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Reproductive Anatomy > Anatomy of the Female Perineum > Flashcards

Anatomy of the Female Perineum Flashcards

1
Q

What is the perineum

A

the region of the body below the pelvic diaphragm

- It is a diamond shaped area between the thighs

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2
Q

What are the boundaries of the perineum?

A
  1. Anteriorly Mons pubis
  2. Laterally Medial surfaces of the thighs
  3. Posteriorly Intergluteal folds
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3
Q

What are the contents of the perineum?

A

Lower ends of urethra, vagina & anal canal
External genitalia
Perineal body & Anococcygeal body

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4
Q

What is the perineal body?

A

an irregular mass of variable size and consistency, located at midpoint of the line between the ischial tuberosities
- Forms the central point of the perineum & blends anteriorly with the perineal membrane

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5
Q

Where is the perineum located?

A

Lies in the subcutaneous tissue, posterior to vestibule and anterior to the anal canal & anus

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6
Q

Functions of the perineal body?

A

Gives attachment to perineal muscles

Plays an important role in visceral support especially in female

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7
Q

What is the anococcygeal body?

A

is a complex musculotendinous structure situated between the anterior aspect of the coccyx and the posterior wall of the anorectal canal
- Receives insertion of fibers of levator ani muscle

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8
Q

What are the bony boundaries of the perineum?

A
  1. Anterior: Symphysis pubis.
  2. Posterior: Coccyx.
  3. Lateral: Ischiopubic rami, ischial tuberosities & sacrotuberous ligament.
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9
Q

How is the perineum divided?

A

By an imaginary line passing through two ischial tuberosities
it is divided into:
1. Urogenital triangle anteriorly.
2. Anal triangle posteriorly.

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10
Q

What are the boundaries of the urogenital triangle?

A

Anteriorly : Symphysis pubis
Posteriorly : Transverse line passing through the 2 ischial tuberosities.
Laterally : Ischiopubic rami & ischial tuberosities.

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11
Q

What are the contents of the urogenital triangle?

A 
Lower part of urethra & vagina.
External genitalia (vulva).
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12
Q

What is the urogenital diaphragm?

A

A triangular musculofascial diaphragm located in the anterior part of the perineum
Fills in the gap between the pubic arch

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13
Q

What is the urogenital diaphragm composed of?

A

Sphincter urethrae and the deep transverse perineal muscles enclosed within the superior and inferior layers of fascia of the urogenital diaphragm
The inferior layer of the fascia is formed by the perineal membrane

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14
Q

What are the structures of the female external genitalia?

A

Mons pubis : a collection of fat overlying the pubes.
Labia majora.
Labia minora.
Clitoris.
Vestibule of vagina: The interval between the two labia minora.
Vagina & urethra open into the vestibule through urethral orifice anteriorly and vaginal orifice posteriorly.

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15
Q

Describe the fascia of the urogenital triangle/perineal fascia?

A

The perineal fascia is continuous anteriorly with the fascia of abdomen and consists of superficial and deep layers

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16
Q

Describe the superficial perineal fascia?

A

Consists of a:

  1. Superficial fatty layer (Camper’s fascia) makes up the substance of mons pubis & labia majora and extends into the anal region
  2. Deep membranous layer (Colle’s fascia ): Does not extend to anal region. Becomes fused with the posterior margin of the perineal membrane
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17
Q

Describe the deep perineal fascia?

A

invests the muscles in the superficial perineal pouch

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18
Q

What is the superficial perineal pouch?

A

It is the space between the deep membranous layer of superficial fascia and the perineal membrane.

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19
Q

What are the boundaries of the superficial perineal pouch?

A

Inferiorly: membranous layer of superficial fascia.
Superiorly: perineal membrane.
Laterally: ischiopubic rami

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20
Q

What are the contents of superficial perineal pouch?

A
  1. Bulbs of vestibule: on each side of vaginal orifice.
  2. Crura of clitoris.
  3. Superficial perineal muscles:
    - Bulbospongiosus muscle, surrounds orifice of vagina and covers vestibular bulb.
    - Ischiocavernosus muscle, covers crus of clitoris on each side.
    - Superficial transverse perineal muscles.
  4. Greater vestibular glands: on each side of vaginal orifice.
  5. Perineal branch of pudendal nerve supplying muscles & skin
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21
Q

Describe the deep perineal pouch?

A

It is a completely closed space deep to the perineal membrane
- same as urogenital diaphragm

22
Q

What are the boundaries of the deep perineal pouch?

A

Inferiorly: Inferior fascia of the urogenital diaphragm (Perineal membrane)
Superiorly: Superior fascia of the urogenital diaphragm
Laterally: Inferior portion of obturator internus facia

23
Q

What are the contents of the deep perineal pouch?

A 
Part of urethra
Part of vagina
Sphincter urethrae muscle, which is  pierced by urethra & vagina.
Deep transverse perineal muscles
Internal pudendal vessels
Dosal nerve of clitoris
24
Q

Describe the vagina?

A

The vagina is a muscular canal that leads from the uterus to the external orifice of the genital canal
It measures about 3 in. (8 cm) long.
It serves as the excretory duct for the menstrual flow & forms part of the birth canal.
The vaginal orifice in a virgin possesses a thin mucosal fold, called the hymen, which is perforated at its center.

25
Q

Describe the arterial supply of the vagina?

A

Vaginal artery, a branch of the internal iliac artery

Vaginal branch of the uterine artery

26
Q

Describe the venous drainage of the vagina?

A

drain into the internal iliac veins

27
Q

What are the boundaries of the anal triangle?

A

Anteriorly: Transverse line passing through the 2 ischial tuberosities.
Posteriorly : coccyx.
Laterally : ischial tuberosity & sacrotuberous lig.

28
Q

What are the contents of the anal triangle?

A

Lower part of Anal canal
Ano-coccygeal body
Ischiorectal fossa on each side

29
Q

Describe the anal canal?

A

It is about 1.5 in. long, descending from the rectal ampulla to the anus.

30
Q

What are the relations of the anal canal in females?

A

Anteriorly: Perineal body, urogenital diaphragm, and lower part of vagina
Posteriorly: Anococcygeal body.
Laterally: Ischiorectal fossae

31
Q

Describe the divisions of the anal canal?

A
  1. Upper half: derived from hindgut (endoderm)
  2. Lower half: derived from the proctodeum (ectoderm)
    - The two parts have different blood supply, nerve supply and lymphatic drainange.
32
Q

Describe the Arterial supply, venous drainage, lymphatic drainage and innervation of upper half of the anal canal?

A
  1. arterial supply - Superior rectal artery (continuation of the inferior mesenteric artery)
  2. venous drainage - Superior rectal vein drained into the inferior mesenteric vein (portal circulation)
  3. lymphatic drainage - Para-rectal nodes drained into inferior mesenteric lymph nodes
  4. innervation - Visceral motor (sympathetic & parasympathetic) & sensory nerves
33
Q

Describe the Arterial supply, venous drainage, lymphatic drainage and innervation of the lower half?

A
  1. arterial supply - Inferior rectal a. (branch of internal pudendal artery)
  2. venous drainage - Inferior rectal vein drained into the internal pudendal vein (Systemic circulation) (site of portal-systemic anastomosis)
  3. lymphatic drainage - Superficial inguinal lymph nodes
  4. innervation - Somatic motor & sensory nerves
34
Q

What is the ischiorectal fascia?

A

A fascial lined wedge-shaped space on each side of the anal canal.

35
Q

What are the boundaries of the ischiorectal fossa?

A

Base: Skin of the perineum.
Medial wall: Levator ani & anal canal.
Lateral wall: Obturator internus, covered with fascia.

36
Q

What are the contents ischiorectal fossa?

A

Dense fat.
Pudendal nerve & internal pudendal vessels within the pudendal canal
Inferior rectal nerve & vessels crossing the fossa to reach anal canal.

37
Q

What is the pudendal canal?

A

A fascial canal formed by obturator fascia, located on the lateral wall of the ischiorectal fossa

38
Q

What are the contents of the pudendal canal?

A

Pudendal nerve

Internal pudendal vessels

39
Q

What is the pudendal nerve block?

A

is used in providing analgesia for the second stage of labour and to provide anesthesia of the perineum in order to create or repair an episiotomy. Can be done by transvaginally or through perineal approach

40
Q

Describe the transvaginal method for the pudendal block?

A

The needle is passed through the vaginal mucous membrane toward the ischial spine. After the needle is passed through the sacrospinous ligament, the anesthetic solution is injected around the pudendal nerve

41
Q

Describe the perineal method for the pudendal block?

A

The ischial tuberosity is palpated subcutaneously through the buttock. The needle is inserted on the medial side of the ischial tuberosity to a depth of about 1 in. (2.5 cm) from the free surface of the tuberosity. The anesthetic is injected around the pudendal nerve.

42
Q

What is an episiotomy?

A

episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor to prevent perineal tear.

43
Q

Describe the types of vaginal tears during vaginal deliveries?

A

1st degree tear: Vaginal skin only
2nd degree tear: Vaginal skin + perineal muscles(superficial)
3rd degree tear: Vaginal skin, Perineal muscles (superficial) + Anal sphincters (EAS +/- IAS)
4th degree tear
- EAS, IAS and mucosa torn

44
Q

Name pelvic floor disorders?

A

Pelvic Organ Prolapse (POP)
Urinary Disorders
Bowel disorders
Pain disorders

45
Q

What is a rectocele prolapse?

A

Posterior vaginal wall prolapse

Dropping of rectum forward and downward against posterior wall of vagina

46
Q

What are the symptoms of the rectocele prolapse?

A

Vaginal mass/ fullness
Sensation of stool becoming ‘stuck’ as it moves through rectum
Incomplete evacuation
Digital splinting to assist evacuation

47
Q

What is a cystocele prolapse?

A

Anterior vaginal wall prolapse

Dropping of bladder base down and backward against anterior vaginal wall

48
Q

What are the symptoms of the cystocele prolapse?

A

Vaginal mass/ fullness
Recurrent UTI secondary to incomplete emptying
Lower abdo dragging/ discomfort
Obstructive/ irritable voiding symptoms
Hesitancy, straining to void, slow flow, incomplete emptying, double voiding, post void dribble, leaning forward to void

49
Q

What is a uterine prolapse?

A

Dropping of uterus down the vagina

50
Q

What are the symptoms of a uterine prolapse?

A 
Vaginal mass/ fullness
Perineal pressure (like a displaced tampon)
LBP
Painful intercourse
Mass at introitus
Obstructive urinary symptoms

Reproductive Anatomy (16 decks)

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