Pudendal Artery, Posterior View

Description

Seen from a posterior approach, the internal pudendal artery descends from the pelvis and courses inferiorly toward the ischioanal (ischiorectal) fossa, hugging the lateral pelvic wall near the ischial spine. The vessel is shown turning around the sacrospinous ligament and passing deep to the sacrotuberous ligament, then running anteriorly within the pudendal (Alcock) canal along the obturator internus fascia. Bony landmarks include the ischium and ilium, with the proximal femur and hip joint positioned inferolaterally; surrounding musculature includes gluteus maximus superficially and deeper pelvic floor and upper thigh groups in relation to the perineal exit. A posterior view makes the vascular “bend” at the ischial spine unambiguous, and that landmark matters in the clinic. Pudendal nerve blocks are often targeted near the ischial spine, where the internal pudendal artery travels with the pudendal nerve, and inadvertent intravascular injection is a known risk when the artery is not appreciated. This same corridor becomes relevant in perineal trauma and pelvic fracture patterns, where injury to internal pudendal branches can contribute to perineal hematoma or erectile dysfunction through compromised flow to the perineum and penis. Common use cases include teaching pelvic and perineal anatomy in gross anatomy and surgical anatomy courses, illustrating the route of the internal pudendal artery for anesthesia training modules, and supporting urology, colorectal, and pelvic floor surgery texts discussing ischioanal fossa approaches and Alcock canal decompression. Anatomical accuracy verified by SciePro's Medical Advisory Board.