The internal pudendal vein accompanies the internal pudendal artery throughout its course and drains the perineum and external genitalia. It begins at the deep structures of the perineum, collecting blood from venous plexuses surrounding the rectum, urethra, and external genital organs.

Like the artery, the vein travels through the pudendal canal (Alcock's canal), along the lateral wall of the ischioanal fossa, and curves around the ischial spine. It leaves the perineum via the lesser sciatic foramen, curves posteriorly around the ischial spine and the sacrospinous ligament and enters the pelvis via the greater sciatic foramen, passing below the piriformis muscle.

Eventually, the internal pudendal vein drains into the internal iliac vein (Read more!), typically joining it near the point where the internal pudendal artery originates from the anterior division of the internal iliac artery.

Along its course, the internal pudendal vein receives the following tributaries:

Inferior anorectal (rectal) veins - drain blood from the anal canal, anorectal junction, and adjacent perineal structures; they accompany the inferior rectal artery across the ischioanal fossa and empty into the internal pudendal vein near the ischial tuberosity; these veins receive blood from the external anal sphincter, perineal skin, and lower rectum; they contribute to the anorectal venous plexus;
Posterior scrotal veins - several small tributaries that accompany the posterior scrotal arteries and drain the skin and superficial tissues of the scrotum, particularly its lateral and posterior regions; they collect blood from the dartos fascia and surrounding structures and empty directly into the internal pudendal vein;
Vein of the bulb of the penis - a short venous tributary that drains the bulb of the penis, bulbourethral gland, and the adjacent part of the urethra; it accompanies the artery of the bulb of the penis and passes laterally through the deep perineal pouch to join the internal pudendal vein.

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Internal pudendal vein