Nerves and lymphatics of the pelvis

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Nerves and lymphatics of the pelvis

USMLE® Step 1 questions

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Nerves and Lymphatics of the Pelvis

Figure 1. A. Anterior view of the lymph nodes in a biologically female pelvis.  B. Midsagittal view of a biologically female pelvis showing the lymphatic drainage of the pelvis and perineum.
Figure 2.  Anterolateral view of a biologically female pelvis showing the nerves of the pelvis.
Figure 3. A. Anterior view of the somatic nerves of the pelvis. B. Posterior view of the course of the gluteal nerves.
Figure 4. Anterior view of the autonomic nerves of the pelvis.
Unlabelled diagrams


USMLE® Step 1 style questions USMLE

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A 60-year-old man presents to his primary care physician because of difficulty urinating and nocturia. Digital rectal examination is performed and reveals nodular enlargement of the prostate. A biopsy is obtained and confirms adenocarcinoma of the prostate. Which of the following lymph nodes are at the greatest risk of subsequent metastasis? 


The neurovascular structures of the pelvis include nerves, arteries, veins, and lymph nodes. These structures lie on the posterolateral walls of the pelvic cavity.

Generally the somatic nerves are the most lateral, arteries lie medial to nerves, and veins lie between these two.

Lymph nodes are usually clustered around the veins, and lymph vessels that come off these nodes ascend parallel to the veins. Now, let's take a closer look at the lymphatics and nerves of the pelvis specifically.

Let’s talk about the lymphatic drainage of the pelvis, which follows various major and minor groups of lymph nodes.

These lymph nodes have variable, sizes, numbers, and locations, and the lymph node clusters’ names are based on the adjacent structures and nearby blood supply.

Furthermore, these nodes are all interconnected, so their drainage often overlaps and can vary quite a bit.

First, there are the inguinal lymph nodes which lie around the inguinal ligament, and they’re divided into superficial and deep inguinal lymph nodes.

The superficial inguinal lymph nodes receive lymphatic drainage from the superficial lower limb, abdominal wall inferior to the umbilicus, gluteal region and superficial perineal structures such as the distal vagina, vulva and scrotum, and typically drain into the external iliac lymph nodes.

The deep inguinal lymph nodes receive lymph from the superficial inguinal nodes, as well as the deep portions of the lower limb, the glans clitoris in females or glans penis in males and the distal spongy urethra. These nodes typically drain into the external and common iliac lymph nodes.


The pelvis is the lower part of the trunk of the body, located between the abdomen and the legs. It has several important nerves that innervate various structures; and a network of lymphatic vessels and lymph nodes.

The nerves of the pelvis are divided into somatic and autonomic nerves. Somatic nerves arise from the lumbosacral and coccygeal plexus, and include the obturator, sciatic, superior gluteal, inferior gluteal, pudendal, nerve to piriformis, nerve to quadratus femoris, nerve to obturator internus, nerves to levator ani and coccygeus, and the posterior cutaneous nerve of the thigh.

Autonomic nerves of the pelvis include the sacral sympathetic trunks, which supply the lower limb. These include the periarterial plexuses, which supply motor fibers to the superior rectal, ovarian, and internal iliac arteries and their branches; the hypogastric plexuses, the main origin of sympathetic fibers in the pelvis; and pelvic splanchnic nerves, which are the main origin of parasympathetic fibers in the pelvis. There are also visceral afferent fibers that receive sensory information from the pelvic viscera.

The lymphatic drainage of the pelvis consists of major and minor lymph nodes. Major lymph nodes include the superficial and deep inguinal, internal iliac, external iliac, sacral, and common iliac lymph nodes; whereas minor lymph nodes lie in the connective tissue that surrounds branches of the internal iliac blood vessels.


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  6. "Last's Anatomy e-Book" Elsevier Health Sciences (2011)
  7. "Clinically Oriented Anatomy" ‎ Lippincott Williams & Wilkins (2008)

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