Home / Comparison tables / Lymph drainage of the pelvis and perineum
Lymph drainage of the pelvis and perineum
Where each pelvic organ and perineal surface drains first — with the classic contrasts that exam questions are built on.
| Structure | First nodes | Why it matters |
|---|---|---|
| Testis | Lumbar (para-aortic) nodes, following the gonadal vessels | Testicular cancer spreads to retroperitoneal, not inguinal, nodes — so orchiectomy is done through the groin, not the scrotum |
| Scrotal skin | Superficial inguinal nodes | Testis and scrotum drain to different places |
| Ovary, uterine tube and uterine fundus | Lumbar (para-aortic) nodes, following the ovarian vessels | Some fundal lymph runs along the round ligament to the superficial inguinal nodes |
| Cervix (uterus) | Internal and external iliac (obturator) and sacral nodes | Obturator nodes are first-echelon; nodal spread upstages cervical cancer |
| Prostate and bladder | Internal and external iliac (obturator) nodes; sacral nodes for the prostate | Obturator nodes are sampled in pelvic lymphadenectomy |
| Upper rectum | Pararectal and inferior mesenteric nodes along the superior rectal vessels | Lower rectum drains to the internal iliac and sacral nodes instead |
| Anal canal above the pectinate line | Internal iliac (and inferior mesenteric) nodes | See the pectinate line table |
| Anal canal below the pectinate line | Superficial inguinal nodes | Anal squamous cell carcinoma can present with inguinal nodes |
| Vulva, lower vagina, penile skin, perianal skin | Superficial inguinal nodes | Inguinal lymphadenopathy means examining the whole perineum |
| Glans of the penis or clitoris | Deep inguinal nodes (and internal iliac) | Deep inguinal nodes lie medial to the femoral vein |
| Lower limb | Superficial inguinal nodes (vertical group) | Examine the feet and legs as well |
Chain: superficial inguinal → deep inguinal → external iliac → common iliac → lumbar (para-aortic) nodes → cisterna chyli → thoracic duct.
Key contrasts: testis → para-aortic, scrotum → superficial inguinal; ovary/fundus → para-aortic, cervix → iliac and sacral. See pelvic and inguinal lymph drainage.