The internal pudendal artery originates as a branch of the anterior trunk of the internal iliac artery in the pelvis (Fig. 5.77). Along with the pudendal nerve, it leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle. It passes around the ischial spine, where the artery lies lateral to the nerve, enters the perineum by coursing through the lesser sciatic foramen, and accompanies the pudendal nerve in the pudendal canal on the lateral wall of the ischio-anal fossa.