of the scrotum. As it crosses the Transversus perinæi superficialis it gives off the transverse perineal artery which runs transversely on the cutaneous surface of the muscle, and anastomoses with the corresponding vessel of the opposite side and with the perineal and inferior anorectal arteries. It supplies the Transversus perinæi superficialis and the structures between the anus and the urethral bulb.  

  • The artery of the bulb of penis is a short vessel of large caliber which arises from the internal pudendal between the two layers of fascia of the urogenital diaphragm; it passes medialward, pierces the inferior fascia of the urogenital diaphragm, and gives off branches which ramify in the bulb of the urethra and in the posterior part of the corpus cavernosum urethræ. It gives off a small branch to the bulbo-urethral gland.  

  • The urethral artery arises a short distance in front of the artery of the urethral bulb. It runs forward and medialward, pierces the inferior fascia of the urogenital diaphragm and enters the corpus cavernosum urethræ, in which it is continued forward to the glans penis.   

  • The deep artery of the penis, one of the terminal branches of the internal pudendal artery, arises from that vessel while it is situated between the two fasciæ of the urogenital diaphragm; it pierces the inferior fascia, and, entering the crus penis obliquely, runs forward in the center of the corpus cavernosum penis, to which its branches are distributed

  • The dorsal artery of the penis ascends between the crus penis and the pubic symphysis, and, piercing the inferior fascia of the urogenital diaphragm, passes between the two layers of the suspensory ligament of the penis, and runs forward on the dorsum of the penis to the glans, where it divides into two branches, which supply the glans and prepuce. On the penis, it lies between the dorsal nerve and deep dorsal vein, the former being on its lateral side. It supplies the integument and fibrous sheath of the corpus cavernosum penis, sending branches through the sheath to anastomose with the preceding vessel

 The internal pudendal artery in the female is smaller than in the male. Its origin and course are similar, and there is considerable analogy in the distribution of its branches. The perineal artery supplies the labia pudendi; the artery of the bulb of vestibule supplies the bulbus vestibuli and the erectile tissue of the vagina; the deep artery of the clitoris supplies the corpus cavernosum clitoridis; and the dorsal artery of the clitoris supplies the dorsum of that organ, and ends in the glans and prepuce of the clitoris