Pudendal DLA

Question 1

What is the perineum?

Answer 1

Compression of the pudendal nerve typically in the pudendal canal leads to;
• Burning sensation/numbness to the perineum region;
• particularly the posterior aspect of the scrotum and labia majora
• Skin of the penis, labia minora and inferior aspect of the vagina and anal canal
• Dorsal nerve of the penis - loss of sensation to the head of the penis and clitoris
• Rectal incontinence
• Sexual impotence (failure to ejaculate) - bulbospongiosus muscle

Question 2

What are the pudendal triangles?

Answer 2

Urogenital triangle (UG)
Lateral: Ischiopubic ramus
Base (posterior): line between the ischial tuberosities
Apex (Anterior): pubic symphysis
Roof: levator ani

Question 3

What are the components of the urogenital triangle?

Answer 3

• Oriented in the horizontal plane
• It is filled with the perineal membrane; a thick fibrous sheet of connective tissue
• Attached anteriorly to the pubic symphyses with a small opening
• Posterior border is free
• Serves as the anchor for the erectile tissue of the external genitalia • Fused with the perineal body in the midline posteriorly

Question 4

What are the components of the urogenital triangle in females?

Answer 4

The erectile tissues are covered by muscles
Which are then covered by fascia, subcutaneous tissue and finally skin

Perineal body
A fibrous body where all the perineal muscles converge and attach to the perineal membrane. Provides extra strength to the supporting structures of the perineum

Question 5

What is the significance of fascia of the urogenital triangle?

Answer 5

The membranous layer (Colle’s) of fascia is continuous with the fascia of the anterior abdominal wall
Fused to the inguinal ligament
Fused to the perineal membrane posteriorly
Fused to the ischiopubic rami laterally

Question 6

What is the significance of the ischioanal fossa?

Answer 6

Fat filled area surrounding the anal canal
Traversed by fibrous bands
Support the anal canal & permit its distention during defecation

Question 7

What is the clinical features of the ischioanal fossa?

Answer 7

2 sides communicate posterior to the anal canal; anteriorly extend superior to the perineal membrane

Infection/Abscess

Abscess leads to fullness & tenderness between anus & ischial tuberosity May rupture into the anal canal / rectum / perianal skin]

Question 8

What are the perineal pouches in females?

Answer 8

Deep pouch: contains deep transverse perineal, external urethral sphincter, compressor urethral and urethrovaginal sphincter muscles Superficial pouch: is continuous with the subcutaneous area of the anterior abdominal wall. Contains the erectile structures, the skeletal muscle associated with them and the greater vestibular (Bartholin’s glands)

Question 9

What are the perineal pouches in males?

Answer 9

Deep pouch: contains the external urethral sphincter, deep transverse perineal muscles, bulbo-urethral glands
Superficial pouch extends around the scrotum and penis. Contains the erectile tissue and the skeletal muscle associated with them

Question 10

What is Colles fascia?

Answer 10

Continuation of the superficial fascia of the anterior abdominal wall