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    12.anatomy of Perineum

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    pasha
    The perineum is the area between the legs that contains two triangles - the urogenital and anal triangles. The urogenital triangle contains the genital structures in males and females. In males it includes the penis, urethra and scrotum. In females it contains the clitoris, urethra and vaginal opening. The anal triangle contains the anus and surrounding muscles. The document describes the structures and contents of these triangles in detail for both males and females in 3 sentences or less.

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    © All Rights Reserved
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    12.anatomy of Perineum

    Uploaded by

    pasha
    172 views58 pages
    The perineum is the area between the legs that contains two triangles - the urogenital and anal triangles. The urogenital triangle contains the genital structures in males and females. In males it includes the penis, urethra and scrotum. In females it contains the clitoris, urethra and vaginal opening. The anal triangle contains the anus and surrounding muscles. The document describes the structures and contents of these triangles in detail for both males and females in 3 sentences or less.

    Original Title

    12.Anatomy of perineum

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    The perineum is the area between the legs that contains two triangles - the urogenital and anal triangles. The urogenital triangle contains the genital structures in males and females. In males it includes the penis, urethra and scrotum. In females it contains the clitoris, urethra and vaginal opening. The anal triangle contains the anus and surrounding muscles. The document describes the structures and contents of these triangles in detail for both males and females in 3 sentences or less.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    172 views58 pages

    12.anatomy of Perineum

    Uploaded by

    pasha
    The perineum is the area between the legs that contains two triangles - the urogenital and anal triangles. The urogenital triangle contains the genital structures in males and females. In males it includes the penis, urethra and scrotum. In females it contains the clitoris, urethra and vaginal opening. The anal triangle contains the anus and surrounding muscles. The document describes the structures and contents of these triangles in detail for both males and females in 3 sentences or less.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 58
    At a glance
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    The document discusses the anatomy of the female and male urogenital systems, including structures like the vagina, anal canal, ischiorectal fossa and pudendal canal.

    The ischiorectal fossa is a wedge-shaped space bounded anteriorly by the perineal membrane, posteriorly by the sacrotuberous ligament and gluteus maximus, and laterally by fascia on the medial aspect of the obturator internus muscle.

    The pudendal canal contains the pudendal nerve, inferior rectal nerve, dorsal nerve of the penis/clitoris, perineal nerve, and scrotal/labial nerves.

    PERINEUM

    DR. ABDUL RASHAD


    SENIOR LECTURER
    DPT,MPHILL(OPT) ,MPPTA, MMTC (NZ), MSTC(AUS),
    IASTM(GREECE)
    UNITED COLLEGE OF PHYSICAL THERAPY
    Perineum
    • Area below the levator ani
    • Boundaries
    • Pubic arch
    • Ischial tuberosities
    • Sacrotuberous ligament
    • Coccyx
    Perineal Triangles
    Perineum
    • Divided into two triangles
    • Urogenital triangle
    • Anal triangle
    • Perineal body central point
    of perineum
    Urogenital Triangle
    • Deep pouch
    • Superficial pouch
    • Perineal membrane
    separates the two
    • Deep is superior to
    perineal membrane
    • Roof is pelvic
    fascia
    Deep Pouch in Male
    • Membranous portion of
    the urethra
    • Sphincter urethra or
    external sphincter
    of bladder
    • Perineal nerve
    • Deep transverse perineal
    muscle
    Deep Pouch in Male
    • Bulbourethreal glands
    • Internal pudendal artery and
    branches
    • Artery to bulb
    • Dorsal nerve of penis
    • Branches of perineal nerve
    Deep Pouch in Female
    • Vagina
    • Urethra
    • Sphincter urethra or external
    sphincter of bladder
    • Perineal nerve
    • Deep transverse perineal muscle
    • Internal pudendal artery
    • Artery to bulb
    • Dorsal nerve of clitoris
    Sphincter Urethrae (Female)
    • Sphincter urethrae
    in the deep pouch
    • Also called external
    sphincter of
    • bladder
    Perineal branch of
    pudendal S 2,3
    Perineal Membrane (Male)
    • Piercing membrane
    • Spongy urethrae
    • Ducts of bulbourethral glands
    • Artery to bulb
    • Internal pudendal artery
    • Deep and dorsal arteries of
    penis
    • Dorsal nerve of penis
    • Deep dorsal vein passes above
    membrane
    • Enters prostatic venous plexus
    Superficial Pouch (Male)
    Superficial Pouch (Male)
    Superficial Pouch (Male)
    Colles’ Fascia
    • Attached posteriorly to
    perineal membrane
    • Sides of pubic arch
    • laterally
    Deep fascia of thigh along a line
    • drawn from pubic tubercle
    • Anterior floor of pouch
    • Layer of scrotum
    • Surrounds penis as
    far as glans
    Passes up on to anterior
    abdominal wall
    Membranous Layer of Superficial or
    Colles’ Fascia
    • Posterior attached to posterior border
    of perineal membrane
    • Anterior it forms floor of superficial
    pouch and forms layer of the scrotum
    • Surrounds penis as far as glans
    • Then on to anterior abdominal wall
    • Attached to fascia lata from a
    horizontal line from pubic tubercle
    • Rupture of spongy urethra is
    limited by the attachment of Colles’
    fascia
    Superficial Pouch (Male)
    • Roof
    • Perineal membrane
    • Floor
    • Colles’ or membranous layer of
    superficial fascia
    • Ruptured urethra in male
    • Urine limited by the attachments
    of Colles’ fascia in superficial
    pouch
    Superficial Pouch (Male)
    • Penis corpus spongiosum
    • Corpora cavernosa
    • Spongy urethra
    • Bulbospongiosus muscle
    • Ischiocavernosus muscle
    • Superficial transverse perinei muscle
    • Internal pudendal artery
    • Deep and dorsal arteries of penis
    • Dorsal nerves of penis
    • Scrotal vessels and nerves
    Contents Superficial Pouch (Male)
    • Root of penis
    • Corpus spongiosum
    • Bulb, body and glans
    • Spongy portion of urethrae
    • Crura and corpora cavernosa
    Penis
    Penis
    Penis
    • Deep artery enters crura of
    corpora cavernosa
    • Dorsal nerve of penis
    • Dorsal artery of penis
    • Deep dorsal vein lies on
    dorsum between Colles’s
    fascia and tunica albuginea
    • Passes above perineal
    membrane
    • Enters prostatic venous
    plexus
    Penis
    • Erectile tissue
    • Helicine arteries
    • Fibrous saccules arterioles
    enter directly
    • Dorsal vein open
    • Parasympathetic causes
    erection L2,3,4
    • Ejaculation is via the
    sympathetic impulses from
    L1-L2
    Corpus Spongiosum
    • Bulb posterior dilatation
    • Body (horizontal)
    • Glans dilated anteriorly
    • Spongy urethra
    • Dilated posteriorly in the bulb
    • Uniform in body
    • Dilated in the glans
    • Fossa navicularis
    • Meatus vertical slit
    Spongy Urethra
    Spongy Urethra
    • Urethra unprotected
    • Before it enters
    • bulb
    • Ducts of bulbo-urethral glands
    • Enter intrabulbar fossa
    Littre’ glands end in navicular
    fossa
    Muscles in Superficial Pouch (Male)

    • Bulbospongiosus muscle
    • Ischiocavernosus muscle
    • Superficial transverse perinei
    muscle
    • Supplied by perineal
    branches of pudendal nerve
    • Enter pouch by piercing
    Colles’ fascia
    Vessels and Nerves
    • Deep and dorsal arteries of
    penis
    • Deep dorsal vein
    • Scrotal nerves
    • Perineal nerve
    • Dorsal nerve of penis
    Lymphatics
    • Skin of scrotum to medial
    superficial inguinal
    • glands
    Testes to para aortic glands
    at L2
    Nerve Supply
    • Preganglionic of sympathetic
    from L1 and L2 cause
    ejaculation
    • Parasympathetic
    preganglionic from S2,3,4
    cause erection
    Female Pelvis and Perineum
    Superficial Pouch (Female)
    • Mons pubis
    • Labia majora
    • Labia minora
    • Dorsal prepuce
    • Frenulum of glans
    • Vestibule
    Superficial Pouch (Female)
    Superficial Pouch (Female)
    • Urethra
    • Vagina
    • Clitoris
    • Crura of clitoris
    • Ischiocavernosa
    • Bulbs of vestibule join, pass
    to glans
    • Bulbospongiosus
    • Bartholin’s or vestibular
    glands
    Superficial Pouch (Female)
    • Crura and glans of clitoris
    • Covered by
    ischiocavernosus muscle
    • Bulbs of vestibule
    • Inferior greater vestibular
    or Bartholin’s glands
    beside vagina
    • Covered by
    bulbospongiosus muscle
    Superficial Pouch (Female)
    Superficial Pouch (Female)
    • Cutaneous anteriorly
    • Ilioinguinal nerve
    • Labial vessels and nerve
    posteriorly
    • Motor
    • Perineal branches of
    pudendal
    Structure of Female Urethra
    • Muscular layer continuous with bladder
    • Spongy erectile tissue
    • Plexus of veins
    • Mucous membrane transitional
    • Distal non-keratinising stratified
    • squamous
    No fascia between lower two thirds of urethra
    and vagina
    Vagina
    • Fornices, gutters which
    surround the cervix
    • Anterior shallow
    • Posterior deeper
    • Superior covered with
    peritoneum of the pouch of
    Douglas
    • Lateral: uterine artery above
    ureter
    Vagina
    • Upper portion of the vagina is
    clasped
    • By the pubovaginalis portion of
    the levator ani
    • Bulbospongiosus muscles
    surrounds outlet
    • Hymen
    Vagina
    • Erectile tissue
    • Muscular
    • wall Pelvic
    • fascia
    Non-keratinised stratified squamous
    • epithelium
    • Urethra lower third anterior wall
    No fascia between lower two thirds
    of urethra and vagina
    Anal Triangle
    • Anal canal
    • Ischiorectal fossa
    Anal Canal
    • Anorectal junction: below
    ampulla of rectum
    • Anus: 4 cm
    • Anterior: perineal body
    • Posterior: anococcygeal
    body
    • Lateral: ischiorectal
    fossae
    Anal Canal
    • Upper two thirds
    • Columnar epithelium
    • Anal columns contain radicles
    of superior rectal artery and
    veins
    • 4, 7, 11 o’clock position
    • Anal valves along
    pectinate line
    • Anal sinus, Hilton white line;
    internal sphincter
    • Subcutaneous deep
    • Lower third skin
    Muscles of Anal Canal
    • Anorectal ring
    • Internal sphincter
    • Puborectalis
    • Puborectal fascia
    • External sphincter
    • Deep; true sphincter
    • Inferior rectal nerve
    • Superficial S4
    • Subcutaneous; true sphincter
    • Inferior rectal nerve
    Muscles of Anal Canal
    • Anorectal ring
    • Puborectalis
    • Internal sphincter
    • Upper two thirds
    • Perianal fascia is medial to
    deep and superficial sphincter
    • Passes to lateral wall forms
    pudendal canal
    • Above subcutaneous
    sphincter
    Blood and Nerve Supply
    • Mucosa upper two thirds
    • Superior rectal artery
    • Autonomic nerves
    • Lower third
    • Inferior rectal
    • Somatic nerves
    Venous Drainage
    • Mucosa upper two thirds
    • Superior rectal vein
    • Portal system
    • Lower third
    • Inferior rectal vein
    • Vein into systemic
    • system
    Portal systemic anastomosis
    4,7,11 o’clock
    Lymphatic Drainage
    • Upper third
    • Pre-aortic inferior mesenteric
    • Waldeyer’s fascia passes from
    sacrum to the ampulla of rectum
    • Encloses superior rectal vessels
    and lymphatics
    • Internal iliac
    • Lower third
    • Inferior rectal cross ischiorectal fossa
    • Medial superficial inguinal glands
    Embryology of Anal Canal
    • Upper two thirds
    • Cloaca
    • Lower third
    • Proctodeum
    Ischiorectal Fossa
    • Wedge shaped fossa
    • Apex: origin of levator ani
    from obturator internus
    • Lunate fascia
    • Base: perianal fascia and
    subcutaneous fat
    • Medial: levator ani
    • External anal sphincters
    Ischiorectal Fossa (Female)
    • Anterior: posterior border
    perineal membrane
    • Posterior: sacrotuberous
    ligament, gluteus maximus
    Ischiorectal Fossa (Male)
    • Lateral: fascia on medial aspect
    of obturator internus ani
    • Pudendal canal
    • Ischial tuberosity
    Ischiorectal Fossa
    • Soft ischiorectal fat
    • Lunate fascia above the fat
    • Inferior rectal vessels pass
    above the fat to reach medial
    wall
    • Perineal branch of S4

    Ischiorectal fossa
    Pudendal Canal
    • Runs posterior to anterior
    • Contents
    • Pudendal nerve
    • Inferior rectal nerve
    • Dorsal nerve of penis or clitoris
    • Perineal nerve
    • Scrotal or labial nerves
    Pudendal Block
    Dermatomes

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