Reproductive System (Perineum) Flashcards
State the principal arteries of the PERINEUM and PELVIS
Perineum - internal pudendal A
Pelvis - internal iliac A
SCROTUM
- ____ of the lower part of ____ abdominal wall
- Contents:
SCROTUM
- OUTPOUCHING of the lower part of ANTERIOR abdominal wall
- Contents: TESTIS + EPIDIDYMIS + SPERMATIC CORD
Explain the descent of testis during embyronic development
- Testis originally located on POSTERIOR ABDOMINAL WALL
- During descent around 12th week - peritoneum evaginates –> processus vaginalis
- Around 9th month, testis travels through deep inguinal ring, inguinal canal, superfiical inguinal ring and reaches scrotal sac
- Obliteration of processus vaginalis occurs a few weeks before birth
- Gubernaculum anchors inferior pole of testis to scrotal skin
What is ‘TUNICA VAGINALIS’ and ‘PROCESSUS VAGINALIS’
tunica vaginalis - visceral layer further from parietal wall
processus vaginalis - evagination of peritoneum
State the functions of fluid found between the layers of the tunica vaginalis. (3)
- Lubrication - allows testis to move smoothly within scrotum by reducing friction and preventing damage to delicate tissues
- Protection - provides cushion to absorb minor shocks or trauma that might occur due to movement/externa l impact
- Temperature regulation - regulates heat to ensure testes are maintained at optimal temperature of spermatogenesis
Define HYDROCELE and state the types of HYDROCELE.
Hydrocele = abnormal collection of serous fluid between 2 layers of tunica vaginalis of testis
- Communicating hydrocele
- Non-commuicating hydrocele
Explain how the 2 types of HYDROCELE occur.
COMMUNICATING HYDROCELE
- When obliteration of processus vaginalis fails to occur –> creates potential space that communicates with peritoneum
NON-COMMUNICATING HYDROCELE
- Upper part of processus vaginalis closes –> no connection between abdomninal cavity and sac around testicle in scrotum
- Occurs due to injuries, infections, tumours, systemic disorders (HF, liver disease)
How do we diagnose and differentiate the different types of HYDROCELE
DIAGNOSIS = transillumination of testicle upon shining of light (as compared to non-transillumination in the event of other scrotal masses)
DIFFERENTIATE
- Communicating hydrocele = clear history of appearance (at end of day) and disappearance (morning) as fluid enters peritoneal cavity during sleep
- Non-communicating hydrocele = no change in size
Recap: Name the layers of the ANTERIOR ABDOMINAL WALL from most superficial to deepest
- skin
- camper fascia
- scarpa fascia
- investing (deep) superficial fascia
- EOM
- investing (deep) intermediate fascia
- IOM
- investing (deep) deep fascia
- TAM
- transversalis fascia
- extraperitoneal fat
- parietal peritoneum
FUSION/CONTINUAITON OF FASCIA OF ANTERIOR ABDOMINAL WALL:
1. Scarpa’s fascia fuses with ____ in the thigh
2. Scarpa’s fascia continues as ____ fascia in the perineal region
3. ____ fascia is attached to the lower part of ____ membrane
4. Camper’s fascia continues as ____ muscle
FUSION/CONTINUAITON OF FASCIA:
1. Scarpa’s fascia fuses with FASCIA LATA in the thigh
2. Scarpa’s fascia continues as COLLES’ fascia in the perineal region
3. COLLES’ fascia is attached to the lower part of PERINEAL membrane
4. Camper’s fascia continues as DARTOS muscle
FUSION/CONTINUATION OF MUSCLES OF ANTERIOR ABDOMINAL WALL:
- EOM continues in testis as ____ fascia
- IOM continues in testis as ____ muscle and fascia
- ____ does not continue into scrotal area
- Transversalis fascia continues as ____ fascia
- Processus vaginalis continues as ____
FUSION/CONTINUATION OF MUSCLES OF ANTERIOR ABDOMINAL WALL:
- EOM continues in testis as EXTENAL SPERMATIC fascia
- IOM continues in testis as CREMASTER muscle and fascia
- TAM does not continue into scrotal area
- Transversalis fascia continues as INTERNAL SPERMATIC fascia
- Processus vaginalis continues as TUNICA VAGINALIS
State the structures that continue as
- dartos muscle
- cremaster muscle
dartos muscle - continuation of CAMPER FASCIA
cremaster muscle - continuation of IOM
INTERNAL PUDENDAL ARTERY
- Branch of anterior division of ____ A (primary blood supply to ____)
- Exits pelvis inferiorly via ____ foramen and re-enters perineum through ____ foramen
- 3 branches:
- Blood supply:
INTERNAL PUDENDAL ARTERY
- Branch of anterior division of **INTERNAL ILIAC A **(primary blood supply to PERINEUM)
- Exits pelvis inferiorly via GREATER SCIATIC foramen and re-enters perineum through **LESSER SCIATIC **foramen
- 3 branches: Inferior rectal A, Perineal A, Dorsal A of penis/clitoris
- Blood supply: Skin, structures of perineum + anal + urogenital regions
PUDENDAL NERVE
- Arises from ____ rami of spinal neres ____ - ____
- Has both ____ and ____ functions
- Carries only ____ autonomic fibers
- Exits pelvis through ____ foramen –> curves around ____ ligament –> enters perineum through ____ foramen
PUDENDAL NERVE
- Arises from ANTERIOR rami of spinal neres S2 - S4
- Has both MOTOR and SENSORY functions
- Carries only SYMPATHETIC autonomic fibers
- Exits pelvis through GREATER SCIATIC foramen –> curves around SACROSPINOUS ligament –> enters perineum through LESSER SCIATIC foramen
State the differences between PELVIC SPLANCHNIC NERVES and PUDENDAL NERVES
PELVIS SPLANCHNIC N
- Parasympathetic N
- Arises from lateral horn grey matter of spinal cord (S2-S4)
PUDENDAL N
- Somatic N + Sympathetic N
- Arises from ventral horn grey matter of spinal cord (S2-S4)
State the lymphatic drainage of PERINEUM and MALE/FEMALE GENITALIA
- Most lymph vesels of perineum - SUPERFICIAL INGUINAL NODES
- Glans penis and clitoris - DEEP INGUINAL NODES
- Testes - PARA-AORTIC LN (Non-inguinal)
What lymph nodes should be checked in TESTICULR CARCINOMA?
PARA-AORTIC LYMPH NODES
PUDENDAL/ALCOCK’S CANAL
- Formed by fascia of ____ muscle and ____ fascia
- Contents (3):
- Bony landmark:
PUDENDAL/ALCOCK’S CANAL
- Formed by fascia of OBTURATOR INTERNUS muscle and DEEP PELVIC fascia
- Contents (3): Pudendal N, Pudendal A, Pudendal V
- Bony landmark: ISCHIAL SPINE
State the purpose of PUDENDAL NERVE BLOCK (4)
- analgesia for 2nd stage of labour
- repair of episotomy or perineal laceration
- outlet instrument delivery (assists pelvic floor relaxation)
- minor surgeries for lower vagina and perineum
State the ANATOMICAL RELATIONS of UROGENITAL TRIANGLE and ANAL TRIANGLE
UROGENITAL TRIANGLE
- anterior (apex) = pubic symphysis
- laterally = ischial tuberosities
ANAL TRIANGLE
- posteriorly (apex) = coccyx
- laterally = sacrotuberous ligaments
State the content of UROGENITAL TRIANGLE AND ANAL TRIANGLE of females and males
ANAL TRIANGLE
- Females and males have the same structural contents
- Anal canal + 2 ischiorectal fossae that lie on either side of the anal canal
UROGENITAL TRIANGLE
- Females = Vaginal orifice, urethral orifice
- Males = Roots of penis, urethral orifice
ISCHIORECTAL FOSSAE
- Wedges shaped spaces filled with ____ and is ____ vascularised
- 2 fossae communicate through ____ space –> clinical application =
- Only ____ side has communication
- Boundaries:
(1) Base of wedge =
(2) Edge of wedge =
(3) Medial wall =
(4) Lateral wall =
ISCHIORECTAL FOSSAE
- Wedges shaped spaces filled with FAT and is POORLY vascularised
- 2 fossae communicate through DEEP POSTANAL space –> clinical application = INFECTION EASILY MOVES FROM ONE SIDE TO ANOTHER
- Only POSTERIOR side has communication
- Boundaries:
(1) Base of wedge = skin
(2) Edge of wedge = junction of medial and lateral walls
(3) Medial wall = sloping levator ani + anal canal
(4) Lateral wall = obturator internus + pudendal/alcock’s canal + ischial tuberosity
State the functions of ISCHIORECTAL FOSSAE (2)
- Passageway for neurovascular structures (pudendal N, pudendal A, pudendal V)
- Facilitates defecation (accommodates movement and expansion of anal canal during defecation -> fat-filled space allows expansion without restriction)
ISCHIORECTAL ABSCESS
- Originates in ____ fossa
- Spreads through ____ tissue without any obvious swelling until considerable tension is present
- Spread is limited ____ by ____ fascia which covers the ____ muscle
- Spread is limited ____ by ____ muscle
ISCHIORECTAL ABSCESS
- Originates in ISCHIORECTAL fossa
- Spreads through ADIPOSE tissue without any obvious swelling until considerable tension is present
- Spread is limited LATERALLY by OBTURATOR fascia which covers the OBTURATOR INTERNUS muscle
- Spread is limited MEDIALLY by LEVATOR ANI muscle
PERIANAL ABSCESS
- Indication for timely ____ and ____
- ____ administration is inadequate and inappropriate as isciorectal fossa is…
- Why can abscesses grow very large?
PERIANAL ABSCESS
- Indication for timely INCISION and DRAINAGE
- ANTIBIOTIC administration is inadequate and inappropriate as isciorectal fossa is FULL OF FAT AND POORLY VASCULARISED
- Why can abscesses grow very large? - FATS HAVE LOW DENSITY –> ALLOWS FOR GROWTH OF PUS
UROGENITAL DIAPHRAGM
- ____-layered tough ____ tissue sheets that fills the ____ triangle
- Membrane gives attachment to ____ genitalia
- ____ layer of the urogenital diaphragm is thicker and is called the perineal membrane (inferior fascia) –> forms the basis upon which the ____ genital organs are fixed
UROGENITAL DIAPHRAGM
- DOUBLE-layered tough FIBROUS tissue sheets that fills the UROGENITAL triangle
- Membrane gives attachment to EXTERNAL genitalia
- INFERIOR layer of the urogenital diaphragm is thicker and is called the perineal membrane (inferior fascia) –> forms the basis upon which the EXTERNAL genital organs are fixed
Name the layers of the UROGENITAL DIAPHRAGM
- superior fascia of urogenital diaphragm
- deep perineal pouch - houses deep transverse perineal muscle
- inferior fascia of urogenital diaphragm/perineal membrane (thicker for fixation of external genitalia)
Name the contents of the DEEP PERINEAL POUCH in MALES (4)
- parts of the membranous urethra
- external urethral sphincter muscle
- bulbourethral glands
- deep transverse cervical muscles
EXTERNAL URETHRAL SPHINCTER
- In both men and women, when urethra passes through ____ pouch
- Type of muscle: ____ muscle (controlled through ____ nervous system)
- Secondary sphincter that controls flow of urine through urethra
EXTERNAL URETHRAL SPHINCTER
- In both men and women, when urethra passes through DEEP PERINEAL pouch
- Type of muscle: SKELETAL muscle (controlled through SOMATIC nervous system)
- Secondary sphincter that controls flow of urine through urethra
Regarding the DEEP TRANSVERSE PERINEAL MUSCLE, state the
- Origin:
- Insertion:
- Action:
- Innervation:
Regarding the DEEP TRANSVERSE PERINEAL MUSCLE, state the
- Origin: internal surface of ramus of ischium
- Insertion: perineal body
- Action: stabilises perineal body –> provides structural support to adjacent pelvic and perineal structures
- Innervation: Internal pudendal N
BULBOURETHRAL GLAND
- Accessory sex gland in male reproductive system
- Produces ____ fluid to ____ acidic urine residue that remains in ____ (helps in preparation for passage of sperm cells during sexual arousal)
- Approximately ____cm long
- Opens into ____ urethra
- Homologous to ____ gland in females
BULBOURETHRAL GLAND
- Accessory sex gland in male reproductive system
- Produces PRE-EJACULATORY fluid to NEUTRALISE acidic urine residue that remains in URETHRA (helps in preparation for passage of sperm cells during sexual arousal)
- Approximately 2.5CM long
- Opens into SPONGY urethra
- Homologous to BARTHOLIN’S gland in females
State the contents of DEEP PERINEAL POUCH in FEMALES (4)
- part of female urethra
- part of vagina
- external urethral sphincter
- deep transverse perineal muscles
State the contents of the SUPERFICIAL PERINEAL POUCH in FEMALES (3)
- urethra
- vagina
- superficial transverse perineal muscle
Regarding the PENIS, state
- 2 functions:
- 3 parts:
PENIS
- Functions = micturition + sexual intercourse
- Parts = root, body, glans penis
Explain how glans penis gets its shape.
Gets its shape from bulbous expansion of corpus spongiosum
What are the 2 types of erectile tissue found in PENIS
- corpus cavernosa
- corpus spongiosum
CORPORA CAVERNOSA
- Pair of ____-shaped corpora cavernosa are seen on each side of ____ triangle
- Each ____ is attached to ____ membrane and ____
CORPORA CAVERNOSA
- Pair of CYLINDRICAL-shaped corpora cavernosa are seen on each side of UROGENITAL triangle
- Each CRUS is attached to PERINEAL membrane and ISCHIOPUBIC RAMUS
CORPORA SPONGIOSUM
- ____ erectile tissue
- Anchored at its base to ____ membrane
- Base part is known as ____
- Distal ends expand as ____
CORPORA SPONGIOSUM
- SINGLE erectile tissue
- Anchored at its base to PERINEAL membrane
- Base part is known as BULB
- Distal ends expand as GLANS PENIS
FORESKIN / ____
- ____-layered structure that includes the outer layer of skin and inner ____ membrane
- Provides ____ to glans penis and maintains its sensitivity by keeping it ____
- Lacks ____ and ____ –> smoother than body skin
FORESKIN / PREPUCE
- DOUBLE-layered structure that includes the outer layer of skin and inner MUCOUS membrane
- Provides PROTECTION to glans penis and maintains its sensitivity by keeping it MOIST
- Lacks HAIR FOLLICLES and SEBACEOUS GLANDS –> smoother than body skin
PHIMOSIS
- Definition:
- Common complications:
- Treatment:
PHIMOSIS
- Definition: inability to retract the skin covering the glans penis
- Common complications: Foreskin inflammation, UTI, Poor hygiene, Penile cancer (long-standing phimosis)
- Treatment: Circumcision
Name the 2 types of MUSCULATURE found in PENIS
- ischiocavernous muscle
- bulbospongiosus muscle
State the functions and innervation of ISCHIOCAVERNOUS and BULBOSPONGIOSUS muscles
Innervation = pudendal nerve (S2-S4 somatic motor + sympathetic)
Ischiocavernosus - spirals over corpora cavernosa –> support and movement of erect organ
Bulbospongiosus - spirals over corpora spongiosum –> emptying of urethra (last few drops) + expulsion of semen during ejaculation
Explain the mechanism of ERECTION and EJACULATION
- male stimulated erotically
- paraysmpathetic fibers stimulated and relaxes smooth muscles in fibrous trabeculae and dilates arteries
- cavernous spaces fill with blood
- blood-filled space compresses veins against tunica albuginea
- blocks backflow of blood which leads to pool of blood int he penis - ERECTION (PARASYMPATHETIC)
- internal urethral sphincter closes to prevent backflow of semen into bladder - EJACULATION (SYMPATHETIC)
STRUCTURES OF THE VULVA:
1. Mons Pubis - mound of ____ skin and ____ located in front of the ____
2. Labia Majora - 2 hair beairng external skin folds filled with ____ tissues and terminal part of the ____ ligament
3. Labia Minora - 2 hairless thin folds of skin lying within ____
4. Vestibule - Area enclosed by labia minora containing openings of vagina and urethra
5. Clitoris - ____ structure homologous to male ____
STRUCTURES OF THE VULVA:
1.Mons Pubis - mound of HAIR skin and SUBCUTANEOUS FAT located in front of the PUBIC SYMPHYSIS
2. Labia Majora - 2 hair beairng external skin folds filled with SUBCUTANEOUS tissues and terminal part of the ROUND ligament
3. Labia Minora - 2 hairless thin folds of skin lying within LABIA MAJORA
4. Vestibule - Area enclosed by labia minora containing openings of vagina and urethra
5. Clitoris - ERECTILE structure homologous to male PENIS
Label the VULVA
State the structures that the CLITORIS contains
- 2 corpora cavernousa
- glans clitoris (area where thin strand of spongiosum ends into clitoris after bilateral vestoibular bulbs unite)
Regarding the CORPORA CAVERNOSA,
- It is a pair of ____ shaped erectile tissues seen on each side of the ____ triangle
- Each crus of clitoris is attached to ____ membrane and _____
Regarding the CORPORA CAVERNOSA,
- It is a pair of CYLINDRICAL shaped erectile tissues seen on each side of the UROGENITAL triangle
- Each crus of clitoris is attached to PERINEAL membrane and ISCHIOPUBIC RAMUS
Regarding the CORPUS SPONGIOSUM,
- It splits into two –> forms ____ bodies of ____ tissue called bulbs of ____ to make way for vagina and urethra
- Bilateral vestibular bulbs unite ____ to urethral orifice –> forms thin strands of ____ erectile tissue that ends into ____ as glans
Regarding the CORPUS SPONGIOSUM,
- It splits into two –> forms TWO bodies of ERECTILE tissue called bulbs of VESTIBULE to make way for vagina and urethra
- Bilateral vestibular bulbs unite VENTRAL to urethral orifice –> forms thin strands of SPONGIOSUM erectile tissue that ends into CLITORIS as glans
State the functions of the two muscles in the CLITORIS
ISCHIOCAVERNOSUS
- Compresses citoral crura –> maintains clitoral erection by compressing veins and preventing outflow of blood –> enahcnes clitoral engorgement and sensitivity
BULBOSPONGIOSUS
- Contributes to clitoral erection
PERINEAL BODY
- Central tendon of ____
- Precise location =
- Structures attached to perineal body (2)
- Muscles attached to perineal body (4)
- Contains ____ muscles, ____ fibres and nerve endings
PERINEAL BODY
- Central tendon of PERINEUM
- Precise location = Midline of perineum situated at junction of anus and urogenital triangle in both females and males
- Structures attached to perineal body (2) = Rectum + Vaginal slips
- Muscles attached to perineal body (4) = Bulbospongiosus muscle + Deep/superficial transverse perineal muscles + External anal sphincter muscle + Levator ani
- Contains SMOOTH muscles, ELASTIC fibres and nerve endings
State the structures that are incised in EPISOTOMY (5)
- subcutaneous tissue
- superficial and deep transverse perineal muscles
- bulbospongiosum
- part of levator ani
- posterior vaginal wall
State the 3 parts of the urethra in MALES
- prostatic urethra
- membranous urethra
- spongy/penile urethra
MEMBRANOUS URETHRA
- About ____cm long surrounded by ____ sphincter
- Formed from ____ muscle and therefore under ____ control
- Innervation of external urethral sphincter =
MEMBRANOUS URETHRA
- About 1-2CM long surrounded by EXTERNAL URETHRAL sphincter
- Formed from SKELETAL muscle and therefore under VOLUNTARY control
- Innervation of external urethral sphincter = PUDENDAL NERVE
In RUPTURE OF SPONGY URETHRA IN MALES, will there be pooling of urine in
- Thigh?
- Anal triangle?
- Anterior abdominal wall?
Thigh - No urine as colles’ fascia fuses with fascia lata
Anal triangle - No urine as colles’ fascia also fuses with perineal membrane
Anterior abdominal wall - Yes urine as urine enters superfiical perineal pouch –> scrotum –> accumulates around penis
State the number of fornices in VAGINA
4 - 1 anterior, 1 posterior, 2 lateral
State the blood supply and lymphatic drainage of vagina and uterus
BLOOD SUPPLY
- Uterine A (from internal iliac A)
- Upper 4/5 - Vaginal A (from internal iliac A)
- Lower 1/5 - Internal pudendal A (from internal iliac A)
LYMPHATIC DRAINAGE
- Upper 4/5 - iliac nodes
- Lower 1/5 - superficial inguinal nodes
State the nerve supply of VAGINA AND UTERUS.
Upper 4/5 - inferior hypogastric plexus (autonomic plexus) –> sensitive only to stretch
Lower 1/5 - pudendal nerve (somatic innervation) –> sensitive to touch and temperature
State the male homologue of BARTHOLIN’S GLAND in FEMALES
cowper’s/ bulbourethral gland
