Male and Female Perineum

Question 1

What are the anatomic boundaries of the perineum?

LO1

Answer 1

anterior: pubic symphysis
anterolateral: ischipubic ramus
posterolateral: sacrotuberous ligament
posterior: coccyx
superior: pelvic diaphragm
inferior: skin associated with external genitalia and anal canal

Question 2

Where is the line distinguishing the UG triangle from anal triangle?
LO1

Answer 2

ischial tuberosities

Question 3

What is contained in the urogenital triangle?

LO1

Answer 3

urethra and external genitalia

Question 4

What is contained in the anal triangle?

LO1

Answer 4

anal canal and anus

• external anal sphincter
• internal anal sphincter

Question 5

What is the external anal sphincter attached to?

Answer 5

levator ani, anococcygxgeal ligament, and perineal body (central tendon)

Question 6

What are the boundaries of the ischiorectal (ischioanal) fossae?

LO2

Answer 6

lateral wall: obturator internus and ischium
superomedial wall: levator ani and anal canal (external anal sphincter)
base: skin of perineum

Question 7

What does the ischioanal canal contain?

LO2

Answer 7

fat, blood vessels, nerves

Question 8

What is the pudendal canal?

LO6

Answer 8

fascial lined space

Question 9

Where is the pudendal canal?

LO6

Answer 9

medial surface of obturator internus

Question 10

What are the contents of the pudendal canal?

Answer 10

1. pudendal N
2. internal pudendal A
3. internal pudendal V

Question 11

What supplies the inferior rectum?
-where do they travel

LO8

Answer 11

• inferior rectal A (branch of internal pudendal A)
• inferior rectal V (tributary to internal pudendal V)
• travel through the ischiorectal fossae

Question 12

What is the inferior rectal N?

LO7

Answer 12

• branch of pudendal N
• travels through ischiorectal fossae
• supplies anal sphincters and skin

Question 13

Describe the two spaces in the urogenital triangle

LO3

Answer 13

superficial perineal space

deep perineal space: urogenital diaphragm and associated fascia and structures

Question 14

What structures are in the deep perineal space in males?

LO3

Answer 14

1. superior fascia
2. inferior fascia or perineal membrane
3. deep transverse perineus m
4. external urethral sphincter
5. membranous urethra
6. bulbourethral glands

Question 15

What structures are in the deep perineal space in females?

LO3

Answer 15

1. superior fascia
2. inferior fascia or perineal membrane
3. deep transverse perineus m
4. external urethra sphincter surrounds urethra
5. compressor urethrae
6. vagina

Question 16

What structures are in the superficial perineal space in males?

LO3
LO10

Answer 16

1. root of penis
   - 2 crura
   - bulb of penis
   - ischiocavernosus m
   - bulbospongiosus m
2. spongy or penile urethra
3. superficial transverse perineus m

Question 17

What are the parts of the body (shaft) of the penis?

LO10

Answer 17

1. skin
2. subcuteaneous tissue
3. corpus spongiosum (contains penile urethra)
4. corpus cavernosum (bilateral)
5. dorsal a, v, n of penis

Question 18

What does the vulva consist of?

LO10

Answer 18

1. labia majora
2. labia minora
3. clitoris

Question 19

What is the vestibule of the vagina?

LO10

Answer 19

• surrounded by labia minora
• contents
  1. external urethral orifice
  2. vaginal orifice
  3. paraurethral glands orifices
  4. greater vestibular glands orifices

Question 20

What are the parts of the clitoris?

LO10

Answer 20

1. bilateral crura covered by ischiocavernosus m
2. bilateral corpora vacernosus
3. body
4. glans clitoris (visible externally)

Question 21

What are the contents of the superficial perineal space of the female?

LO3

Answer 21

1. bulbs of the vestibule
2. bulbospongiosus m (bulbocavernosus m)
3. greater vestibular (Bartholin’s) glands
4. superficial transverse perineus m
5. clitoris
6. ischiocavernosus m

Question 22

Describe the blood supply of the perineum

LO10

Answer 22

1. external pudendal A
   - scrotum and penis in males
   - labia majora and clitoris in females
2. internal pudendal A (branch of internal iliac A_
   - passes through greater and lesser sciatic foramena to enter pudendal canal
   - branches to all perineal structures

Question 23

What are the pudendal N contents?

LO5

Answer 23

1. preganglionic parasympathetic
2. somatic motor fibers
3. somatic sensory fibers
4. postganglionic sympathetic

Question 24

What is the path of the pudendal N?
-branches and what they innervate

LO4
LO5

Answer 24

S2-S4 –> greater sciatic foramen –> under ischial spine and sacrospinous ligament –> lesser sciatic foramen –> pudendal canal

branches

• inferior rectal nerve (external anal sphincter and anal skin)
• dorsal nerve (penis/clitoris)
• pudendal N (ischiocavernosus, bulbospongliosus, deep transverse perineal, superficial transverse perineal, sphincter urethrae, scrotum/labia majora, and urethra/labia minora)

Question 25

What are the causes of male impotence?

LO11

Answer 25

1. nerve damage to prostatic nerve plexus
2. atherosclerosis advrsely affect blood supply to erectile tissues
3. type II diabetes
4. spinal cord injury
5. hormonal disorders
6. psychological disorders

Question 26

Where does lymph go from the distal portions of vagina and anal canal?

Answer 26

Superficial Inguinal lymph nodes

Question 27

Path of lymph from the proximal vagina, proximal anal canal?

Answer 27

Internal iliac lymph nodes

Question 28

What is an episiotomy?

Answer 28

Surgical incision btwn vagina and anus to prevent perineal tear during delivery.
4 types
Most common is a medio-lateral incision. Incision made through posterior vaginal wall, bulbospongiosus m, superficial transverse perneus m, skin and associated fascia.
Repair involves 3 layers of sutures in vaginal wall, muscle layer, and subcutaneous fascia and skin.