Male and female Perineum

Question 1

what is the Perineum?

Answer 1

Perineum is a 3 dimensional space that contains the external genitalia and the anal canal

Question 2

what are the boundaries of the perineum?

Answer 2

Anterior: Pubic symphysis

Posterior: coccyx

Lateral:
-ischiopubic rami and the sacrotuberous ligaments

superior: pelvic diaphragm (muscular floor of pelvic cavity)

Inferior: skin associated with external genitalia and anal canal

Question 3

what are the two triangles of the perineum, what do they contain and the line that splits them?

Answer 3

Imaginary line connecting the ischial tuberosities divides diamond shaped perineum into the two triangles

Urogenital triangle: contains the urethra and the external genitalia
-the more anterior triangle

Anal triangle:

• contains the anal canal and anus
• posterior triangle

Question 4

what is the anal canal composed of?

Answer 4

External sphincter

• skeletal muscle that is the distal 2/3 of the canal
• attached to the levator ani, anococcyxgeal ligament and the perineal body (central tendon)

Internal anal sphincter

• smooth muscle that is proximal 2/3 of the canal
• continuous with rectum

Question 5

what is the boundaries of the ischiorectal Fossae and what are its contents? what is its function

Answer 5

Lateral wall: obturator internus and ischium

superomedial wall: levator ani and anal canal (external anal sphinter)

Base: skin of perineum

contents:

• fat
• blood vessels
• nerves (pudendal canal

during distention of the anal canal during defication is made possible due to the ishiorectal fossae

Question 6

where is the pudendal canal and what three contents run through it?

Answer 6

Fascial lined space

On medial surface of obturator internus Muscle

Contents:

• Pudendal N
• Internal pudendal artery
• Internal pudendal V

Question 7

what are the inferior rectal vessels and where do they travel?

Answer 7

Inferior rectal artery: branch of the internal pudendal artery

Inferior rectal vein: tributary to internal pudendal vein

Vessels travel through the ischiorectal fossae

Question 8

what is the inferior rectal nerve? what does it supply? where does it travel?

Answer 8

Inferior rectal nerve is a branch of the pudendal nerve

travels through the ischiorectal fossae

supplies the anal sphincters and skin

Question 9

what are the two spaces in the urogenital triangle for males?

Answer 9

• Superficial perineal space: a potential space deep to the perineal skin that covers the external genitalia
• Deep perineal space which includes the urogenital diaphragm and associated fascia structures

Question 10

what makes up the urogenital diaphragm as well as the deep perineal space for males

Answer 10

1) superior fascia
2) inferior fascia or perineal membrane
3) Deep transverse perineus muscle
4) external urethral sphincter surrounds the membranous urethra
5) Membranous urethra
6) Bulbourethral glands: produce mucosus which is secreted into the penile urethra prior to ejaculation

Question 11

what makes up the Urogenital diaphragm or deep perineal space for the female?

Answer 11

1) superior fascia
2) Inferior fascia or perineal membrane
3) Deep transverse perineus muscle
4) External urethral sphincter surrounds urethra
5) compressor urethrae
6) Vagina

Question 12

what makes up the superficial perineal space in the males?

Answer 12

Root of the penis:

1) Two crura
2) bulb of penis
3) Ischiocavernosus muscle
4) Bulbospongiosus muscle

spongy or penile urethra

Superficial transverse perineus muscle

Question 13

what makes up the shaft of the penis

Answer 13

1) skin
2) subcutaneous tissue (no fat)
3) Corpus spongiosum (contains penile urethra)
4) Corpus cavernosum (bilateral)
5) Dorsal a,n,v, of the penis

Question 14

what makes up the Vulva

Answer 14

Vulva:

• Lavia majora
• Labia minora
• Clitoris

Question 15

what makes up the Vestibule of the Vagina and what surrounds it?

Answer 15

Surrounded by the labia minora

Contents:

• External urethra; orifice
• vaginal orifice
• paraurethral glands orifices
• sgreater vestibular glands orifices

Question 16

what are the components of the Clitoris?

Answer 16

1) Bilateral crura covered by ischiocavernosus muscles
2) bilateral corpora cavernosus
3) body
4) Glans clitoris (visible externally)

Question 17

what are the contents of the superficial perineal space femal

Answer 17

1) bulbs of the vestibule
2) bulbospongiosus muscle (bulbcavernosus m)
3) Greater vestibular (bartholins) glands
4) superfical transverse perineus muscle
5) Clitoris
6) Ischiocavernosus muscle

Question 18

What is the blood supply to the Perineum

Answer 18

1) External pudendal artery supplies the scrotum and penis in males and the labia majora and clitoris in females

2) internal pudendal artery, a branch of internal iliac artery: passes through the greater and lesser sciatic foramena to enter the pudendal canal
- then branches to all perineal structures both deep and superficial
- branches are inferior rectal artery, perineal arteries, dorsal artery, and deep artery of the penis/clitoris

Question 19

What are the contents of the Pudendal Nerve?

Answer 19

S2-S4

1) preganglionic parasympathetic
2) somatic motor fibers
3) somatic sensory fibers
4) Postganglionic sympathetic fibers

Question 20

what are the branches of the Pudendal nerve and what do they innervate?

Answer 20

Inferior rectal nerve:

• external anal sphincter (S2-S3)
• anal skin

Dorsal nerve:
-Penis and clitoris

Perineal nerve:

• Scrotum/labia majora
• urethra/labia minora
• Ischiocavernosus
• bulbospongiosus
• deep transverse perineal
• superficial transverse perineal
• sphincter urethrae

Question 21

what are 6 causes of Male Imotence:

Answer 21

1) Nerve damage to prostatic nerve plexus
2) Athersclerosis can adversly affect blood supply to erectile tissues
3) Type II diabetes
4) spinal cord injuries
5) Hormonal disorders
6) psycholocical disorders

Question 22

what is the lymphatic drainage of the Perineum

Answer 22

1) superficial perineal space, distal portions of vagina and anal canal (inferior to pectinate line) drain to the superficial inguinal nodes
2) Deep perineal space, proximal vagina, proximal anal canal (superior to pectinate line) will drain to the internal iliac nodes

Question 23

What is an Episiotomy?

Answer 23

Surgical incision between the vagina and anus to prevent perineal tear during delivery

Four types of episiotomy: most common is the medio-lateral incision.

Incision is made with scissors through the posterior vaginal wall, bulbospongious muscle, superficial transverse perineus muscle, skin and associad fascia

Repair involves 3 layers of sutures in vaginal wall, muscular layer and subcutaneous fascia and skin