Pudendal nerve (S2–S4)

Nerves · S2 S3 S4

Leaves the pelvis through the greater sciatic foramen below piriformis, hooks around the ischial spine and sacrospinous ligament medial to the internal pudendal vessels, re-enters through the lesser sciatic foramen and runs forward in the pudendal (Alcock's) canal on obturator internus in the lateral wall of the ischio-anal fossa.

Traced from the start

  1. S1 anterior ramusS2 anterior ramusS3 anterior ramusS4 anterior ramus
  2. Sacral plexus anterior divisions
  3. Pudendal nerve (S2–S4)

Detail

Branches
Inferior rectal, perineal, dorsal nerve of the penis or clitoris
Motor
External anal sphincter, external urethral sphincter, bulbospongiosus, ischiocavernosus and the other perineal muscles
Sensory
Perineum, anal canal below the pectinate line, posterior scrotum or labia, penis or clitoris
Partner
Somatic; parasympathetic control of erection and the detrusor comes from the pelvic splanchnics (S2–S4)

When it goes wrong

Stretch in a prolonged second stage of labour or forceps delivery; chronic compression in Alcock's canal (cyclists)

Faecal and stress urinary incontinence, perineal numbness or burning pain that is worse sitting; a pudendal block injected at the ischial spine (transvaginal) anaesthetises the perineum for forceps or episiotomy

Practise this structure

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