Anatomy 1C Joshua Montelibano 4th shift 2015-2016

PELVIS

PELVIS
PELVIS
False Pelvis
 Main function: Transmit the weight of the body from the vertebral column  Flares out at its upper end; considered as part of the abdominal cavity
to the femurs  Supports abdominal contents
 After 3 month of pregnancy- helps support the gravid uterus
rd
 Other functions: It contains, supports, and protects the pelvic viscera;
Provides attachment for trunk and lower limb muscles During early stages of labor – helps guide the fetus into the true pelvis
 Forms a strong basin-shaped structure containing and protecting lower
parts of the intestinal and urinary tracts and reproductive organs True Pelvis
 Bony canal through which the child passes during birth
Composed of 4 bones
1. 2 Hip bones – form the lateral and anterior walls Pelvic Inlet  Pelvic Brim
 Symphysis pubis – anterior articulation of the 2 hip bones Boundaries 3 wide notches
 Sacroiliac joint – posterior articulation together with the sacrum Anterior: Pubic arch, Anterior: Pubic arch
2. Sacrum and Coccyx – part of the vertebral column; forms the back wall ischiopubic rami Lateral: Greater & Lesser
Posterior: Coccyx sciatic notch
Pelvic Brim Lateral: Ischial tuberosities
 Formed by:  Diamond shaped
Anterior: Symphysis pubis Pelvic  Sacrotuberous and sacrospinous ligaments
Posterior: Sacral promontory (anterior and upper margin of S1) Outlet 1. Divides sciatic notch into greater and lesser sciatic
Lateral: Iliopectineal line (Line running downward and forward around foramina
the inner surface of the ileum) 2. Prevent lower end of the sacrum and coccyx from
 Divides the pelvis into 2 parts – True and false pelvis being rotated upward at the sacroiliac joint by the
weight of the body
Boundaries of the True & False pelvis  Sacrotuberous ligaments – strong and inflexible; forms
True pelvis (Lesser pelvis) False Pelvis (Greater pelvis) part of the pelvic outlet perimeter and posterior boundary
Lower part of the anterior  Lies between the inlet and outlet
Pubic symphysis and pubic arch Pelvic
Anterior abdominal wall (incomplete  Short, curved canal with a shallow anterior wall and a
between the ischiopubic rami Cavity
infront) much deeper posterior wall
Posterior Sacrum & coccyx Lumbar vertebrae
Iliopectineal lines & ischial Pelvic Walls
Lateral Iliac fossae and Iliacus muscle
tuberosities  Formed by bones and ligaments; partly lined by muscles covered with
fascia and parietal peritoneum
 Anterior, Posterior, Lateral, and Inferior Walls

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ANTERIOR WALL
 Shallowest Wall; Formed by the bodies of the:
1. Pubic bones
2. Pubic rami
3. Symphysis pubis
POSTERIOR WALL
 Extensive; formed by the sacrum, coccyx, & piriformis muscle
SACRUM
 Consists of 5 rudimentary vertebrae fused forming a single wedge-shaped
bone with a forward concavity
 Sacrum + Vertebral foramina = Sacral canal
 Contains anterior & posterior roots of the lumbar, sacral, and
coccygeal spinal nerves; filum terminale and fibrofatty material
 With lower part of the subarachnoid space up to
lower border of S2
 Laminae of S5 – fail to meet in midline – forms sacral hiatus
 Upper border (base) – articulates with L5
 Narrow inferior border – articulates with the coccyx
 Laterally – articulates with 2 iliac bones (forms the sacroiliac joints)
 Anterior and upper margins of S1 bulge forward as the posterior margin of
the pelvic inlet – Sacral promontory (landmark for pelvis measurement)
 Anterior & posterior surfaces – possess on each side 4 foramina – passage of
anterior and posterior rami of upper 4 sacral nerves
 Tilted forward – forms an angle with L5 (lumbosacral angle)
COCCYX
 Consists of 4 vertebrae fused forming a small triangular bone
 Articulates at its base with the lower end of the sacrum
 Coccygeal vertebrae consist of bodies only

st
1 coccygeal vertebra – possesses a rudimentary transverse process and
cornua
 Cornua – remains of the pedicels and superior articular processes;
project upward articulating with the sacral cornua
PIRIFORMIS MUSCLE
Anatomy 1C Joshua Montelibano 4th shift 2015-2016
LATERAL WALL
HIP BONE
 Formed from 3 bones – ileum (superior), ishium (posterior), pubis
(anteroinferior) - joined by cartilage at the acetabulum
 Articulate with sacrum at sacroiliac joint; anteriorly at symphysis pubis
 Forms anterolateral walls of the pelvis
Acetabulum
 Deep depression at outer surface of hip bone
 Articulates with hemispherical head of the femur
 Ischial spine – separates greater sciatic notch behind the acetabulum
from the lesser sciatic notches
Ilium – Upper flatted part possessing the iliac crest at the superior iliac spines
Ischium – Inferoposterior part possessing ischial spine and ischial tuberosity
Pubis – Anterior part with a body and superior & inferior pubic rami
 Body – bears the pubic crest and pubic tubercle
 Obturator foramen – bounded by ischium and pubis
SACROTUBEROUS LIGAMENT
 Strong ligament – extends from the lateral part of the sacrum and coccyx
and the posterior inferior iliac spine to the ischial tuberosity
SACROSPINUOUS LIGAMENT
 Strong and triangle shaped
 Base – attached to the lateral part of the sacrum and coccyx
 Apex – attached to spine of the ischium
OBTURATOR MEMBRANE
 Fibrous sheet almost completely encloses the obturator foramen
 Leaves a small gap – Obturator Canal – passage of obturator nerve and
vessel as they leave the pelvis entering the thigh
OBTURATOR INTERNUS MUSCLE
INFERIOR WALL (PELVIC FLOOR)
 Supports the pelvic viscera
 Formed by the pelvic diaphragm
 Stretches across the pelvis – divides pelvis into main pelvic cavity above
and perineum below
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Male Pelvis Female pelvis

Narrower, heart-shaped Circular, wider, oval
Inlet
Android Gynecoid
Outlet Narrow, oval Circular, larger
ischial spine project farther medially project laterally
Cavity Funnel shaped Wide, shallow, cylindrical
Pubic symphysis Taller Shorter
Angle between
Acute (70 degrees) Obtuse (90-100 degrees)
inferior pubic rami
narrow, pointed, wide, semicircular
(pubic arch)
Obturator foramen Round Oval
Long, narrow, straighter Shorter, wider, more curved
Sacrum pronounced sacral posteriorly
promontory less pronounced promontory
Greater sciatic
Narrower Wider
notch

Pelvic Measurements
 True conjugate - plane of the pelvic inlet; anteroposterior diameter;
distance between upper margin of the symphysis pubis and
sacral promontory
 Diagonal conjugate - distance from the lower margin the
symphysis pubis and sacral promontory
 Obstetrical conjugate - shortest distance from symphysis pubis to
sacral promontory; cannot be measured directly with fingers
 Transverse diameter – at right angle with the obstetrical conjugate; greatest
distance between the iliopectineal lines
 Midpelvis – at level of the ischial spines – interspinous diameter (usually
smallest pelvic diameter); important following engagement of
fetal head in obstructed labor
 Anteroposterior diameter of the pelvic outlet – lower margin of symphysis
pubis to tip of the sacrum

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PELVIC DIAPHRAGM

 Formed by the levator ani muscles and coccygeus muscles

 Incomplete anteriorly – allows passage of urethra and vagina
 Supports pelvic viscera and closes the pelvic outlet

Levator Ani Muscle

 Wide thin sheet with 3 extensive origin
 Groups of fibers sweep downward and medially to their insertion:
1. Anterior fibers – Levator prostate (Sphincter vaginae)
 Form a sling around the prostate/vagina and stabilizes
perineal body (where it is inserted in front of anal canal)
 Levator prostate – support the prostate
 Sphincter vaginae – constrict the vagina
2. Intermediate fibers
 Puborectalis - forms a sling around the junction of the
rectum and anal canal; medial
 Puboccygeus - passes posteriorly; inserted into the
anococcygeal body (between coccyx tip and anal canal)
3. Posterior fibers – Iliococcygeus
 Arises from arcus tendineus
 Inserted into anococcygeal body and coccyx

Coccygeus Muscle
 Small triangular muscle completing the pelvic diaphragm

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Muscles of the Pelvic Walls and FLoor

Origin Insertion Innervation Action
Piriformis Front of sacrum Sacral plexus
Obturator membrane Greater trochanter of femur Nerve to obturator Lateral rotator of femur at hip joint
Obturator internus
Adjoining part of hip bone internus (sacral plexus)
Body of pubis Perineal body Supports pelvic viscera
Levator ani Fascia of obturator internus Anoccocygeal body S4, Pudendal nerve Sphincter to anorectal junction and
Ischium spine Walls of prostate, vagina, rectum vagina
Coccygeus Ischium spine Lower end of sacrum; coccyx S4, S5 Assists levator ani; flexes coccyx

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PELVIC FASCIA Arterial supply of the Pelvis

 Connective tissue continuous above with the fascia lining the abdominal
walls; below with the fascia of the perineum Branches of the Internal Iliac artery
 Divided into parietal and visceral layers  Anterior Division
Parietal fascia
 Lines walls of the pelvis; named according to muscle it overlies
 Becomes continuous through the opening of the pelvic diaphragm where it
is deficient anteriorly – covers inferior surface of the pelvic diaphragm in
the perineum
 Covers sphincter urethrae muscle and perineal membrane
 Forms superficial layer of the urogenital diaphragm
Visceral fascia
 Covers and supports all pelvic viscera
 Thickens and extends from the viscus to the pelvic walls in certain locations
– provides support
 Named according to their attachments (ex. Pubovesical, sacrocervical
ligaments)
Arterial supply of the Pelvis
Arteries of the True Pelvis
1. Internal iliac artery
2. Superior Rectal artery (Branch of Inferior Mesenteric artery)
3. Ovarian artery (Branch of abdominal aorta at L1)
4. Median sacral artery (Branch of the abdominal aorta at its bifurcation)
INTERNAL ILIAC ARTERY  Posterior Division
Origin: Common Iliac artery
Commencement: Sacroiliac joint
 Passes down into the pelvis to the upper margin of the greater sciatic
foramen – divides into anterior and posterior divisions
1. Umbilical artery
 Arises the superior vesical artery – supplies upper portion of
the bladder
2. Obturator artery
 Runs forward along the lateral wall of the pelvis with the
obturator nerve; leaves pelvis through obturator canal
3. Inferior vesical artery
 Supplies base of the bladder, prostate, seminal vesicles, and
vas deferens
4. Middle rectal artery
 Arises with the inferior vesical; supplies lower rectum muscles
 Anastomoses with superior and inferior rectal arteries
5. Internal pudendal artery
 Leaves the pelvis through greater sciatic foramen; enters the
gluteal region below the piriformis muscle
 Supply anal canal musculature and perineum skin and muscles
6. Inferior gluteal artery
 Leaves the pelvis through greater sciatic foramen below the
piriformis muscles
 Passes between S1 and S2 or S2 and S3 nerves
7. Uterine artery – crosses the ureter superiorly
 Anastomoses with the ovarian artery; gives off vaginal branch
8. Vaginal artery - supplies vagina and bladder base
1. Iliolumbar artery
 Ascends across the pelvic inlet anterior to the external iliac
vessels, psoas, and iliacus muscles
2. Lateral sacral arteries
 Descend in front of the sacral plexus
3. Superior gluteal arteries
 Leaves the pelvis through the greater sciatic foramen above
the piriformis muscle; supplies gluteal region

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SACRAL PLEXUS Obturator Nerve

 Branch of the lumbar plexus ( L2 – L4)
 Lies on the posterior pelvic wall anterior the piriformis muscle  Emerges from the medial border of the psoas muscle; accompanies
 lumbosacral trunk into the pelvis
th th
Formed from the anterior rami of the 4 and 5 lumbar nerves and anterior
st th
rami of the 1 -4 sacral nerves (L4, L5 + S1-S4)  Crosses the front of the sacroiliac joint; runs forward on the lateral pelvic
 L4 + L5 – forms lumbosacral trunk – passes down into the pelvis and joins wall between internal and external iliac vessels
the sacral nerves  Reaches obturator canal – splits into anterior and posterior divisions
Relation with other structures
Anterior: Internal Iliac vessels and branches
Posterior: Piriformis muscle

Branches
 To the lower limb leaving via the greater sciatic foramen
1. Sciatic nerve (L4, L5, S1-S3)
 Largest branch of the plexus and
largest nerve of the body
2. Superior gluteal nerve - (L4, L5, S1) supplies gluteus medius and
minimus and tensor fasciae latae muscles
3. Inferior gluteal nerve – (L5, S1, S2) supplies gluteus maximus
4. Nerve to quadratus femoris muscle - (L4, L5, S1)
supplies inferior gemellus
5. Nerve to obturator internus muscle – (L5, S1, S2)
supplies superior gemellus
6. Posterior cutaneous nerve of the thigh - (anterior S2, S3, posterior
S1, S2) supplies skin of the buttock and back of the thigh
 Branches to pelvic muscles, viscera, and perineum
1. Pudendal nerve (S2-4)
 Leaves pelvis through greater sciatic foramen;
enters the perineum through lesser sciatic foramen
 Branches: Inferior rectal nerve, dorsal nerve of the penis
and clitoris, perineal nerve
2. Nerve to the piriformis muscle
3. Pelvic splanchnic nerves
 Constitute the sacral part of the parasympathetic system
 S2-S4 – distributed to pelvic viscera
 Perforating cutaneous nerves - (S2, S3) supplies skin of lower medial part
of the buttock

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Branches of the Sacral Plexus and Distribution

Branches Distribution
Superior gluteal Gluteus medius, gluteus minimus, tensor fasciae latae muscles
Inferior gluteal Gluteus maximus
Nerve to piriformis Piriformis muscle
Nerve to obturator Obturator internus and superior gemellus muscle
internus
Nerve to quadratus Quadratus femoris and inferior gemullus muscle
femoris
Perforating Skin over medial aspect of buttock
cutaneous
Posterior cutaneous Skin over posterior thigh surface and popliteal fossa
nerve of thigh lower part of buttock, scrotum, or labia majora
Sciatic nerve Leg muscles
Pudendal nerve Perineum muscles, perianal skin, skin of penis, scrotum, clitoris,
labia majora and minora

SUPERIOR HYPOGASTRIC PLEXUS INFERIOR HYPOGASTRIC PLEXUS

 In front of the sacrum promontory
 Formed as a continuation of the
aortic plexus from branches of L3 &
L4 lumbar sympathetic ganglia
 Contains sympathetic and sacral
parasympathetic nerve fibers and
visceral afferent nerve fibers
 Divides inferiorly into right and left
hypogastric nerves
 Lie on each side of the rectum, base
of the bladder, and vagina
 Formed from a hypogastric nerve and
pelvic splanchnic nerve
 Contains sympathetic fibers, pre- and
post-ganglionic fibers, and visceral
afferent fibers
 Branches pass to pelvic viscera via
small subsidiary plexuses

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EXTERNAL GENITALIA & PERINEUM

PERINEUM
PERINEUM MALE EXTERNAL GENITALIA

 Diamond shaped PENIS

 Can be divided into 2 triangles by a base line drawn between the anterior  Fixed root but body hangs free
ends of the ischial tuberosities – forms anal and urogenital triangle  With superficial and deep fascia (Dartos and Buck’s fascia)
Boundaries Root of the penis
Anterior: Symphysis pubis  Made up of 3 masses of erectile tissue
Posterior: Tip of the coccyx 1. Bulb of the penis
Lateral: Ischial tuberosities  Situated in the midline; attached to the undersurface of the
urogenital diaphragm
Urogenital Boundaries  Traversed by the urethra and is covered by the bulbospongiosus
triangle Anterior: Pubic arch muscle
(Anterior) Lateral: Ischial tuberosities  Continued forward into the body of the penis – forms the corpus
Boundaries spongiosum
Anal triangle Posterior: Tip of the coccyx 2. Right and Left Crura of the penis
(Posterior) Lateral: Ischial tuberosities and sacrotuberous ligament  Attached to the side of the pubic arch
Anus – lies in midline with ishiorectal fossa on each side  Covered by the ischiocavernosus muscle
 Converge anteriorly and come to lie side by side in dorsal part of
penis body – forms corpora carvernosa
Body of the penis
 Composed of 3 cylinders of erectile tissue – enclosed in Buck’s fascia
 Erectile tissue – 2 dorsal corpora carvernosa and 1 ventral corpora
spongiosum
 At distal extremity – corpus spongiosum expands to form glans penis (covers
ends of the corpora cavernosa)
 External urethral meatus – slitlike orifice of the urethra on tip of the glans
penis
 Supported by 2 condensations of deep fascia extending downward from the
linea alba and symphysis pubis to be attached to penis fascia

Prepuce (Foreskin) – hoodlike fold of skin covering the glans

Frenulum – fold connecting the prepuce to glans below the urethral orifice

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PENIS and CLITORIS

 Corpora cavernosa – deep arteries of the penis
Arterial  Corpora spongiosum – artery of the bulb
Supply
Dorsal artery of the penis
(Branches of the Internal pudendal artery)
Venous
Drain into the internal pudendal vein
Drainage
Innervation Pudendal nerve and Pelvic plexuses
Lymph  Penile skin – medial group of superficial
inguinal nodes
Drainage
 Deep penile structures – internal iliac nodes

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SCROTUM

 Outpouching of the lower part of the anterior abdominal wall

 Contains testis, epididymis, and lower ends of the spermatic cords
 Homologue of the labia majora in females
 Scrotal raphe – line of fusion in the midline; represents bilateral
origin of the scrotum

Scrotum wall layers

 Skin
 Superficial fascia – dartos muscle and Colle’s fascia (from Camper’s and
Scarpa’s fascia respectively)
 External spermatic fascia – derived from external oblique
 Cremasteric fascia – derived from internal oblique
 Internal spermatic fascia – derived from fascia transversalis
 Tunica vaginalis - covers the anterior, medial, and lateral surfaces

 External pudendal branches of the femoral artery

Arterial Supply
 Scrotal branches of the internal pudendal arteries
Venous Drainage External pudendal and scrotal veins
 Anterior surface – ilioinguinal nerves and the
genital branch of the genitofemoral nerves
Innervation  Posterior surface – branches of the perineal
nerves and posterior cutaneous nerves of the
thigh
 Scrotum wall – medial group of superficial
inguinal lymph nodes
Lymph Drainage
 Testis and epidydimis – lumbar (para-aortic)
nodes at L1

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FEMALE EXTERNAL GENITALIA (VULVA)

 Mons pubis – rounded, hair-bearing elevation of skin anterior to the pubis

 Labia majora – prominent, hair-bearing folds of skin extending posteriorly
from the mons pubis to unite posteriorly in the midline
 Labia minora – 2 smaller, hairless folds of soft skin between the majora
 Fourchette - united sharp fold of the minora at the posterior end; split
anteriorly to form an anterior prepuce and posterior frenulum
 Vestibule - smooth triangular area bounded laterally by the labia minora,
clitoris at its apex, and fourchette at its base

CLITORIS

 Corresponds to the penis in the male – partly hidden by the prepuce

 Situated at the apex of the vestibule anteriorly

Root of the Clitoris

 Made up of 3 masses of erectile tissue
1. Bulb of the vestibule
 Corresponds to bulb of the penis but it is divided into 2 halves due
to presence of vagina
 Attached to the undersurface of the urogenital diaphragm
 Covered by the bulbospongiosus muscles
2. Right and Left crura of the clitoris
 Corresponds to crura of the penis
 Becomes corpora cavernosa anteriorly
 Remains separate and is covered by the ischiocavernosus muscle

Body of the Clitoris

 Consists of 2 corpora cavernosa covered by their ischiocavernosus muscle
 Corpus spongiosum – represented by a small amount of erectile tissue

Glans of the Clitoris

 Small mass of erectile tissue capping the clitoris body
 Partly hidden by prepuce with numerous sensory endings

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SUPERFICIAL PERINEAL POUCH DEEP PERINEAL POUCH

Boundaries
Anterior: Urogenital diaphragm
Posterior: Membranous layer of superficial fascia
Lateral: Closed by the attachment to pubic arch margins
Contents
Contains structures forming the root of the penis/clitoris
together with bulbospongiosus and ischiocavernosus
muscles
 Compress penile part of the urethra and empty it of
residual urine or semen
 Anterior fibers compress deep dorsal vein of penis/
Bulbospongious muscle reduces size of vaginal –
impedes venous drainage of erectile tissue(assists in
penile/clitoris erection)
 Innervation: perenial branch of pudendal nerve
Male/Female
perineal pouch
Superficial Transverse Perineal Muscles
 Arises from the ischial ramus
Perineal body
 Small fibrous tissue at posterior margin of
urogenital diaphragm
 Common attachment of perineal muscles
 Support posterior vaginal wall
Perineal branch of the pudendal nerve
 Supplies muscles and skin
Contents
Membranous part of the urethra
 0.5 in (1.3cm), lies in urogenital diaphragm
 Surrounded by sphincter urethrae – shortest and least
dilatable part of the urethra
Sphincter urethrae muscle
 Surrounds urethra arising from pubic arch
 Innervation: perineal branch of the pudendal nerve
 Compresses membranous urethra and relaxes during
micturition
Male
 Bulbourethral glands – lie beneath the muscle; ducts
perineal
pierce the perineal membrane and enter the penile
pouch
portion of the urethra
Deep Transverse Perineal muscles
 Lie posterior to sphincter urethrae muscle
 Arises from ischial ramus and inserts into perineal
body (clinically unimportant muscles)
Internal pudendal artery
 Gives rise to artery to bulb of penis, arteries to the
crura of penis, and dorsal artery of the penis
Dorsal nerve of the penis - supplies penis skin
Contains part of the urethra and vagina; sphincter urethra
Female
(pierced by the urethra and vagina); deep transverse perianal
perineal
msuscles, internal pudendal artery, and dorsal nerves of the
pouch
clitoris

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Muscles of the Perineum

Origin Insertion Innervation Action
Male Urogenital Muscles
Fascia of penis bulb
Bulbospongiosus Perineal body Compresses urethra
Corpus spongiosum & cavernosum
Assists in erection
Ischicavernosus Ischial tuberosity Fascia covering corpus cavernosum
Perineal branch of
Sphincter urethrae Pubic arch Surrounds urethra Voluntary urethral sphincter
pudendal nerve
Superficial transverse
Ischial tuberosity
perianal Perineal body Fixes perineal body
Deep transverse perianal Ischial ramus
Female Urogenital Muscles
Bulbospongiosus Perineal body Perineal branch of Vagina sphincter; assists in erection
Fascia of corpus cavernosum
Ischicavernosus Ischial tuberosity pudendal nerve Causes clitoris erection
Sphincter urethrae
Superficial transverse
perianal Same as in male
Deep transverse perianal
External Anal Sphincter Muscles
Inferior rectal nerve
Subcutaneous part Voluntary anal sphincter
Encircles anal canal perineal branch of S4
Deep part
Superficial part Perineal body Coccyx
Sling around junction of rectum and Perineal branch of S4
Puborectalis Pubic bones Voluntary anal sphincter
anal canal and pudendal nerce
Internal Pudendal Artery
ISCHIORECTAL FOSSA  Branch of the internal iliac artery passing from the pelvis
 Wedge-shaped, fat-filled space located on each side of the anal canal  Enters greater sciatic foramen then the perineum via the lesser foramen
 Base of the wedge – superficial and formed by skin Branches
 Edge of the wedge – junction of the medial and lateral walls  Inferior rectal artery and Branches to the penis/ labia and clitoris
 Medial wall – formed by the sloping levator ani muscle and the anal canal Pudendal Nerve
 Lateral wall – lower part of the obturator internus muscle  Branch of the sacral plexus and leaves the main cavity through the
greater sciatic foramen – enters the perineum via the lesser foramen
Alcock’s canal (Pudendal canal) – on the lateral wall of the ishiorectal fossa; medial  Passes forward in the pudendal canal and supplies the external anal
to the ischial tuberosity; contains pudendal vessels and nerve sphincter and perneal muscles and skin

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ANAL CANAL

 1.5 in (4 cm) – passes downward an backward from the rectal ampulla to

the anus
 Divided into outer longitudinal and inner circular layer of smooth muscle

Relation with other structures

Anterior: Perineal body, urogenital diaphragm, membranous part of the
urethra, bulb of penis, lower part of vagina
Posterior: anococcygeal body – fibrous tissue between anal canal and coccyx
Lateral: Fat-filled ischiorectal fossa

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Anal Canal Structure Longitudinal smooth muscle of the anal canal – continuous with the rectum

 Pectinate line – indicates level where upper half joins the lower half Forms a continuous coat and descends between the internal and external anal
Mucous membrane of the Mucous membrane of the sphincters – some are attached to mucous membrane, others pass lateral into the
upper half lower half ischiorectal fossa
Embryonic
Hindgut entoderm Proctodeum ectoderm
derivative
Epithelial Stratified squamous
Columnar epithelium
lining epithelium
Anal columns With anal columns of
Morgagni (vertical folds) joined
No anal columns
together at lower ends by anal
valves (semilunar folds)
Arterial Superior rectal artery Inferior rectal artery
supply (branch of the inferior (branch of the internal
mesenteric artery) pudendal artery)
Venous
Superior rectal vein Inferior rectal vein
drainage
Innervation Somatic inferior rectal nerve –
Autonomic hypogastric
sensitive to pain,
plexuses – sensitive to stretch
temperature, touch, pressure
Lymph Pararectal nodes to the inferior Medial group of superficial
drainage mesenteric nodes inguinal nodes

Anal Sphincters
 Internal Sphincter
 Thickening of smooth muscle of the circular coat the upper end of
the anal canal
 Enclosed by a sheath of striped muscle (external sphincter)
 External Sphincter (can be divided into 3 parts)
1. Subcutaneous part – encircles lower end; no bony attachments
2. *Superficial part – attached to the coccyx and perineal body
3. Deep part - encircles upper end; no bony attachments

Anorectal ring
 Distinct ring at recto-anal junction formed by the internal sphincter, deep
part of the external sphincter and puborectalis muscle

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MALE REPRODUCTIVE ORGAN

MALE REPRODUCTIVE ORGAN

TESTIS EPIDIDYMIS

 Firm, mobile organ within the scrotum  Firm structure posterior to the testis and lateral to the vas deferens
 Suspended into the scrotum by the spermatic cord  Coiled tube – nearly 20 ft. (6cm.), embedded in connective tissue
 Left testis usually lies at a lower level than the right – due to venous  Sinus of the epididymis – lateral distinct groove between the testis and
drainage (left testis draining into left renal vein) epididymis; lined with inner visceral layer of the tunica vaginalis
Parts:
 External to the tunica albuginea 1. Head – upper expanded end receiving the efferent ductules
Tunica
 Lower expanded portion of the processus vaginalis 2. Body - highly convoluted ducts without efferent ductules
Vaginalis
 With parietal and visceral layers 3. Tail - continuous with the vas deferens
 White, tough fibrous capsule surrounding the testis Functions
Tunica  Storage space for spermatozoa and site of maturation
 Inner surface extends into the testis – divides the
albuginea  Absorption of fluid
interior of the organ into lobules
 Addition of substances to seminal fluid to nourish the maturing sperm
Seminiferous tubules
 Highly coiled structure in lobules formed by the tunica albuginea
 Open into the rete testis and eventually to efferent ductules to the upper
end (head) of the epididymis
 Function: Site of formation of sperm (spermatogenesis)

TESTIS AND EPIDIDYMIS

Arterial Supply Testicular artery (Branch of the abdominal aorta)
Pampiniform plexus – Drains into the testicular vein
Venous
 Right testicular vein – drains to IVC
Drainage
 Left testicular vein – drains to left renal vein
Lymph vessels ascend in the spermatic cord – end in the
Lymph Drainage lymph nodes on the side of the aorta
 Lumbar or para-aortic nodes – at level of L1

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Course
1. Arises from the lower end (tail) of the epididymis
2. Passes through the inguinal canal – emerges from the deep inguinal ring
3. Passes around the lateral margin of the inferior epigastric artery
4. Passes downward and backward on the lateral wall of the pelvis
5. Crosses the ureter in the region of the ischial spine
6. Runs medially and downward on the posterior surface of the bladder
7. Terminal part – Ampulla of the vas deferens
 Inferior end of the ampulla – narrows down and joins the
seminal vesicle (forms the ejaculatory duct)

Arterial Artery of the vas deferens (ductus deferens)

Supply (Branch of the superior and/or inferior vesical artery)
Venous  Pampiniform plexus – Proximal portion
Drainage  Vesicular/Prostatic venous plexus – Distal portion
Innervation Inferior hypogastric plexus
Lymph
External iliac nodes
Drainage

VAS DEFERENS

 Thick-walled tube; 18 in (45cm)

 Function: Conveys mature sperm from the epididymis to the ejaculatory
duct and urethra

Relation with other structures

Anterior: Urinary bladder
Inferior: Seminal vesicle

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SEMINAL VESICLES

 Two lobulated organs

 2 in (5cm); consists of a much-coiled tube embedded in connective tissue
 Inferiorly – narrows and joins the vas deferens forming the
ejaculatory duct

Function - Produce secretions added to the seminal fluid

 Thick alkaline fluid producing fructose with some other components such
as prostaglandins – provides energy for sperm and vaginal acidity
neutralization
 Secretions nourish the spermatozoa

Relation with other structures

Anterior: Urinary bladder
Posterior: Rectum
Medial: Terminal part of the vas deferens

Inferior vesicle, Internal Pudendal, Middle rectal arteries

Arterial Supply
(Branch of the Internal Iliac artery)
Venous Drainage Internal iliac veins
Innervation Inferior hypogastric plexus (Sympathetic nervous plexus)
Lymph Drainage Internal iliac nodes

EJACULATORY DUCTS

 Two ejaculatory ducts; < 1 in(2.5cm)

Inferior vesicle artery
 Formed by the union of the vas deferens and duct of the seminal vesicle Arterial Supply
(Branch of the Internal Iliac artery)
 Pierces the posterior surface of the prostate
 Converge to open into the prostatic part of the urethra (on the seminal Venous Drainage Prostatic venous plexus
colliculus, close to the margins of the prostatic utricle) Innervation Inferior hypogastric plexus
Lymph Drainage Internal iliac nodes
Function: Drain the seminal fluid into the prostatic urethra; transmits seminal
fluid and sperm

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PROSTATE GLAND

 Walnut shaped, largest accessory gland of the male reproductive system
 Fibromuscular glandular gland (1/3 fibromuscular, 2/3 glandular)
 Surrounds the prostatic urethra and ejaculatory duct
 1.25 in (3 cm); Surrounded by a fibrous capsule
 Two ejaculatory ducts pierce the upper part of the posterior surface of
the prostate – opens into the prostatic urethra at the lateral margins of
the prostatic urethra
 Lies between neck of bladder above and urogenital diaphragm below
 Base – directed upwards, lie against the bladder neck above
 Apex – directed downwards, lie against the urogenital diaphragm
Function
 Produces a thin, milky fluid – contains citric acid and acid phosphatase
added to the seminal fluid during ejaculation
 Prostatic secretion – alkaline – helps neutralize vagina acidity
Relation with other structures
Superior: Neck of the bladder
Inferior: Upper surface of the urogenital diaphragm (also with the external
urethral sphincter)
Anterior: Symphysis pubis
 Extraperitoneal fat – separates prostate with symphysis pubis in the
retropubic space (Cave of Retzius)
 Puboprostatic ligaments – connects prostate to the posterior aspect
of the pubic bones
Posterior: Anterior surface of the rectal ampulla
 Rectovesical septum (Fascia of Denonvilliers) – separates prostate
to the rectal ampulla; formed in fetal life by fusion of walls of the
lower end of the rectovesical pouch
Lateral: Anterior fibers of the levator ani
Structure of the Prostate
 Numerous glands of the prostate – embedded in smooth muscle and
connective tissue; ducts open into the prostatic urethra
 Incompletely divided into 5 lobes
1. Anterior lobe - front of the urethra; no glandular tissue
2. Median (Middle) lobe - between the urethra and the 2 ejaculatory
ducts; upper surface related to the trigone of the bladder and is
rich in glands
3. Posterior lobe – behind the urethra and below the ejaculatory
ducts; with glandular tissue
4. Right & Left lateral lobes - on either side of the urethra; separated
from one another by a shallow vertical groove on the posterior
surface of the prostate; also with glands
Zones of the Prostate
 Peripheral Zone - Lies under the capsule; vulnerable to cancer
 Central Zone - Encloses the ejaculatory duct
 Transitional zone - Encloses the urethra; where benign prostatic
hyperplasia arises
Inferior vesical, Internal Pudendal, Middle rectal arteries
Arterial Supply
(Branch of the Internal Iliac artery)
Venous Drainage Prostatic venous plexus (drains to the internal iliac veins)
Inferior hypogastric plexus
Innervation Sympathetic nerves stimulate smooth muscle during
ejaculation
Lymph Drainage Internal iliac nodes

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FEMALE REPRODUCTIVE ORGAN

FEMALE REPRODUCTIVE ORGAN

UTERUS
In the erect position and the bladder empty – uterus lies in an
 Hollow, pear-shaped organ with thick muscular walls almost horizontal plane
 Measurements in a young nulliparous adult
- 3 in.(8cm) long, 2 in.(5cm) wide, 1 in.(2.5cm) thick
 Function: site for the reception, retention, and
nutrition of the fertilized ovum

Parts of the uterus

1. Fundus – part above the entrance of the fallopian(uterine) tubes
(above the level of the utero-tubal junction)
2. Body – broad part below the entrance of the fallopian tubes;
Plicae palmatae – anterior and posterior vertical folds on uterine surface
Cavity of the body - triangular coronal section; cleft in sagittal plane
3. Cervix - lower narrow part piercing the anterior wall of the vagina

Cervix
 Divided into supravaginal and vaginal parts
 Cervical canal – communicates with the cavity of the uterine body through the
internal os and with the vagina through the external os
 Before child birth – external os is circular
 In a parous woman – vaginal part of the cervix is larger; external os
becomes a transverse slit possessing an anterior and posterior lip

Positions of the Uterus

 Anteversion of the uterus - long axis of the uterus is bent forward
on the long axis of the vagina
 Anteflexion of the uterus - long axis of the uterus is bent forward at the
level of the internal os with the long axis of the cervix
 Retroverted uterus – Fundus and body are bent backward on the vagina and
lie in the rectouterine pouch (Pouch of Douglas)
 Retroflexed uterus - Body of the uterus is bent backward on the cervix

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Uterus Structure
 Covered with peritoneum except anteriorly below the level of
the internal os – peritoneum passes forward onto the bladder
 Lateral – with space between the attachment of the layers of the
broad ligament
 Myometrium - Muscular wall; thick and made up of smooth
muscle supported by a connective tissue
 Endometrium – Mucous membrane
 Lines the uterine body continuous above with the mucous
membrane lining the fallopian tubes; below with the
mucous membrane lining the cervix
 Applied directly to the muscle (no submucosa)
 From puberty to menopause – undergos extensive
changes during the menstrual cycle in response to ovarian
hormones (FSH, LH)
 Supravaginal part of the cervix – surrounded by parametrium
(visceral pelvic fascia)
- Parametrium – where uterine artery crosses the ureter

Uterine artery (Branch of the Internal Iliac artery)

 Reaches the uterus by running medially in the
base of the broad ligament
 **Crosses above the ureter at right angles and
Arterial
reaches the cervix at the level of the internal os
Supply
 Then ascends along the lateral margin of the
uterus in the broad ligament – ends by
anastomosing with the ovarian artery
 Also supplies cervix and vagina
Venous
Uterine vein into the internal iliac vein
Drainage
Inferior hypogastric plexus - sympathetic and
Innervation
parasympathetic nerves
Fundus – accompany the ovarian artery; drains into
Lymph the para-aortic nodes at L1
Drainage Body and cervix - Internal and external iliac lymph
nodes

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Support of the uterus

1. Levatores Ani Muscles

 Forms a broad muscular sheet stretching across the pelvic cavity
 Together with the pelvic fascia on upper surface – effectively
support the pelvic viscera and resist intra-abdominal pressure
 Medial edges of the anterior parts of the levator ani – attached
to the cervix via the pelvic fascia
2. Perineal Body
 Maintains pelvic floor integrity
 Lies in the perineum between the vagina and anal canal
 Slung up to the pelvic walls by the levatores ani – supports
vagina directly and uterus indirectly
 If damaged during childbirth – pelvic viscera prolapse may occur
3. Uterine Ligaments

Uterine Ligaments
 Subperitoneal condensations of the pelvic fascia on the
upper surface of the levatores ani muscles
 Attached to the cervix and vault of the vagina
 Supports the uterus and keeps cervix in correct position

1. Transverse Cervical (Cardinal/Mackenrodt’s) Ligament

 Fibromuscular condensations of pelvic fascia
 Pass to the cervix and upper end of the vagina from the
lateral walls of the pelvis (anchors cervix on the lateral wall)
 **Uterine vessels run at its superior surface
2. Pubocervical (Pubovesical) Ligament
 Consists of 2 firm bands of connective tissue – passes to the
cervix from the posterior surface of the pubis
 Positioned on each side of the bladder neck
3. Sacrocervical (Utero-sacral) Ligament
 2 firm fibromuscular bands of pelvic fascia passing to the cervix
and upper end of vagina from lower end of sacrum
 Form 2 ridges – one on each side of the pouch of Douglas

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Minor support of the uterus UTERINE TUBE (FALLOPIAN TUBE)

1. Broad ligament of the uterus (Mesometrium)
 Double layer of peritoneum
 Forms 2 visceral pouches – Vesicouterine and Rectouterine pouch
2. Round Ligament of the uterus
 Represents the remains of the lower half of the gubernaculum
 Extends between the superolateral angle of uterus to the subcutaneous
tissue of the labia majora via the deep inguinal ring and inguinal canal
(attaches uterus to anterior pelvis)
 Keeps uterus anterverted (tilted forward) and
anteflexed (bent forward)
Relations:
Anterior: Uterovesical pouch and superior surface of the bladder
 Supravaginal cervix - superior surface of the bladder
 Vaginal cervix – anterior fornix of the vagina
Posterior: Rectouterine pouch (pouch of Douglas)
with ileum or sigmoid colon
Lateral: Broad ligament, Uterine artery and vein
 Supravaginal cervix – ureter (as it passes forward to enter the bladder)
 Vaginal cervix – lateral fornix of the vagina
 Fallopian tubes enter the superolateral angles with round ligament of the
ovary and of the uterus just below the tubes
 2 tubes about 4 in.(10cm) in the upper border of the broad ligament
 Connects the peritoneal cavity in the ovary region to the uterine cavity
 Covered by the broad ligament (Mesosalphinx)
Mesosalphinx – part of the broad ligament between the uterine tube
and the mesovarium
Function:
 Receives the ovum from the ovary
 Provides site of fertilization (usually in the ampulla)
 Provides nourishment for fertilized ovum and
transports it to uterine cavity
 Conduit along which spermatozoa travel to reach the ovum
Parts
1. Infundibulum – funnel-shaped lateral end projecting beyond the
broad ligament and overlies the ovary; free edge has several
fingerlike processes (fimbriae) draped over the ovary
 Abdominal ostium – opening at the end of each
fallopian tube at the center of the fimbriae
2. Ampulla – widest part of the tube
3. Isthmus – narrowest part of the tube just lateral to the uterus
4. Intramural part – segment that pierces the uterine wall; opens into
the uterus through the uterine ostium

 Uterine artery (Branch of the Internal Iliac artery)

Arterial Supply
 Ovarian artery (Branch of the abdominal aorta)
Venous
Uterine and Ovarian vein
Drainage
Inferior hypogastric plexus - sympathetic and
Innervation
parasympathetic nerves
Lymph
Internal iliac and para-aortic nodes
Drainage

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OVARY

 Oval shaped; 1.5 x 0.75 in (4x2 cm)

 Usually lies against the lateral wall of the pelvis – Ovarian
fossa (Fossa ovarica of Waldeyer) – bounded by the
internal iliac vessels behind
 Ovary position varies – can be found hanging down in
pouch of Douglas
 Tunica albuginea – thin fibrous capsule surrounding the ovary;
covered externally by the germinal epithelium
(modified area of peritoneum)
 Germinal epithelium – misnomer; does not give
rise to the ova
Oogonia develop before birth from
primordial germ cells
 Smooth before puberty; becomes progressively scarred after
puberty as successive corpora lutea degenerate; in
menopause – shrunken

Function
 Responsible for the production of female germ cells – ova
 Produces female sex hormones – estrogen and progesterone
Support of the ovary
1. Broad ligament (Mesovarium)
 Attaches ovary to the posterior of the broad ligament
 Peritoneal reflection covering the ovary
2. Suspensory ligament of the ovary
 Part of the broad ligament extending between the
mesovarium attachment and the lateral wall of
the pelvis
 **Passageway of ovarian neurovascular structures
3. Round ligament of the ovary
 Remains of the upper part of the gubernaculum
 Connects the lateral margin of the uterus to the ovary
Arterial Supply Ovarian artery (Branch of the abdominal aorta at L1)
Ovarian vein
Venous Drainage  Righ side – drains into the IVC
 Left side – drains into the left renal vein
Innervation Aortic plexus - accompanies ovarian artery
Lymph Drainage Follows the ovarian artery to the para-aortic nodes (L1)
Blood supply, lymph drainage, and nerve supply
 Passes over the pelvic inlet and crosses the external iliac vessels
 Reach the ovary by passing through the lateral end of the broad ligament
(suspensory ligament of the ovary)
 Vessels and nerves finally enter the ovary hilum via the mesovarium

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VAGINA Relations:
Anterior: Bladder above; Urethra below
 Muscular tube extending upward and backward from the vulva of the Posterior: Upper 1/3 – Rectouterine pouch (pouch of Douglas)
uterus Middle 1/3 – Ampulla of the rectum
 3 in (8cm) – with anterior and posterior walls (normally in apposition) Lower 1/3 – Perineal body (separates it from the anal canal)
 Area of the vaginal lumen surrounding the cervix – divided into 4 regions Lateral: Upper part – ureter
(fornices) – anterior, posterior, right lateral, left lateral Middle part – anterior fibers of the levator ani
 Anterior fornix - related to the vesicouterine pouch Lower part – urogenital diaphragm and vesituble bulb
 Posterior fornix – related to the pouch
Support of the Vagina
 Vagina has no glands
 Upper part – levatores ani muscle and the 3 ligaments of the uterus
 Vaginal orifice in virgins possesses a hymen – thin mucosal fold
(attached to vaginal wall by pelvic fascia)
After childbirth – hymen usually consists of tags
 Middle part – urogenital diaphragm
 Lower part – perineal body
 Lies above the pelvic floor
Upper half of
 Anterior wall is pierced by the cervix – projects
the Vagina
downward and backward into the vagina
 Lies in the perineum
Lower half of  Has the vaginal and urethral orifices and openings of
the Vagina vestibular glands (Bartholin’s glands located in
superficial perineal pouch)

Function
 Receives the penis during sexual intercourse
 Serves as a conduit for menstrual flow
 Passageway of the baby during childbirth (birth canal)

 Vaginal artery (Branch of the Internal iliac artery)

Arterial Supply
 Uterine artery
Vaginal veins
Venous Drainage
(Forms a plexus – drains into the internal iliac vein)
Innervation Inferior hypogastric plexus
 Upper 1/3 – external and internal iliac nodes
Lymph Drainage  Middle 1/3 – internal iliac nodes
 Lower 1/3 – superficial inguinal nodes

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