Female Pelvis & Perineum Flashcards
The Hip bone is also known as the _________ bone
Innominate
What are the 3 bones that make up the hip
Illium (crests)
Ischium
Pubis
Attachments for the Inguinal Ligament
Anterior Superior Iliac Spine–> Pubic Tubercle
The Pubis has 2 rami (True or False)
True (superior and inferior)
Angle inbetween the inferior rami of the pubis bones as they approach the symphysis; is wider in females to facilitate childbirth
Pubic Arch
The LATERAL attachment for the Inguinal Ligament
Anterior Superior Iliac Spine
The MEDIAL attachment for the Inguinal Ligament
Pubic Tubercle
Pointed triangular eminence pointing behind the Ischium; separates the Greater and Lesser Sciatic notches; IMPORTANT landmark for Pudendal nerve blocks
Ischial Spine
Pelvic structure that serves as important landmark when performing Pudendal nerve blocks
Ischial Spine
The Ischial Spine separates what two structures
The Greater and Lesser Sciatic Notches
Tuberosity located on the posteroinferior aspect of the hip; serves as attachment for the hamstring muscles
Ischial Tuberosity
Bony connection between the Ischium and the Inferior Ramus of the Pubis; site of attachment for erectile tissues of the genitalia
Ischiopubic Ramus
Opening at the inferior end of the Sacrum
Sacral Hiatus
Main differences between the Male and Female Pelvis
Male: taller, narrower with smaller Pubic arch
Female: larger, broader and wider Pubic arch
Muscular lining that defines the floor of the Pelvic cavity
Pelvic Diaphragm
The Pelvic Inlet is also known as…
the Pelvic Brim
What divides the Pelvis into the “true” and “false” pelvis
Pelvic Inlet (or Brim)
Strong synovial joints between the sacrum and the Hip bones (ilium)
Sacroiliac joints
Strong cartilaginous joint at the anterior midline that joins the Pubic bones
Pubic Symphysis
What hormone, during pregnancy, relaxes the hip ligaments (Sacroiliac, Pubic Symphysis, etc.) to facilitate childbirth
Relaxin
What two posterior ligaments help to further stabilize the Sacrum to the hip bones
Sacrospinous ligament (sacrum to ischial spine) Sacrotuberous ligament (sacrum to ischial tuberosity)
What foramina are present in the Hip (3 total)
Greater Sciatic foramen
Lesser Sciatic foramen
Obturator foramen
The Pelvic (wall/floor) muscles eventually exit the pelvic cavity and attach to the femur to move the hip joint
Wall
The Pelvic (wall/floor) muscles support the overlying pelvic organs
Floor
Examples of Pelvic Wall muscles (2 total)
Piriformis
Obturator Internus
Pelvic Wall muscle; forms the posterior wall of pelvis and passes through the Greater Sciatic Foramen and attaches to femur
Piriformis
Pelvic Wall muscle; forms the lateral wall of the pelvis and passes through the Lesser Sciatic Foramen and attaches to femur
Obturator Internus
The Piriformis exits through the (Greater/Lesser) Sciatic Foramen
Greater
The Obturator Internus exits through the (Greater/Lesser) Sciatic Foramen
Lesser
Thickening of the Obturator Fascia (which covers obturator internus); forms a line from the Pubis to the Ischial Spine; site of attachment for pelvic floor muscles
Arcus Tendineus
What are the muscles that form the Pelvic Diaphragm (2 total)
Levator Ani*
Coccygeus
*largest
Which of the Pelvic Floor muscles, the Levator Ani or the Coccygeus, is the largest
Levator Ani
The Levator Ani is made of what 3 muscles
Pubococcygeus (middle)
Iliococcygeus (posterior)
Puborectalis (anorectal)
Opening in the Levator Ani pelvic floor muscle; allows passage of the Urethra, Vagina and Rectum
Levator Hiatus
The Levator Hiatus allows the passage of what structures
Urethra
Vagina
Rectum
Pelvic floor muscle that plays a huge role in Urinary and Fecal continence
pelvic diaphragm (especially Levator Ani b/c it’s the largest and has puborectalis that surrounds the levator hiatus)
Fibromuscular mass (central tendon of perineum) at the base of the pelvic diaphragm; site were several muscles of the Perineum converge; essential for the integrity of the Pelvic floor, and if ruptured during vaginal birth –> causes organ prolapse
Perineal body
Strongest of the Levator Ani pelvic floor muscles; tears (during childbirth) can result in cystocele (bladder incontinence) and rectocele (defecatory dysfunction)
Pubococcygeus
Prolapse of the bladder through the Pelvic diaphragm
Cystocele
Prolapse of the rectum through the Pelvic diaphragm
Rectocele
Peritoneal recess between the Bladder and Uterus
Vesicouterine Pouch
Peritoneal recess between the Uterus and the Rectum
Rectouterine Pouch
The Rectouterine Pouch is also known as…
the Pouch of Douglas
The most inferior recess of the FEMALE Peritoneal cavity
Rectouterine Pouch
Peritoneal recess between the Bladder and Rectum (only in Males)
Rectovesical Pouch
Which Peritoneal recess is ONLY seen in Males
Rectovesical pouch (because females have the uterus between the bladder and rectum instead)
The most inferior recess of the MALE Peritoneal cavity
Rectovesical Pouch
Subperitoneal space between the Pubic Symphysis and the Bladder
Retropubic space
Subperitoneal space between the Rectum and Sacrum
Retrorectal space
fibrous fascia/septum between the Rectum and Vagina
Rectovaginal septum/fascia
The pelvic viscera are vascularized by the (external/internal) Iliac artery
Internal
The Aorta divides into the Right and Left Common Iliac arteries at what vertebral level
L4
The Internal Iliac artery descends into the Pelvic cavity and further divides into what?
Anterior and Posterior division
The Posterior division of the Internal Iliac artery has what branches?
Iliolumbar
Lateral Sacral
Superior Gluteal
(Mnemonic: I Like Spaghetti)
The (Anterior/Posterior) division of the Internal Iliac Artery provides the main supply for the Pelvic Viscera
Anterior
Branch of the Anterior division of the Internal Iliac artery; traverses OVER the ureter to supply the Uterus
Uterine artery
The Ureter goes (over/under) the Uterine artery
Under
Branch of the Anterior division of the Internal Iliac artery; supplies the Perineum
Internal Pudendal artery
Which branch of the Anterior division of the Internal Iliac actually EXITS the Pelvis through the Greater Sciatic Foramen, traverses AROUND the ischial spine, and RE-ENTERS the Lesser Sciatic Foramen
Internal Pudendal Artery
What are the 3 main branches of the Internal Pudendal artery
Inferior Rectal artery (external anal sphincter) Perineal artery Dorsal Clitoral (or dorsal penile) artery
What are the 2 divisions of the ventral ramus of the L1 nerve
Iliohypogastric nerve
Ilioinguinal nerve
Division of the L1 ventral ramus; supplies sensation to the hypogastric region
Iliohypogastric nerve
Division of the L1 ventral ramus; passes through the inguinal canal and supplies sensation to the scrotum and labia majora
Ilioinguinal nerve
Nerve from L1 and L2; provides sensation for the medial groin and labia/scrotum
Genitofemoral nerve
The main source of SOMATIC innervation for the Perineum is what?
Pudendal nerve
What are the 3 divisions of the Pudendal nerve
Inferior Rectal nerve (anus)
Perineal nerve (scrotum/labia)
Dorsal penile/clitoral nerve
*same divisions as the artery
Inferior Hypogastric Plexus is aka
Pelvic Plexus
Inferior Hypogastric Plexus is divided into what smaller plexuses
- Vesical plexus
- Uterovaginal plexus
- Rectal Plexus
A smaller plexus of Inferior Hypogastric Plexus that provides autonomic innervation to the bladder
Vesical plexus
A smaller plexus of Inferior Hypogastric Plexus that provides autonomic innervation to the uterus and vagina
Uterovaginal plexus
Sympathetic splanchnic nerves arise from
T10-L2
Parasympathetic splanchnic nerves arise from
S2-4
Parasympathetic splanchnic nerves is aka
pelvic splanchnic nerves
Pain sensations from the fundus and body of uterus are conveyed via visceral sensory nerves that retrograde with the
Sympathetic splanchnic nerves (T10-L2)
Pain sensations from the cervix and upper vagina are conveyed via visceral sensory nerves that retrograde with the
pelvic (parasympathetic) splanchnic nerves (S2-S4)
Creates an imaginary line within the pelvis for pain
pelvic pain line
When structures above or in contact with the peritoneum convey visceral pain sensations via the sympathetic splanchnic nerves is referred to as
above the pelvic pain line
When structures below the peritoneum convey visceral pain sensations via the pelvic splanchnic nerves is referred to as
below the pelvic pain line
Pelvic diaphragm/Levator ani is innervated by what nerves?
Sacral nerves (S2-S4) and pudendal nerve
What skeletal muscles are strengthened by kegel exercises?
Pelvic diaphragm/pelvic floor muscles (levator ani majorly)
- Pubococcygeus (middle)
- Iliococcygeus (posterior)
- Puborectalis (anorectal)
Weakening of pelvic diaphragm can result in prolapse of
uterus, bladder, and rectum
spaces filled with a loose connective tissue called endopelvic fascia
subperitoneal recesses
- starts with “RETRO-“
What nerves traverse alongside the ischial spine?
- pudendal nerve
2. Sacral plexus (S2-S4)