Pudendal nerve

Question 1

Pudendal nerve anatomy

Answer 1

• S2–S4
• Exits the pelvis initially through the greater sciatic foramen below the piriformis
• Importantly, it runs behind the lateral third of the sacrospinous ligament and ischial spine alongside the internal pudendal artery and immediately re-enters the pelvis through the lesser sciatic foramen to the pudendal canal (Alcock’s canal)

Question 2

Pudendal nerve injury

Answer 2

Susceptible to entrapment injuries during sacrospinous ligament fixation as it runs behind the lateral aspect of the sacrospinous ligament

Question 3

Pudendal nerve injury symptoms

Answer 3

Postoperative gluteal, perineal and vulval pain, which worsens in the seated position if the nerve is damaged.[