The pudendal nerve is responsible for orgasm, urination, and defecation in both sexes. The pudendal nerve innervates the penis and clitoris, bulbospongiosus and ischiocavernosus muscles, and areas around the scrotum, perineum, and anus. At sexual climax, the spasms in the bulbospongiosus and ischiocavernous results in ejaculation in the male and most of the feelings of orgasm in both sexes. These muscles pulse at 0.8Hz at orgasm in both sexes. Difficult childbirth or cycling can compress or stretch the pudendal nerve but permanent injury is rare. Entrapment of the nerve is very rare but can happen. Pudendal Nerve Entrapment (PNE) is akin to Carpal Tunnel syndrome.
In the upper part of its course the nerve rests upon the posterior surface of the ischium, the nerve to the Quadratus femoris, the Obturator internus and Gemelli, and the Quadratus femoris; it is accompanied by the posterior femoral cutaneous nerve and the inferior gluteal artery, and is covered by the Glutæus maximus.
The perforating cutaneous nerve may arise from the pudendal or it may be absent; in the latter case its place may be taken by a branch from the posterior femoral cutaneous nerve or by a branch from the third and fourth, or fourth and fifth, sacral nerves.
Branches of this nerve communicate with the perineal branch of the posterior femoral cutaneous and with the posterior scrotal nerves at the forepart of the perineum.
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