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_______________________ Anatomy The pudendal nerve carries both motor and sensory neurons arising from sacral segments S2, S3 and S4. These fibers join to form the nerve traveling under the piriformis muscle. The nerve then travels caudally into a small space “clamp” between the sacrospinous ligament and the sacrotuberous ligament. The nerve runs underneath the sacrospinous ligament just medial to its attachment at the ischial spine and superior to the sacrotuberous ligament. The nerve then passes ventrally, medially and caudally through the lesser sciatic foramen. The nerve then enters the pudendal canal (Alcock’s Canal) formed by a duplication of the aponeurosis of the obturator internus muscle. At this level, it crosses over the falciform process of the sacrotuberous ligament. During its course, the nerve gives off several branches. The first being the levator branch followed by the inferior rectal branch. Some anatomic variations of course occur. The remaining nerve is the perineal nerve branch (often called the perineal nerve) innervating the perineal skin and superficial muscles. The nerve them terminates in the dorsal penile or clitoral branch. Keep in mind the nerve is a accompanied by the pudendal artery and venous complex during its course. _______________________ |
