PELVIS AND PERINEUM
Conceptual Overview
General Description
-- false (major or great) pelvis: between iliac crests and the pelvic
brim (linea terminalis)
-- true (lesser, deep, minor) pelvis: inferior to the pelvic inlet
-- sexual differences in the pelvis:
Functions
-- Contain and support bladder, rectum, anal canal, and reproductive
tracts
-- Anchors the roots of the external genitalia
Component parts
-- pelvic inlet
-- pelvic wall
-- pelvic outlet
tip of coccyx
ischial tuberosities
inferior pubic ramus
sarcotuberous ligament
pubic symphysis
-- pelvic floor
pelvic diaphragm
-- pelvic cavity
birth canal
gastrointestinal tract
1
urinary tract
reproductive organs
Key features
The pelvic cavity projects posteriorly: angle 50-60o
Important structures cross the ureters in the pelvic cavity
The prostate is anterior to rectum
The perineum is innervated by sacral spinal cord segments
Nerves are related to bone
Ischial spine  Pudendal nerve block
6. Parasympathetic innervation from spinal cord levels S2 to S4
1.
2.
3.
4.
5.
control erection: inferior hypogastric plexus
7. Muscle and fascia of the pelvic floor and perineum intersect at
the perineal body
Levator ani muscle
Sphincters
8. Gender determines the course of the urethra
2
Perineum
Definition: The area between the ischial tuberosities, extending from the
pubis to the coccyx; separate from the main pelvic cavity by pelvic
diaphragm
Perineal membrane
Superficial perineal pouch
Deep perineal pouch
Ischioanal (ischiorectal) fossa
-- subcutaneous region about the anal canal
-- boundaries:
1. Superiorly: levator ani muscle
2. Anterolaterally: obturator internus muscle
3. Posterolaterally: sacrotuberosu lig.
4. Anteriorly: external urethra sphincter and deep transverse
perineal body
-- content:
1.
fat tissue: resistant to resorption with starvation; gluteus
2.
3.
maximus muscle compresses the fat
internal pudendal vessel  inferior rectal vessel
pudendal n.  inferior rectal n. innerve external anal
sphincter and perineal skin
Somatic nerves (Fig 5.76)
Pudendal(S2~4;從greater sciatic foramen穿出，再從lesser sciatic
foramen穿入)
├ inferior rectal (external anal sphincter)
├ perineal
│
├ motor branches
│
└ posterior scrotal/labial (sensory)
3
└ dorsal n. of penis/clitoris (sensory)
Arteries (Fig 5.77)
Internal iliac (anterior trunk)
└ internal pudendal
├ inferior rectal─ middle (internal iliac) & superior rectal (IMA)
├ perineal
│
└ posterior scrotal/labial
├ a. of bulb of penis/vestibule
├ urethral
├ deep a. of penis/clitoris
└ dorsal a. of penis/clitoris
External iliac
├ femoral─ external pudendal─ superficial & deep br.─ anterior
scrotal/labia
│
└ inferior epigastric─ cremasteric
Abdominal aorta─ testicular
Vein (Fig 5.78)
Two major drainage
┌ internal pudendal─ internal iliac
└ external pudendal─ femoral
4
Exceptions
┌ Deep dorsal v. of penis
─ v. plexus of prostate
└ Deep dorsal v. of clitoris─ v. plexus of bladder
Lymphatics (Fig 5.79)
internal iliac nodes: deep parts of perineum
superficial inguinal nodes: superficial tissues of penis/clitoris
deep inguinal & external iliac nodes: glans penis/clitoris, labia minora
lateral aortic & preaortic nodes: testes
Divisions
The transverse diameter (a line connecting the ischial tuberosities)
divides the perineum into
Anal triangle
-- External anal sphincter: voluntary muscle
deep
superficial
subcutaneous
-- innervation
inferior rectal br. of pudendal n.
br. directly from anterior rami of S4
Urogenital triangle
-- Superficial fascia
fatty layer
membranous layer (Colles’ fascia)
-- Superfical perineal pouch
-- Deep perineal pouch
-- Erectile structures
corpus cavernosum
corpus spongiosum(♂ )/bulbs of vestibule(♀ )
-- Skeletal muscles
ischiocavernous
bulbospongiosus
superficial transverse perinaeal
5
Male urogenital triangle
Penis
Ligament
Suspensory ligament
Fundiforms ligament of penis
Bulb of the penis corpus spongiosum gland penis  external
urethral meatus
right & left crura of the peins  corpora cavernosa
propuce (foreskin)
frenulum
-- innervation
pudendal n. and pelvic plexuses
-- vasculation
1. Erectile tissue: femoral a. internal pudenal a.  deep a. of
penis, a. of the bulb, dorsal a. of the penis
2. Superficial skin: femoral a.  internal and external pudenal
a. perineal br.
3. Deep dorsal v. of the penis  prostatic v. plexus internal
pudendal v.
Scrotum
midline raphe
dartos layer (smooth muscle)
-- innervation
1. anterior: ilioinguinal, genitofemoral
2. posterior: pudendal n., and perineal br. of posterior femoral
cutaneous n.
-- vasculation
1. anterior scrotal a.: external pudendal br. of femoral a.
2. posterior scrotal a: scrotal br. of the internal pudendal a.
-- lymph drainage
1. scrotum: superficial inguinal lymph nodes
2. testis and epididymis: lumbar (para-aortic) lymph node
Spermatic cord
-- forms during the descent of the testes
6
-- External spermatic fascia:  deep fascia of the external oblique
muscle
-- Cremaster muscle: internal oblique muscle
-- Internal spermatic fascia: transversalis fascia
-- Tunica vaginalis:pariental peritoneum,visceral peritoneum
Superficial perineal pouch (space)
-- Boundaries: between deep layer of superficial perineal fascia and
inferior fascia of the urogenital diaphragm (perineal membrane)
-- Contents
Corpora cavernosa
Bulb of the penis
Ischiocavernosus muscle
Bulbocavernosus muscle
Superficial transverse perineal muscle
Deep perineal pouch
-- Boundaries: between superior and inferior fascial planes of the
deep transverse perineal muscle
-- Content
Deep transverse perineal muscle
External urethral sphincter
Paired bulbourethral gland (cowper’s gland)
Dorsal nerve and artery of penis
Female urogenital triangle
Vagina
Clitoris: homology to penis
Body of the clitoris
Vestibular bulbs
Glans clitoris
Labia minor (prepuce)
-- Vasculation
1. Internal iliac a.  internal pudendal a.
2. Deep dorsal v.  vesical v. plexus
-- Innveration
br. of pudendal n.
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Vulva
Labia major
Anterior commissure mons pubis
Posterior commissure
Labia minor
Prepuce: superior to the clitoris
Frenulum: inferior to the clitoris
Fourchette (frenulum of the labia)
Vestibule (urogenital sinus)
External urethral ostium
Vaginal introitus
Fossa navicularis (between vaginal introitus and fourchette)
-- Vasculation
1. Internal and external pudendal a.
2. Internal pudendal v.
-- Innervation
br. of pudendal n.
Superifical perineal pouch
Crura of the clitoris, ischiocavernosus
Bulbs of the vestibule, bulbospongiosus
Superficial transverse perineal muscles
Branches of internal pudendal vessels, perineal nerves
Greater vestibular glands (Bartholin’s glands)
Deep perineal pouch
Proximal part of the urethra
External urethral sphincter muscle
Deep transverse perineal muscles
Dorsal nerve and artery of clitoris
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Pelvis
Bones
Coxal (hip or pelvic) bone: ilium, ischium and pubic bone join and fuse
at the acetabulum; Two hip bones form the pelvic girdle.
ilium
(1) alar plate: attachment for the thigh musculature
(2) iliac fossa: attachment for the iliacus muscle
(3) iliac crest: attachment for back and abdominal
musculature
(4) Iliac spines
(5) greater sciatic notch
1. piriformis muscle
2. suprapiriform recess: superior gluteal neurovascular
bundle
3. infrapiriform recess: inferior gluteal neurovascular
bundle, sciatic nerve, pudendal neurovascular bundle
(5) arcuate line (iliopectineal line; linea terminalis)
ischium
(1) ischial ramus:
(2) ischial tuberosity: attachment of posterior thigh muscles
and sacrotuberous ligament.
(3) ischial spine: attachment for the sacrospinous ligament
(4) lesser sciatic notch
1. obturator internus, n. to the obturator internus
2. pudendal neurovascular bundle
pubis
(1) superior pubic ramus, pubic crest, body of pubic
(2) pectineal line
(3) inferior pubic ramus
(4) pubic symphysis, superior and inferior pubic lig.
Sacrum
A. median sacral crest: spinous processes
B. ala: transverse processes
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C. sacral foramina:
(1) posterior sacral foramina: transmit dorsal primary rami
(2) anterior sacral foramina: transmit ventral primary rami
D. sacral hiatus
E. sacral cornua
Coccyx
Joint and ligaments
Lumbosacral joint
Zygapophyisal joint
Intervertebral disc
(Anterior longitudinal ligament)
Sacroiliac joint: alar plates of sacrum and ilium
A. sacrotuberous ligament: sacrum to the ischial tuberosity
B. sacrospinous ligament: sacrum to the ischial spine
C. iliolumbar ligament: iliac crest and transverse processes of L5
D. lumbosacral ligament
E. dorsal sacroiliac ligament: posterior-superior iliac spine and
dorsum of the sacrum
F. ventral sacroiliac ligament:
G. interosseous ligaments: between sacroiliac articular surfaces
Pubic symphysis joint
Gender differences
Pelvic inlet
♂: heart-shaped
♀: circular-shaped
Pubic arch
♂: 50-60o
♀: 80-85o
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True pelvis
Pelvic inlet
pubic symphysis
pubic tubercle
Linea terminalis
pubic crest, pecten pubis, arcuate line
sacral alae
sacral promontory
Pelvic wall
anterior – pubic bone
lateral – hip bond, obturator foramen, obturator internus muscle
posterior – sacrum, coccyx, piriformis
ligaments - sacrospinous ligament, sacrotuberous ligament
Muscle
-- lateral rotate extended hip joint; abduct flexed hip
Obturator internus




origin : pelvic surfaces of ilium and ischium; obturator membrane
insertion : Greater trochanter of femur
innervation : n. to obturator internus
pass through lesser sciatic foramen
Piriformis
 origin : superior margin of greater sciatic notch; sacrotuberous
ligament
 insertion : upper border of Greater trochanter of femur
 innervation : n. to piriformis
 pass through great sciatic foramen
Apertures
Obturator canal
obturator n. v.
Greater sciatic foramen
superior gluteal n. v.
11
Sciatic n.
inferior gluteal n. v.
posterior femoral cutaneous n
quadratus femoris n. v
Less sciatic foramen
pudendal n.
internal pudendal v.
nerve to obturator internus
obturator internus muscle
Pelvic floor
pelvic diaphragm
A. coccygeus muscle: ischial spine --> inferior end of sacrum
*sacrospinous ligament is a degenerated portion of the
coccygeus muscle
B. levator ani muscle
1. pubococcygeus
-- anterior fibers
-- levator prostate or sphincter vaginae
2. puborectalis
-- intermediate fibers
-- most massive portion of the levator ani muscle
-- medialmost part of pubococcygeus
3. iliococcygeus
-- posterior fibers
Perineal membrane and deep perineal pouch
External urethral sphincter
Sphincter urethovaginalis
Compressor urethra
Deep transverse perineal muscle
Perineal body
Levaor ani muscles
Deep transverse perineal muscle
Superficial transverse perineal muscle
Sphincter urethrovaginalis
12
External anal sphincter
Bubosponngiosus muscle of perineum
13
Pelvic cavity and Viscera
Gastrointestinal system
Rectum
-- upper 2/3 is covered by peritoneum
A. rectal ampulla: above the plevic diaphragm
B. rectal sling: form by puborectalis muscle of levator ani muscle
C. internal structure: 3 transverse rectal folds
a. inferior rectal fold: 1 inch above the anal canal
b. middle rectal fold
c. superior rectal fold
D. muscular coat: outer longitudinal and inner circular
Anal canal
-- upper 2/3: simple columnar epithelium
pectinate line
anal column
anal valves
anal sinus
-- lower 1/3
anal pecten: nonkeratinized stratified squamous epithelium
anocutaneous(white) line: true skin
Arteries
1. superior rectal a.  inferior mesenteric a.
2. middle rectal a.  internal iliac a.
3. inferior rectal a.  internal pudendal a.
Veins
1. superior rectal v.  inferior mesenteric v.
2. middle rectal v.  internal iliac v.
3. inferior rectal v  internal pudendal v.  internal iliac v.
Innervation
1.
parasympathetic innervation: pelvic splanchnic n., nervi
erigentes (S2-4)  inferior mesenteric plexus
14
2.
sympathetic innervation: lumbar splanchnic n. (L1-L2) inferior
3.
4.
hypogastric plexuses  pelvic plexus
afferent innervation: pelvic splanchnic n.  S2-4
referd pain: posterior thigh and posterior leg
Lymphatic drainage
1. superficial and deep inguinal node (below the pectinate line)
2. internal iliac nodes (above the pectinate line)
*internal hemorrhoids: occur above the pectinate line
*external hemorrhoids: occur below the pectinate line
15
Urinary system
Ureter
Correlation
-- anterior to common iliac a.; internal iliac a.
-- crossed by ductus deferens(♂)/uterine a.(♀)
Urinary bladder
-- lies behind the pubic symphysis and the superior pubic rami
A. external structure
a. apex, body, fundus, neck uvula
b. base
i. trigone: where ureters enter and the urethra leaves
ii. next to the prostate gland
c. anterior surface: retropubic space
d. posterior surface: cover by peritoneum
i. Relate to the rectovesical pouch, rectovesical septum
and seminal vesicles
ii. Relate to vesicouterine pouch and vesicovaginal
septum
e. median umbilical ligament (urachus)
-- remnant of allantoic duct
-- support the bladder superiorly
f. medial umbilical ligaments
-- remnant of the umbilical a.
-- support the bladder anterolaterally
g. at base support by urogenital diaphragm and endopelvic fascia
B. internal structure:
a. detrusor muscle
b. mucosal lining consists of transitional epithelium
c. trigone
d. uvula: longitudinal mucosal folding at the trigone apex
C. vasculature:
a. superior vesical a.; umbilical a.
b. middle vesical a.
16
c. inferior vesical a.:  internal iliac a. or deferential a.
d. venous return: prostatic venous plexus internal iliac v.
e. lymph node internal and external iliac nodes
D. innervation:
a. sacral parasympathetic n.  pelvic splanchnic n.
b. afferent n.  hypogastric n.  T12-L2
c. refered pain  upper lumbar dermatomes, lowest thoracic
dermatome
Urethra
A. in male (20 cm)
a. Preprostatic urethra = internal urethral sphincter
b. prostatic urethra: the thickest wall of the urethra
i. urethral crest
ii. seminal colliculus
iii. prostatic utricle
iv. openings of ejaculatory ducts
c. membranous urethra
-- the narrowest and least distensible portion of the urethra
-- correlate to the external urethral sphincter
d. spongy urethra
-- begin at the inferior fascia of the urogenital diaphragm and
terminate at the external urethral meatue of the glans penis
(navicular fossa)
B. in female
a. corresponds to prostatic urethra and membranous urethra of
the male
b. urethral orifice lies in the vestibule between the labia minor
c. the external urethral sphincter in the female is incomplete
d. paraurethral mucous glands (Skene’s glands)
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Reproductive system
Male internal genital organs
Testes
*Seminiferous tubule  rete testis  efferent ductules
Epididymis
Efferent ductules
Head
True epididymis
body, tail
Ductus deferens (Vas deferens)
a. duct of epididymis  vas deferens
b. external portion: spermatic cord internal spermatic
fasciainguinal canal abdominal cavity
c. internal course: lies within the transversalis fascia  deep
inguinal ring  testicular neurovascular bundle  external iliac
vessels obturator neurovascular bundle deep pelvis  passes
anterosuperior to the ureters  ampulla (at the base of prostate
gland)
Seminal vesicles
a. join the vas deferens where the ampulla become the ejaculatory
duct
b. location: posterior base of the urinary bladder
c. these glands do not store sperm
d. lateral pelvic plexus parasympathetic n; hypogastric plexus
sympathetic n. (for contraction)
e. ejaculatory duct: thin-walled terminal intraprostatic portion of
the vas deferens
Prostate gland
-- lies between the base of the urinary bladder and the deep
transverse perineal muscle
a. Anterior surface: retropubic space; puboprostatic ligament
18
b. Posterior surface: seminal vesicles and the rectovesical septum;
c.
d.
e.
f.
g.
rectal ampulla
lobes: anterior, median, posterior, lateral right, and lateral left
prostatic duct
supply by inferior vesical and middle rectal a. (high variation)
prostatic venous plexus internal iliac v. or vertebral v. plexus
lateral pelvic plexus parasympathetic n;
hypogastric plexus sympathetic n. (for contraction)
Bulbourethral gland
19
Female internal genital organs
Ovary
-- 3x 1.5x1 cm3
-- lies on the posterior side of the broad ligament
a. ovarian fossae: triangular depression bounded by external and
internal iliac vessel
b. ligamentous support:
i. mesovarium broad ligament
ii. suspensory ligament (infundibulopelvic ligament ) contains
the ovarian neurovascular bundle  lateral pelvic wall
iii. ovarian ligament: uterus  round ligament of uterus
c. cortex: functional portion of the ovary
d. medulla: connective tissue and vasculature
e. abdominal aortaovarian a. tubal vr.
f. right ovarian v inferior vena cava; left ovarian v. left renal v.;
ovary tubal v.  uterine v.
g. lymph node para-aortic nodes at L1
aortic plexus  automonic innervation of the ovary; T10-12
sympathetic pathway of ovary
Uterine tube
a. infundibulum: fimbriae
b. ampulla
c. isthmus
d. intramural part
Uterus
-- 8x2.5x5 cm3
fundus
body
i.
ii.
iii.
cervix
i.
cornu
uterine cavity
isthmus: corresponds with the internal os.
internal os.
20
ii.
cervical canal
iii. external os
1. relations
a. anteriorly: uterovesical pouch
b. superiorly: bladder
c. posteriorly: rectouterine pouch, sigmoid colon
d. laterally: broad ligament, uterine a. and v.
2. support
a. levator ani muscle and urogenital diaphragm bladder
uterus
b. mesometrium (broad lig.)
c. round ligament of uterus
d. transverse cervical ligament (cardinal lig.)
e. uterosacral (sacrocervical) and pubocervical ligament
3. blood supply
a. internal iliac a.  uterine a. (run in the transverse cervical lig.
At the base of the broad lig.)
b. uterine a.  ascending br.  tubal br.  anastomoses with
ovary a.
c. uterine a.  descending br. (vaginal br. ) anastomoses with
ovary a. and internal pudendal a.
d. venous return generally parallel the arterial supply
e. lymph drainge
i. uterine fundus  para-aortic nodes (L1)
ii. uterine body  internal iliac nodes
iii. cervix  internal iliac nodes and sacral nodes
4. nerve supply: inferior hypogastric plexue
Vagina
anterior fornix
posterior fornix: relates to the rectouterine pouch
right lateral fornix
left lateral fornix
21
1. relations
a. anteriorly: base of the bladder, lower half of the urethra
b. posteriorly: rectrovaginal septum, perineal body
c. laterally: levator ani muscle, endopelvic fascia, ureters and
uterine a.
d. upper 2/3 within the pelvic cavity; lower 1/3 within the
perineum
2. support
a. Upper: levatores ani muscle, transverse cervical lig.,
pubocervical lig., sacrocervical lig.
b. Middle: urogenital diaphragm
c. Lower: perineal body
3. blood supply:
a. vaginal br. of the uterine a.; vaginal br. of internal iliac a.;
vaginal br. of middle rectal a.; vaginal br. of internal pudendal
a.: run along the lateral vaginal wall
b. vaginal venous plexus  internal iliac v.
c. lymphatic drainage
i. upper 1/3  external and internal nodes
ii. middle 1/3  internal iliac nodes
iii. lower 1/3  internal iliac nodes and superficial
inguinal nodes
4. nerve supply
i. uterobaginal plexus  upper 2/3
ii. pudendal n.  lower 1/3
22
Pelvic fascia
parietal fascia
A. location: covers the piriformis muscle and obturator internus
muscle
B. subdivisions: at the arcus tendineus
i. superior fascia: visceral fascia
ii. inferior fascia: superior fascia of the urogenital diaphragm
iii. pudendal canal: inferior arcus tendineus
visceral fascia
-- lies between the peritoneum and the pelvic viscera
pelvic ligaments
-- thicken fascial continuities between the parietal and visceral
fascia
In female:
Pubocervical ligament
Transverse cervical (cardinal ligament)
Uterosacral ligament
In male:
Prostatic fascia
Rectovesical septum
Pelvic peritoneum
parietal peritoneum
-- cover portions of the pelvic wall and visceral fasciae
visceral peritoneum
-- lines the uterus, ovaries, and uterine tubes
In female:
Vesico-uterine pouch
Recto-uterine pouch
In male:
Rectovesical pouch (pouch of Douglas)
Somatic nerves
lumbar plexus (T12-L4)
-- lies in the posterior abdominal wall and iliac fossa
1. subcostal n. (T12)
23
2.
iliohypogastric n (T12-L1)
3.
4.
5.
6.
7.
ilioinguinal n. (L1)
genitofemoral n. (L1-l2)
lateral femoral cutaneous n. (L2-L3)
femoral n. (L2-L4)
obturator n. (L2-L4)
lumbosacral trunk (L4-L5)
1. anterior division; tibial portion of the sciatic n.
2. posterior division: superior and inferior gluteal n., common
peroneal portion of the sciatic n.
sacral plexus (L4-S3)
-- in the deep pelvis; in front of the piriformis muscle
1 parietal pelvic fascia separate the plexus from internal iliac
vessels
2 sciatic n.
A. common peroneal n.
a. infrapiriformis region of the greater sciatic foramen
b. posterior component of the sciatic n.
3
4
5
6
7
c. innervate the posterior aspect of the leg and the
dorsum of the foot
B. tibial n.
a. anterior component of the sciatic n.
b. infrapiriformis region of the greater sciatic foramen
c. innervate the posterior region of the thigh and leg and
the plantear surface of the foot
superior gluteal n.:
a. suprapiriformis portion of the greater sciatic
formation
b. gluteus medius and gluteus minimus muscle
inferior gluteal n.
a. infrapiriform region of the greater sciatic
foramen
b. gluteus maximus muscle
nerve to the quadratus femoris muscle, inferior gemellus
nerve to the obturator internus muscle, superior gemellus
posterior cutaneous n. of the thigh (posterior femoral
24
cutaneous n.)
8
Perforating cutaneous n.:  sacrotuberous lig.  skin of
inferior part of buttocks
9 pudendal n.:
a. Infrapiriform region of the greater sciatic foramen
b. Pudendal canal:  lesser sciatic foramen
c. Inferior rectal n.
d. Deep and superficial perineal n.
e. Dorsal nerve of penis
10 nerves to the piriformis muscle
11 anococcygeal n.: S5 & Co + S4  sacrospinous and
sacrotuberous lig.  skin of anal triangle
Visceral plexuses
1. paravertebral sympathetic chain  superior hypogastic plexus 
hypogastric n.  inferior hypogastric plexus
2. postganglionic sympathetic fibers + anterior rami of sacral n.
3. sacral splanchnic n. + prevertebral plexus (sympathetic fiber)
4. pelvic splanchnic n. + parasympathetic fiber  pelvic plexus
(inferior hypogastric plexus)
5. Pelvic splanchnic nerve: arise form spinal nerve S2-S4; anterior
ramus S4 only has a ventral division.
6. parasympathetic fiber  inferior hypogastric plexus  rectal,
uterovaginal , prostatic, and vesical plexus  vasodilation, bladder
contraction, erection
7. inferior hypogastric plexus  cavernous n.  erectile tissues
8. sympathetic fiber  sacral splanchnic n.  vasocontraction
internal urethral sphincter, internal anal sphincters, smooth muscle
contraction, ejaculation.
9. refered pain
Arteries
1. common iliac a.: at L4  left and right common iliac a.
2. external iliac a.: supplies somatic structures; inguinal
ligamentfemoral a.
A. inferior epigastric:  cremasteric a.
B. deep iliac circumflex a.
3. internal iliac a.:
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A.
anterior trunks:
a. Umbilical a.: supply urinary bladder; medial umbilical
ligament
Umbilical a. > abdominal aorta
Umbilical a.  superior vesical a.
b. Obturator a.: 30% arise from inferior epigastric a.
c. Uterine a.: tubal br.  oviducts, ovary; vaginal br.
d. Deferential a.(a. of ductus deferens): supply the vas
deferens and epididymis
e. middle rectal a.:
Inferior mesenteric a. superior rectal a. middle
rectal a. inferior rectal a. internal pudendal a.
f. internal pudendal a.: infrapiriform portion of the greater
sciatic foramen  lesser sciatic foramen
g. inferior gluteal a.: infrapiriform portion of the greater
sciatic foramen; supply coccygeus, piriformis, levator ani
muscles, gluteus maximus, lateral roator muscles, and hip
joint
h. inferior vesical a (in male): supply the neck of the urinary
bladder, prostate, seminal vesicle
B.
4.
5.
6.
i. Vaginal a. (in female): vaginal a. uterine a.
posterior trunks:
a. Iliolumbar a.
lumbar br.
-- supply the psoas and quadratus lumborum muscle,
lower lumbar vertebral and dural sac
iliac br.
-- supply the iliacus muscle
b. Lateral sacral a.
c. superior gluteal a.: the largest br.; pass through
suprapiriformis portion of the greater sciatic foramen;
supply gluteus maximus, medius, minimus., and hip joint
Superior rectal a.
Ovarian a.
Median sacral a.
Veins
1. follow the course of all br. of the internal iliac a. (except umbilical
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a. & iliolumbar a.)
2. rectal venous plexus: connect the portal system
3. Vesical venous: lie about the base of the bladder and prostate;
drain into internal iliac v. vertebral venous plexus, obturator v. and
rectal plexus
4. deep dorsal vein:  prostatic plexus of veins (in male) or vescial
plexus of vein (in female)
5. superficial vein of penis  external pudendal v  great saphenous
v
6. median sacral veins  left common iliac vein or junction of the two
common iliac veins
7. ovarian veins  left renal vein (left),
inferior vena cava (right)
Lymphatic drainage
1.
2.
3.
4.
preaortic nodes  lumbar trunk
lateral aortic nodes: along lateral surfaces of the abdominal aorta
External iliac nodes: along external and common iliac vessels
internal iliac nodes (pelvic nodes): along the internal iliac vessels
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