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38. The perineum. The formation of the placenta. The structure of the
matured placenta.
Posted in Pelvis by Sahaja on January 8, 2009

38. The perineum. The formation of the placenta. The structure of the matured placenta.

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Anatomy of the perineum.

Perineum
diamond shaped space w/ same boundaries as pelvic outlet
inf to pelvic diaphragm (& UG diaphragm)

NOTE – MALE = BLUE, FEMALE = PINK

Borders

ant = pubic symphysis

post = tip of coccyx
ant/lat = ischiopubic ramus
lat = ischial tuberosity
post/lat = sacrotuberous lig

Layers of Perineum: (outside –> in)

1. Skin
2. subcutaneous adipose tissue
3. Superficial perineal fascia
4. Superficial perineal space
bulb/crura of penis/clitoris
sup transverse perineal m
ischiocavernosus m
bulbospongiosusm

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a/v/n
5. UG diaphagm
Inferior fascia of UG diaphragm = deep perineal fascia = perineal membrane
deep transverse perineal m (post) + sphincter urethra (ant)
superior fascia of UG diaphragm
6. Deep perineal space – ant continuation of ischio-anal fossa, has pudendal canal
7. Pelvic diaphragm
inferior fascia of levator ani m
levator ani m
superior fascia of levator ani m
8. Lesser pelvis

*OTE = Inf fascia of UG diaphragm is the SAME AS deep perineal fascia is SAME AS = perineal membrane

Layers of Perineal Area Female

Perineal Layers Male

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A line b/w the 2 ischial tuberosities, divides the perineum into 2 triangles
ant = Urogenital triangle
post = anal triangle

Urogenital Triangle
A. Superficial perineal space
b/w inf fascia of UG diaphragm & membranous layer of sup perineal fascia (Colles’)

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Superficial Perineal Space

1. Colles fascia

deep membranous layer of sup perineal fascia

inf boundary of sup perineal fascia
cont w. tunic dartos of scrotum, w/ sup fascia of pelvis & w/ Scarpa’s fascia of ant ab wall

2. Perineal Membrane

inf fascia of UG diaphram & lies b/w it and ext genitalia

perforated by urethra & attached to post margin of UG diaphragm & ischiopubic rami
thickened ant to form transverse lig of perineum, covers the inf pubic rami
lies post to deep dorsal v of penis/clitoris

3. M of sup perineal space

a) Ischiocavernosus m – ischial tuberosity –> ischiopubic rami –> corpus cavernosum

contains perineal br of pudendal n

helps maintain erection of penis, by compressing the crus of penis, & deep dorsal v of penis
this stops venous return of blood from area
b) Bulbospongiosus m
Origin:
(M) = perineal body, fibrous raphe of bulb of penis
(F) = perineal body
Insertion:
(M) = corpus spongiosum & perineal membrane
(F) = pubic arch, dorsum of clitoris

Action of musc:
(M) = compress bulb of penis, stop venous return –> keep erection,

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contraction of corpus spongiosum –> expel urine or semen

(F) = compress eretile tissue of bulb of vestibule –> constrict vaginal orifice

c) Superficial transverse perineal m

ischial rami of tuberosities –> perineal body (tendon)
stabilizes central tendon (perineal body)

d) Perineal body (central tendon)

fibromuscular mass @ center
site of attachment for UG diaphragm m.

e)Bartholin’s gland (bulbourethral glands)

compressed in sex & secrete mucus to lubricate vagina
ducts open in vestibule b/w labia minora below hymen

B. Deep perineal space

b/w sup/inf fascia of UG diaphragm

UG diaphragm
deep transverse perineal m, sphincter urethrae m
b/w 2 pubic rami & ischial rami
inf fascia provide attachment to bulb of penis
pierced by membranous urethrae (M) or urethra & vagina (F)
does not reach pubic symphysis ant

Bulbourethral Glands
lie b/w fibers of sphincter urethrae in deep perineal space
on post/lat side of membranous urethra
ducts pass thru inf fascia of UG diaphragm to open into bulbous part of penile urethra

M of deep perineal space

a)Deep transverse perineal m
inf surface of ischial rami –> med tendionous raphe and perineal body (in Female = vaginal wall)
stabilizes perineal body and supports the prostate and vagina

b) Sphincter Urethrae m
Inf pubic ramus –> median raphe and perineal body
surrounds the body of membranous urethra in male

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inf part = attached to ant/lat wall of vagina (F) = urethrovaginal sphincter that compresses urethra and vagina

Anal Triangle
the Post triangle - everything posterior to the line b/w 2 ischial tuberosities

Ischioanal fossa
space lateral to rectum-anal canal, & medial to by levator ani & its fascia that lines the pelvis

Borders:

ant = post border of sup/deep transverse perineal m

post = glut max m, sacrotuberous lig
sup/med = sphincter ani ext + levator ani m
lat = obturator fascia over obturator ani m
floor = skin over anal triangle

Contents:

ischioanal fat
inf rectal a/v/n (from int pudendal a, pudendal n)
perineal br of post femoral cut n

On lateral wall, running through obturator fascia = Alcock’s canal aka pudendal canal

contains pudendal n
int pudendal a/v

Muscles of Anal Triangle

1. Obturator Internus – lat rotation of thigh
inner surface of obturator mem –> med side of greater trochanter of femur
has tendon that passes around lesser sciatic notch
(n to obturator)

2.Sphincter Ani Ext – closes the anus

Tip of coccyx & anococcygeal lig –> central tendon of perineum (perineal body)
(inf rectal n)

3. Levator Ani m – support and raise pelvic floor

body of pubis, arcus tendonous of levator ani (thickened part of obturator fascia, ishial spine) –> coccyx & anorectal
raphe/lig
has 3 parts: puborectalis, pubococcygeus, iliococcygeus
has as ant fibers (most med) = levator prostatae, pubovaginalis
(br of ant rami of S3-4 + perineal br of pudendal n)

4.Coccygeus m – support and raise pelvic floor

ischial spine & sacrospinous lig –> coccyx + lowers sacrum
(br of S4-5)

Pelvic Diaphragm
= levator ani m + coccygeus m
divides pelvis into 2 compartments:
1. superior = w/ viscera
2. inf = ischiorectal fossa

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Pelvic Diaphragm

Inf to pelvic diaphragm = UG diaphragm

is on the ant portion of perineum, and ischioanal fossa posteriorly
made up of sup/inf fascia + deep/sup transverse perineal m
w. perineal body in center

Deep transverse m has urethra & vagina pierce it

m goes around urethra, forms sphincter urethra (M) & urethrovaginal sphincter(F)
does NOT attach to symphysis,
there is a space b/w it and symphysis = retropubic space, where deep/dorsal a of pelvis exit

*erve Supply:

Pudendal n (S2-4) -
passes thru gr. sciatic foramen, b/w piriformis & coccygeus m –> crosses ischial spine & enters perineum w/ int
pudendal a
thru lesser sciatic foramen –> pudendal canal
Gives rise to:
inf rectal n – several br. in canal, crosses ischio-anal fossa => sphincter ani ext m, skin around anus
perineal n – arises in canal
deep br => all perineal m
sup br => br to scrotum, labia majora
Deep dorsal n - thru perineal mem b/w 2 layers => skin, foreskin, glans
lies on dorsum of clitoris or penis

Blood Supply::

Int pudendal a – leaves pelvis thru gr. sciatic foramen below piriformis & coccygeus m –> enters perineum via lesser
sciatic foramen around ischial spine
Branches:
Inf rectal a - w/ in canal, thru wall of it, br => m and skin around anal canal
perineal a – => superficial perineal m, transv perineal br, post scrotal/labial br
a of bulb => bulb of penis, bulbourethral glands (M), vestibular bulbs & gr vestibular glands (F)
urethral a – corpus spongiosum, glans of penis
deep a – pierce perineal mem –> run thru center of corpus cavernosum => erectile tissue of penis &
clitoris
dorsal a – pierce perineal mem & pass thru suspensory lig of penis/clitoris, runs along dorsum on each
side of deep dorsal v and deep to Buck’s fascia & superficial to tunica albuginea => glans & foreskin

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Ext pudendal a- from femoral a

runs thru saphenous ring & passes med over spermatic cord (or round ligament of uterus)
=> skin above pubis, penis, scrotum or labia majora
Veins of pelvis
deep dorsal v -
unpaired veins, that begins in sulcus behind glans & lies in dorsal midline ,
deep to Buck’s fascia & sup to tunica albuginea –> leaves perineum thru gap b/w arcuate pubic lig &
transv. perineal lig –> suspensory lig, below arcuate pubic ligament and drains into –> prostatic and
pelvic venous plexus
sup dorsal v – runs toward pubic symphysis b/w sup & deep fascia in dorsum of penis
divides into R & L br,
terminates in sup pudendal v –> drains into gr. saphenous v

Lymph Drainage:

1. Lymph drainage of perineum – occurs via sup inguinal l.n

rec lymph from lower ab wall, buttocks, penis, scrotum, labia majora, lower vaginal/anal canal
nodes have efferent vessels that drain primarily into –> ext iliac nodes –> lumbar nodes
2. Lymph drainage of Pelvis
1. –> common iliac l.n. –> lumbar nodes
follows int iliac v –> int iliac nodes –> lumbar nodes
Int iliac nodes -rec upper part of rectum, vagina and other pelvic organs
3. upper rectum –> inf mesenteric nodes –> aortic nodes
4. testis/ovaries drains along gonadal vessels –> aortic nodes

Histology : The structure of the matured placenta.

Embryology: The formation of the placenta.

Tagged with: Perineum

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39. Bones, muscles and ligaments of the pelvis. The blood vessels and nerves of the pelvis. The bone tissue. Gastrulation,
early differentiation of the intraembryonic mesoderm »

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This site was made for the Anatomy, Histology, Embryology class in 2nd yr, 1st semester at the University of Debrecen. All
theoretical topics are listed as described on the website of the Anatomy department.

We combined Practical class notes, Moore, Board Review Series textbooks of Gross Anatomy and Embryology, Langman’s,
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On the left are the newest topics we’ve added.

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But the best way to find the topic that you want?

Scroll down and click on the “Link to Topics” Page. There is the list of all topics. If a link to your topic of choice
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Gastrulation, early differentiation of the intraembryonic mesoderm
38. The perineum. The formation of the placenta. The structure of the matured placenta.
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