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Pudendal artery

The pudendal artery, more precisely the internal pudendal artery, is a terminal branch of the anterior division of the internal iliac artery. It exits the pelvis through the greater sciatic foramen below the piriformis, curves around the sacrospinous ligament and ischial spine, then enters the perineum via the lesser sciatic foramen to travel within the pudendal canal (Alcock’s canal).

It supplies arterial blood to the perineum, external genitalia, anal canal, and associated muscles. Along its course, it gives off important branches: the inferior rectal artery, perineal artery, dorsal artery of penis/clitoris, and deep artery of penis/clitoris.

The pudendal artery is clinically significant in pelvic trauma, urologic and gynecological surgery, erectile dysfunction interventions, and perineal reconstruction. It may serve as a target for embolization in postpartum hemorrhage or pelvic bleeding.

Synonyms

  • Internal pudendal artery

  • Arteria pudenda interna

Function

  • Provides arterial supply to perineum and external genitalia

  • Branches vascularize anal canal, perineal muscles, urethra, penis, and clitoris

  • Supports erectile function via deep and dorsal penile/clitoral arteries

  • Contributes to collateral circulation in pelvis

MRI Appearance

T1-weighted images:

  • Artery appears as a linear hypointense flow void along the ischial spine and within pudendal canal

  • Surrounded by hyperintense perivascular fat

T2-weighted images:

  • Normal artery: flow void

  • Pathology (thrombosis, aneurysm): hyperintense lumen signal

STIR:

  • Fat suppression enhances artery visualization against pelvic fat

  • Highlights perivascular edema, hematoma, or inflammatory changes

T1 Fat-Suppressed Post-Gadolinium:

  • Pudendal artery enhances brightly and homogeneously

  • Branches (perineal, inferior rectal, penile/clitoral) visualized clearly

  • Useful for mapping vascular malformations or tumor feeders

MRA Pelvis with Gadolinium:

  • Best non-invasive technique to delineate pudendal artery

  • Shows origin from internal iliac artery, course around ischial spine, and branches within perineum

  • Critical in erectile dysfunction work-up, pelvic trauma, and surgical planning

CT Appearance

Non-contrast CT:

  • Artery not well visualized without contrast

  • May detect vascular calcifications along pelvic sidewall in older patients

CT Post-Contrast:

  • Artery enhances brightly

  • Demonstrates vascular anatomy in relation to pelvic organs and muscles

  • Detects active hemorrhage, aneurysms, or pseudoaneurysms

CT Angiography (CTA):

  • Gold-standard for mapping pudendal artery in trauma or surgical planning

  • Multiplanar and 3D reconstructions show arterial origin, branches, and anastomoses

  • Used in embolization procedures, erectile dysfunction interventions, and hemorrhage control

CT VRT 3D image

Pudendal artery CT 3D VRT anatomy image

CT image

Pudendal artery CT axial anatomy image-img-00000-00000

MRI image

Pudendal artery MRI axial image MRI axial anatomy image-img-00000-00000

MRI image

Internal pudendal artery