REB 31. Perineum, Pouches, Penis, Urethra, Vulva Flashcards
What is the anatomical position of the pelvis?
the ASIS and the pubic tubercle are in line with each other and the ground
What type of joint is the sacroiliac joint?
synovial joint
Where is the false pelvis located?
- superior to pelvic brin
- considered part of abdominal cavity
Where is the true pelvis located?
- inferior to pelvic brim
- the floor is the levator ani muscle
Where is the perineum located?
it is inferior to the levator ani muscle
What are the boundaries of the perineum?
[1] pubic symphysis
[2] ischiopubic ramus
[3] sacrotuberous ligament
[4] coccyx
What is the perineal membrane?
- it is a thin layer of dense fascia
- separates the urogenital triangle and anal triangle
- it runs between the ischiopubic rami
What is the external urethral orifice?
- it is between the vaginal orifice and clitoris
- it is where urine comes out of
About how long is the female urethra?
3 to 4 cm
What type of muscle is the internal urethral sphincter made up of in females?
- the detrusor muscle thickens
- it is smooth muscle
- under involuntary control
What type of muscle is the external urethral sphincter made up of in females?
- skeletal muscle
- it is under voluntary control
How many layers is the female urethra internal sphincter made up of?
it is made up of 4 layers which porbably contributes to closure
Explain and describe the parts of the perineum. (pouches and layers)
[1] Deep Perineal Pouch - lies below thin layer of pelvic fascia - lies above thick perineal membrane [2] Superficial Perineal Pouch - lies below thick perineal membrane [3] Thin Layer of Pelvic Fascia [4] Thick Perineal Membrane [5] Superficial Perineal Membrane - Colle's Fascia which is a continuation of Scarpa's fascia
What are the layers of the Urogenital diaphragm? [3]
[1] Superior (or Deep) Layer
- thin layer of pelvic fascia (fascia on undersurface of levator ani)
[2] Middle Layer
- Deep Perineal Pouch
- — muscles, neurovascular etc.
[3] Inferior (of Superficial) Layer
- Perineal Membrane
What are the muscles of the deep perineal pouch in males?
[1] External Urethral Sphincter
[2] Deep Transverse Perinei
What are the muscles of the deep perineal pouch in females?
[1] External Urethral Sphincter
[2] Deep Transverse Perinei
[3] Sphincter Urethrovaginalis
What is the most important muscle of the deep perineal pouch?
External Urethral Sphincter
What is the Central Perineal Tendon? Where is it located?
- fibromuscular node
- located in the midline, at thhe junction of urogenital + anal triangles
What are the main muscle attachments to the perineal body? [3]
[1] Levator Ani
[2] External Anal Sphincter
[3] Sphincter Urethrae
- important for fecal continence
- damage may result in incontinence and prolapse
- may be damaged during childbirth or trauma
What are the contents (other than the muscles) of the deep perineal pouch?
[1] Pudendal Nerve
[2] Internal Pudendal Artery (+ Vein)
——-
[3] Bulbourethral Glands (of Cowper) in the Male
What is Alcock’s Canal?
is an anatomical structure in the pelvis through which the internal pudendal artery, internal pudendal veins, and the pudendal nerve pass
VAN
Where is the superficial perineal pouch located?
- it is located inferior to the perineal membrane
they are components of the external genitalia basically
What is the superficial perineal fascia made up of?
It is made up of Colle’s Fascia
- it lies just beneath the skin of the perineum
- it is continuous with Scarpa’s fascia (which lines the ant. abdominal wall)
What is the root of the external genitalia, the penis?
[1] crus
[2] bulb
What does the crus become as you progress down the penis?
the crus becomes the corpus cavernosum (2x)
- it is surrounded by the ischiocavernosus muscle
What does the bulb become as you progress down the penis?
the bulb becomes the corpus spongiosum
- it is surrounded by the bulbospongiosus muscle
What is Buck’s Fascia?
- is a layer of deep fascia covering the three erectile bodies of the penis
- the 3 parts are:
[a] corpus spongiosum containing urethra
[b] corpora cavernosa (x2)
What is the glans penis?
- it is the rounded head/tip of the penis
What is the blood supply of the penis?
Penile Artery is a branch of the Internal Pudendal Artery
It is made up of 3 branches: [1] Bulbourethral Artery [2] Dorsal Artery [3] Cavernosal Artery * diff names - refer to slide 27
What is the dorsal nerve?
it supplies the penis
What are the neurovasculature structures that are present in the penis?
[1] Superficial + Deep Dorsal Vein
[2] Dorsal Artery
[3] Dorsal Nerve
During an erection, the corpora cavernosa fills up with blood and….?
it may occlude the veins to maintain the pressure in the phallus
Where are the deep arteries in the penis located?
it is located in the corpora cavernosa (therefore, there are 2 arteries)
What are the penile arteries? [3]
they are ALL from the PUDENDAL ARTERY (INTERNAL ILIAC)
[1] Artery to Bulb - Corpus Spongiosum
[2] Deep Artery - Corpra Cavernosa
[3] Dorsal Artery - Skin, Glans
What is the lymphatic drainage of the skin of the penis + scrotum?
superficial inguinal nodes
What is the lymphatic drainage of the glans?
deep inguinal nodes
What is the lymphatic drainage of the corpora + penile urethra?
internal iliac nodes
What is the lymphatic drainage of the testis?
para-aortic and lumbar nodes
What are the dermatomes of the pelvic region?
- you sit on your S3 and S4 region
- the rectum is S5
What are two palpable bones in the pelvic region?
[1] Pubic Symphysis
[2] Coccyx
- palpable in females
What are the muscles in the external aspect of the vagina?
same as males
[1] Bulbospongiosus Muscle
[2] Ischiocavernous Muscle
What are the layers of the uterus (from outside to in)?
[1] Perimetrium
[2] Myometrium
[3] Endometrium
What is the lymphatic drainage of the skin of labia?
superficial inguinal nodes
What is the lymphatic drainage of the clitoris?
[1] deep inguinal nodes
[2] internal iliac nodes
What is the innervation (nerve to) the clitoris?
dorsal nerve of clitoris
What is an episiotomy?
It is making an incision in the perineum at the time of delivery.
- to prevent a perineal tear or excess stretching of the muscles
- to protect hte fetus if delivery is slow/in distress
- it is a Posterolateral Incision (it gives the best protection against sphincter damage)
What is a clinical uterine prolapse?
it is when the uterus goes into the vagina
- due to the prolapse of the lateral ligaments
What is the definition of female genital mutilation?
it involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons
- it is a CRIME + VIOLATION OF HUMAN RIGHTS
- there are 3 types of female genital mutilation
