Perineum Flashcards
Region of the trunk inferior to the pelvic diaphragm and between the thighs
Perineum
Forms the margins of the perineum
Pelvic outlet
Creat the diamond-shaped space of the pelvic outlet
Pubic symphysis, inferior pubic rami, ischial rami/tuberosities, sacrotberous ligaments, coccyx
Forms the roof of the perineum
Pelvic diaphragm
2 triangles of the perineum
Urogenital, anal
Line of division b/t the 2 triangles of the perineum
B/t the anterior portions of the ischial tuberosities
Central tendon of the perineum (fibromuscular mass)
Perineal body
Triangular, durable sheet of fascia spanning the ishiopubic rami
Perineal membrane
Thicken of the anterior margin of the perineal membrane
Transverse perineal ligament
Deep dorsal vein of the penis/clitoris passes thru what
A gap b/t the transverse perineal ligament and the pubic symphysis
Found in the middle of the anal triangle
Anal canal and anus
Skeletal muscle that surrounds the anal canal/anus
External anal sphincter
3 parts of the external anal sphincter
Deep part, superficial part, subcutaneous part
Forms a ring around the anal canal, merging with the fibers of the puborectalis
Deep part of the external anal sphincter
Surrounds the anal canal and attaches superiorly to the perineal body and posteriorly to the coccyx
Superficial part of the external anal sphincter
Attaches the superficial part to the coccyx
Anococcygeal ligament
Open, wedge-shaped spaces lateral to the anal canal, that are continuous with each other posteriorly and inconsistently anteriorly
Ischioanal fossae
What passes thru the ischioanal fossae
Inferior rectal nerve and vessels
Boundaries of the ichioanal fossae
Obturator internus (and fascia) anteriorly, inferior surface of the levator ani muscle superomedially, skin of the perineum inferiorly
Pass thru the pudendal canal
Internal pudendal artery and pudendal nerve
Positioning of the ischioanal fossae
projects anteriorly into the urogenital triangle,
superior to the deep perineal pouch as the anterior recesses of the ischioanal fossa.
first branch of the internal pudendal artery within the pudendal canal
Inferior rectal artery
Path of the inferior rectal artery
courses medially through the fat in the ischioanal fossa to anastomose with middle and superior
rectal arteries from internal iliac and inferior mesenteric arteries
branches from the pudendal nerve near the initial portion of the pudendal canal
Inferior rectal nerve
Path of the inferior rectal nerve
courses medially with the inferior rectal artery towards the anus
Divisions of the urogenital triangle
Superficial perineal space and deep perineal space (pouch) via the perineal membrane
Primary arterial and nerve supply to the urogenital triangle
Internal pudendal artery and pudendal nerve
Components of penis
Roots, body, glans
Makes up the root of the penis
2 crura and the bulb
The crus is anchored to what?
Ischiopubic ramus
The bulb is anchored to what?
Perineal membrane
the free, middle portion of the penis that lies inferior to the symphysis pubis and anterior to the scrotum when flaccid
The body of the penis
Expanded, distal end of the penis
Glans
Prominent margin of the glans that projects backwards over the body of
the penis
Corona
The constriction between the body of the penis and the glans
Neck of the glans
Paired erectile tissue that forms the crura of the penis
Corpora cavernosa
Surrounds the corpora cavernosa and forms the septum of the body of the penis
Tunica albuginea
Single erectile mass surrounded by a tunica albuginea
Corpus spongiosum
What does the corpus spongiosum connect?
the bulb and glans
The portion of the urethra within the penis
Spongy urethra
Dilated urethra within the glans
navicular fossa
Pea-sized accessory glands embedded in the fibers of the urethral sphincter muscle
Bulbourethral glands (Cowper’s glands)
Free fold of skin that overlaps the glans
Prepuce (foreskin), continuous with the skin of the glans
Fold of skin connecting the deep surface of the prepuce with the glans, immediately ventral to the external urethral orifice
Frenulum of the prepuce
Inability to retract the prepuce from the glans penis due to a constriction in the preputial orifice
Phimosis
Superficial penile fascia
Dartos (Colles’) fascia, continuous with Sacrpa’s fascia
Investing penile fascia that is continuous with the deep perineal fascia and aponeurosis of the external abdominal oblique
Deep penile fascia (Buck’s fascia)
Triangular shaped ligament that attaches to the pubic symphsis and to the deep penile fascia at the proximal end of the body of the penis
Suspensory ligament of penis
Structure that arises from superfiscial fascia in the area of the linea alba, splits to encircle the body of the penis near the pubic symphysis
Fundiform ligament of penis
Symmetrical, bilateral pair of thin skeletal muscles that covers the bulb of the penis
Bulbospongiosus (attaches posteriorly at the perineal body)
Skeletal muscle that covers the crura of the penis
Ischiocavernosus (arises from the medial aspect of ischial tuberosity and ischiopubic rami)
Small skeletal muscles of the superficial perineal pouch that runs along the posterior border of the urogenital triangle
Superficial transverse perineal meuscles that attach to the ischial tuberosity and insert into the perineal body
Divides the 2 chambers of the scrotum
Scrotal septum
Primary layers of the scrotum
Skin and dartos fascia
Term for all external female genitalia
Vulva
Fatty subcutaneous tissue that forms a rounded eminence anterior to the pubic symphysis
Mons pubis
Encapsulated fatty tissue fills bilateral, longitudinal ridges of skin
Labia Majora
Passes thru the superficial inguinal ring ending the labium majus
Round ligament of the uterus
Inner surfaces of the labia majora
Lateral boundary of the pudendal cleft
Two labia majora converge anteriorly at the midline as what?
Anterior labial commisure
Posterior midline of the pudendal cleft
Posterior labial commissure
Internal folds of skin
Labia minora
What do the labia minora bind?
Vestibule of the vagina
Unites the labia minora posteriorly
Frenulum of the labia
Lateral portions of the labia minora meet at the midline anterior to the clitoris to form what?
Prepuce of the clitoris
Medial portions of the labia minora meet posterior to the blans of the clitoris to form what?
Frenulum of the clitoris
What forms the clitoris?
Paired masses of eretile tissue called corpora cavernosa clitoridis
Cavernous bodies that attach to the ischiopubic rami and perineal membrane
Crura of the clitoris
Meeting of the corpora cavernosa clitoridis
Body of the clitoris
End of the clitoris
Glans of clitoris beneath the prepuce of the clitoris
Attaches the clitoral bod yto the pubic symphysis
Suspensory ligament of the clitoris
Space between the labia minora
Vestibule of the vagina
Opening into the anterior part of the vestibule of the vagina
External urethral orifice
Median slit located posterior to the urethral orifice
Orifice of the vagina
Thin fold of mucous membrane that partially closes the vaginal orifice
Hymen
Rounded elevations around the margins of the vaginal orfice that represent remnents of the hymen
Hymeneal caruncles
3cm elongated masses of erectile tissue, situated deep to the bulbospongiosus muscle in the labia majora
Vestibular bulb
Glands located on the lateral aspect of the vaginal orifice
Greater vestibular glands (Bartholin glands)
Minute channels on either side of the uretral orifice
Paraurethral glands (Skene’s)
Skeletal muscles that cover the vestibular bulb and greater vestibular glands
Bulbospongiosus (inserts posteriorly into the perineal body and anteriorly into the clitoris)
Layers of superficial perineal fascia in a female
Fatty superficial layer, deep membranous layer (Colles’) that is continuous with the Scarpa’s fascia
Fascia continuous with the aponeurosis of the external abdominal oblique muscle
Deep perineal fascia (Gallaudet’s fascia)Splits to invest the superficial perineal muscles and in continuous with deep penile fascia
Limits the superficial perineal space (superficially and deeply)
(superficially, inferiorly) Superficial fascia (Colles’) and (deeply, spueriorly) perineal membrane
8 things in male superficial perineal space
Bulb of penis, crura of penis, bulbospongiosus, ischiocavernosus, spongy urethra, superficial transverse perineal muscle, branches of internal pudendal vessels, pudendal nerve
9 things is female superficial perineal space
Bulb of vestibule, crura of clitoris, greater vestibular glands, bulbospongiosus, ischiocavernosus, superficial transverse perineal muscle, branches of internal pudendal vessels, pudendal nerve
What is the deep perineal space bounded by?
Perineal membrane (inferior), inferior fascia of the pelvic diaphragm (superior), Obturator fascia (lateral)
8 things in male deep perineal space
Anterior recess of ischioanal fossa, deep transverse perineal muscle, external urethral sphincter, membranous urethra, bulbourethral glands, internal pudendal vessels, branches of pudendal nerve
9 things in female deep perineal space
Anterior recess of ischioanal fossa, deep transverse perineal muscle, external urethral sphincter, compressor urethrae, urethrovaginal sphincter, transverse vaginal muscles, proximal portion of urethra, internal pudendal vessels, branches of pudendal nerve
Where do most superficial structures in the superficial perineal pouch of the perineum drain their lymph to?
Superficial inguinal lymph nodes
Where do gential glans drain to?
Deep inguinal nodes
Where do deep perinal space and superior part of the anal canal above the pectinate line drain to?
Internal iliac nodes
Path of the internal pudendal artery
With pudendal nerve, exits pelvic cavity thru greater sciatic foramen, thru gluteal region, enters perineum thru the lesser sciatic foramen, runs thru the pudendal canal, deep into the superficial perineal space to supply the perineum
Path of the perineal artery
From the internal pudendal artery, superficial within the superficial perineal space, b/t the bulbospongiosus and ischocavernosus (female) and on the surface of ischocavernosus (males)
Path of the transverse perineal artery
Arises from perineal artery to course along the superficial transverse perineal muscle
Path of the posterior scrotal/labial artery
Arises from perineal artery to supply skin and fascia
Path of the artery of the bulb of the genitals
Arises from the internal pudendal artery, courses medially and pierces the perineal membrane before entering the bulb
Path of the urethral artery
Arises from the internal pudendal artery, pierces the perineal membrane and then enters the corpus spongiosum to run alongside the urethra to the glans penis
Path of the deep artery of the penis/clitoris
Aka cavernosal artery, one of the terminal branches of the internal pudendal artery, pierces the perineal membrane, enters the crus, and runs thru the center of the corpus cavernosum
2 terminal branches of the internal pudendal artery
Dorsal artery and deep artery of the penis/clitoris
3 arteries that pierce the perineal membrane
Urethral artery, deep artery, dorsal artery
External pudendal artery branches
Superficial and deep external pudendal arteries
Gives rise to the external pudendal arteries
Femoral artery
Supplies the skin of the penis/vulve and the anterior aspect of the scrotum/labia majora
superficial external pudendal artery
Supplies the skin of the scrotum/labia majora
deep external pudendal artery
Path of the deep dorsal vein
Unpairs from the midline of the dorsal aspect of the penis/clitoris, deep into the deep fascia b/t the right and left dorsal arteries, thru the suspensory ligament, terminates in the prostatic venous plexus (male) vesical venous plexus (female)
Drains most structures in the perineum
Internal pudendal vein and drains into the internal iliac veins
Innervation of the penis
Dorsal nerve of penis (off of pudendal), S2-S4
Carries parasympathetic to penis
Cavernous nerves (from inferior hypogastric plexus)
Innervates bulbospongiosus and ischiocavernosus
Deep branch of perineal nerve
Innervates anterior aspect of vulva
anterior labial nerves from Ilioinguinal and Genitofemoral nerves
Innervates the posterior aspect of vulva
posterior labial nerves from perineal branch of posterior cutaneous nerve of the thigh and perineal nerve (from pudendal nerve)
Innervates the deep perineal muscles and clitoris
Dorsal nerve of the clitoris