The internal pudendal artery is a terminal branch of the anterior division of the internal iliac artery (Read more!). It primarily supplies the perineum and the external genitalia. Occasionally, it may arise from a common trunk shared with the inferior gluteal artery or the middle rectal artery.

This is the main artery that supplies the perineum and structures found within it. It has a relatively long course, transversing the pelvic cavity, gluteal region, and perineum.

After the internal pudendal artery arises, it descends inferolaterally toward the ischial spine and the greater sciatic foramen. It leaves the pelvic cavity via the greater sciatic foramen below the piriformis (between the piriformis and the coccygeus), curves posteriorly around the ischial spine and the sacrospinous ligament, traverses the lesser sciatic foramen and enters the perineum. As this artery crosses the ischial spine, it is covered by the gluteus maximus muscle.

Then, the internal pudendal artery passes anteriorly along the lateral wall of the ischioanal fossa. It goes through the pudendal canal (Alcock's canal) together with the internal pudendal vein and the pudendal nerve to reach the genitalia. The pudendal canal is a fascial sheath formed by the obturator internus fascia and surrounding connective tissue.

As the internal pudendal artery travels further anteriorly and medially, it continues to go along the ischial ramus. It passes forward between the two layers of the fascia of the perineal membrane (urogenital diaphragm). It then travels forward along the inferior pubic ramus and pierces the inferior fascia of the urogenital diaphragm to reach the root of the penis, where it terminates by dividing into two terminal branches - the deep artery of penis and the dorsal artery of penis.

Along its course, the internal pudendal artery gives off the following branches:

Inferior (anorectal) rectal artery - stems from the internal pudendal artery as it enters the pudendal canal and passes above the ischial tuberosity; it pierces the wall of the pudendal canal and divides into two or three branches that cross the ischioanal fossa and are distributed to the muscles and integument of the rectal and anal areas; it supplies the lower aspect of the rectum, anorectal junction, anal canal, and anal sphincters; this artery anastomoses with the contralateral inferior rectal artery, middle rectal artery, superior rectal artery, and perineal artery;
Perineal artery - it arises within the distal portion of the pudendal canal and travels forward in the superficial perineal pouch between the perineal membrane and superficial perineal fascia; it crosses either over or under the superficial transverse perineal muscle; supplies the superficial perineal muscles, external genitalia, and perineal skin;
- Posterior scrotal arteries - several small branches of the perineal artery that are distributed to the skin and dartos fascia of the scrotum; supply the skin and superficial tissues of the scrotum, mainly its lateral and posterior parts; they anastomose with the anterior scrotal arteries, ensuring a rich blood supply to the scrotal wall;
Artery of bulb of penis - a short vessel that arises between the two layers of the fascia of the perineal membrane after the internal pudendal artery enters the deep perineal pouch; it passes medially, pierces the inferior fascia of the urogenital diaphragm, and ramifies in the bulb of the penis, also giving small branches to the urethra and the bulbourethral gland; supplies the bulb of the penis, bulbourethral gland, and the adjacent part of the urethra;
Urethral artery - it arises close to the origin site of the artery of bulb of penis; after it arises, this artery descends anteriorly, pierces the inferior fascia of the urogenital diaphragm and enters the corpus spongiosum of the penis, where it accompanies the urethra till the glans penis;
Perforating arteries of penis - small arteries that penetrate the tunica albuginea and play a crucial role in erectile function by supplying blood to the corpus cavernosum, which is responsible for penile rigidity; they contribute to the vascular network involved in erection to ensure adequate filling and pressure within the corpus cavernosum;
Deep artery of penis - one of two terminal branches of the internal pudendal artery; it arises in the deep perineal pouch between the two fasciae of the perineal membrane and pierces the inferior fascia of the urogenital diaphragm to reach the corpus cavernosum of the penis; it enters the crus penis and goes through the central portion of the corpus cavernosum, supplying it;
- Helicine branches - small, coiled arteries that supply blood to the erectile tissue of the corpus cavernosum; their coiled shape allows them to straighten during erection, accommodating penile lengthening without damaging the vessel walls; in the flaccid state, these arteries remain constricted, limiting blood flow; during sexual arousal, they dilate, allowing a sudden increase of blood into the cavernous spaces, which leads to engorgement and erection;
Dorsal artery of penis - also one of the terminal branches of the internal pudendal artery that arises in the deep perineal pouch; it ascends between the crus of the penis and pubic symphysis; this artery pierces through the inferior fascia of the urogenital diaphragm, travels between the two layers of the suspensory ligament of the penis, and goes anterior on the dorsum of the penis to the glans of the penis; at the glans penis, it divides into two branches that supply the glans and prepuce; it supplies the corpus spongiosum of the penis and adjacent skin and fasciae.

Overall, the branches of the internal pudendal artery in the male body supply the lower part of the rectum, anal canal, urethra, structures of the perineum, and external genitalia. The internal pudendal artery plays a central role in regulating blood flow to the external genitalia, making it essential for the vascular component of the sexual response in both men and women.

Note: In some cases, the internal pudendal artery may be smaller than usual or may not give rise to all of its typical branches. When this occurs, an additional vessel - known as the accessory pudendal artery - often compensates for the missing branches. This vessel commonly originates from the internal pudendal artery before it exits the greater sciatic foramen. It courses forward along the lower surface of the urinary bladder, across the lateral aspect of the prostate, and reaches the root of the penis, where it pierces the perineal membrane to give off branches typically provided by the internal pudendal artery. The most frequently observed variation involves the internal pudendal artery terminating as the artery of bulb of penis and the urethral artery, while the dorsal artery of penis and the deep artery of penis arise from the accessory pudendal artery. In other instances, the internal pudendal artery may end as the perineal artery, with the accessory pudendal artery supplying the remaining branches. Occasionally, the accessory pudendal artery may stem from another branch of the internal iliac artery, such as the inferior vesical artery or the obturator artery.

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Internal pudendal artery