Female Perineum

MEMBERS

 Abdilahi Abokor Mohamed

 Ayaan Ismail Sh.Yasin
 Amira Hussein Mahdi
 Abdilahi Ibrahim Abdi
 Umulkhayr Hamud Muxumed
 Siciid Abdi Cali
OBJECTIVES

 Introduction
 Boundaries
 Anal Triangle
 Urogenital Triangle
 Perineal Body
 Neurovascular Supply
 Clinical Correlation
 INTRODUCTION

 The trunk is divided into 4 main cavities: thoracic,

abdominal, pelvic, and perineal.
 The pelvis has an inlet and an outlet. The lowest part
of the pelvic outlet is the perineum.
 The perineum is separated from the pelvic cavity
superiorly by the pelvic floor
 PERINEUM

 The perineum is an anatomical region in the pelvis. It is located between

the thighs, and represents the most inferior part of the pelvic outlet.
 The perineum is separated from the pelvic cavity superiorly by the pelvic
floor.
 This region contains structures that support the urogenital and
gastrointestinal systems – and it therefore plays an important role in
functions as such micturition, defecation, sexual intercourse and childbirth.
 BOUNDARIES
 In clinical practice, the term “perineum” is frequently used to describe the
area between the external genitalia and the anus. However, in anatomical
terms, the perineum is a diamond-shaped structure.
 There are two main ways in which the boundaries of the perineum can be
described.
 The anatomical borders refer to its exact bony margins, whilst the surface
borders describe the surface anatomy of the perineum.
 ANATOMICAL BORDERS
 The anatomical borders of the perineum are:
 Anterior – pubic symphysis.
 Posterior – tip of the coccyx.
 Laterally –inferior pubic rami and inferior ischial rami,
and the sacrotuberous ligament.
 Roof – pelvic floor.
 Base – skin and fascia.
 SURFACE BORDERS
 The surface boundaries are best shown
when the lower limbs are abducted, and a
diamond shape is depicted:
 Anterior – mons pubis in females
 Laterally – medial surfaces of the thighs.
 Posterior – superior end of the
intergluteal cleft.
 CONTENTS

 The perineum can be subdivided by a theoretical line drawn transversely between

the ischial tuberosities. This split forms the anterior urogenital and posterior
anal triangles.
 These triangles are associated with different components of the perineum –
which we shall now examine in more detail.
 ANAL TRIANGLE
 The anal triangle is the posterior half of the perineum. It is bounded by the
coccyx, sacrotuberous ligaments, and a theoretical line between the ischial
tuberosities.

 The main contents of the anal triangle are:

 Anal aperture – the opening of the anus.
 External anal sphincter muscle – voluntary muscle responsible for opening
and closing the anus.
 Ischioanal fossae (x2) – spaces located laterally to the anus.
CONT…
 The anal aperture is located centrally in the triangle with the ischioanal
fossae either side.

 These fossae contain fat and connective tissue, which allow for expansion of
the anal canal during defecation. They extend from the skin of the anal region
(inferiorly) to the pelvic diaphragm (superiorly).

 Another important anatomical structure within the anal triangle is

the pudendal nerve, which supplies the whole perineum with somatic fibres.
 UROGENITAL TRIANGLE
 The urogenital triangle is the anterior half of the perineum. It is bounded by

the pubic symphysis, ischiopubic rami, and a theorectical line between the

two ischial tuberosities. The triangle is associated with the structures of the

urogenital system – the external genitalia and urethra.

 Structurally, the urogenital triangle is complex, with a number of fascial layers

and pouches. Unlike the anal triangle, the urogenital triangle has an additional

layer of strong deep fascia; the perineal membrane.

 This membrane has pouches on its superior and inferior surfaces.

CONT…
 The layers of the urogenital triangle (deep to superficial):

 Deep perineal pouch – a potential space between the deep fascia of the pelvic

floor (superiorly) and the perineal membrane (inferiorly). It contains part of the

urethra, external urethral sphincter, and the vagina in the female. In males, it also

contains the bulbourethral glands and the deep transverse perineal muscles.

 Perineal membrane – a layer of tough fascia, which is perforated by the urethra

(and the vagina in the female). The role of the membrane is to provide

attachment for the muscles of the external genitalia.

CONT…

 Superficial perineal pouch – a potential space between the perineal

membrane (superiorly) and the superficial perineal fascia (inferiorly). It

contains the erectile tissues that form the penis and clitoris, and three muscles

– the ischiocavernosus, bulbospongiosus and superficial transverse perineal

muscles. The greater vestibular glands (Bartholin’s glands) are also located in

the superficial perineal pouch. The pouch is bounded posteriorly to the

perineal body.
 CONT…
 Perineal fascia – a continuity of the abdominal fascia that has two components:
 Deep fascia: covers the superficial perineal muscles and protruding structures (e.g. penis &

clitoris).

 Superficial fascia: is composed of a further two layers of fascia:

 Superficial layer – continuous with Camper’s fascia of the anterior abdominal wall

 Deep layer (Colles’ fascia) – continuous with Scarpa’s fascia of the anterior abdominal

wall

 Skin – The urethral and vaginal orifices open out onto the skin.
 THE PERINEAL BODY
 The perineal body is an irregular fibromuscular mass. It is located at the junction of
the urogenital and anal triangles – the central point of the perineum. This structure
contains skeletal muscle, smooth muscle and collagenous and elastic fibres.

 Anatomically, the perineal body lies just deep to the skin. It acts as a point
of attachment for muscle fibres from the pelvic floor and the perineum itself:
 Levator ani (part of the pelvic floor).
 Bulbospongiosus muscle.
 Superficial and deep transverse perineal muscles.
 External anal sphincter muscle.
 External urethral sphincter muscle fibres.
 NEUROVASCULAR SUPPLY
 The major neurovascular supply to the perineum is from the pudendal
nerve (S2 to S4) and the internal pudendal artery.
 The pudendal nerve (along with the internal pudendal artery and vein) travel
along the inner surface of the ischial tuberosities, through a “canal” formed
by a thickening of the obturator fascia (Alcock’s canal).
 The pudendal neurovascular bundle courses downwards through each
ischioanal fossa and gives branches to both the anal and genital triangle.
CONT…

 The perineal artery is a terminal branch of the internal pudendal artery, supplying
blood to the perineal structures inferior to the pelvic diaphragm. It passes within the
superficial perineal pouch towards the scrotum in the male and the labia majora in
the female.
 Within the superficial perineal pouch, the perineal artery in females divides into
sets of arteries;
 transverse perineal
 labial arteries
 artery of bulb of vestibule in females.

 These branches supply various structures of the perineum, such as the perineal
body, transverse perinei muscles and skin of the perineal region.
CLINICAL RELEVANCE - THE PERINEAL BODY

 The perineal body is a central attachment for perineal muscles, and functions to
support the pelvic floor.
 Childbirth can lead to damage (stretching/tearing) of the perineal body, thus leading
to possible prolapse of pelvic viscera. This may be avoided by an episiotomy (a
surgical cut in the perineum). This inevitably causes damage to the vaginal
mucosa, but prevents uncontrolled tearing of the perineal body.
 BARTHOLIN’S GLAND CYSTS
 The Bartholin’s glands are located within the superficial perineal pouch of the
urogenital triangle. Their role is to make a small amount of mucus-like fluid.
 Normally, the Bartholin’s glands are not detected on physical examination.
However, if the duct becomes blocked, then these glands can swell to
form fluid-filled cysts.
 These cysts can become infected and inflamed, a condition known
as bartholinitis. The most common cause of infection is from bacteria such
as Staphylococcus spp. and Escherichia coli.
THANK YOU