Intra-operative photographs of sacrotuberous ligament and pudendal nerve, right side, with patient in prone position.

A: Bilateral markings to indicate the sacrotuberous ligament (STL) (vertical lines) connecting the sacrum (dashed lines) to the ischial tuberosity (dashed circles), with the proposed angled incision from the ischiorectal fossa (arrows), then crossing the STL. B: The intact STL (arrow) is noted between the gluteus maximus muscle fibers. C: A blue vessel loop is about the pudendal nerve (arrow) exiting the STL. D: The blackened, cauterized, edges of the STL (arrows) are separated about 1.5 to 2.0 cm after division of the ligament.