PERINEUM

PERINEUM (continued)

• The perineum refers to the diamond-shaped region

roughly extending between the coccyx and pubic
symphysis

• Boundaries of the perineum

– Pubic symphysis (anteriorly)
– Inferior pubic rami and ischial rami (anterolaterally)
– Ischial tuberosities (laterally on each side)
– Sacrotuberous ligaments (posterolaterally)
– Tip of coccyx (posteriorly)
PERINEUM (continued)

- Structures in the perineal region lie between

the pelvic diaphragm superiorly and the skin
inferiorly

- The region extending between the pelvic

diaphragm and skin is called the perineal
compartment
PERINEUM (continued)

- Pelvic diaphragm

- Levator ani muscle

- Coccygeus muscle
(coccygeus)
PERINEUM (continued)

Perineal body

• The midpoint of the line joining the ischial

tuberosities indicates the location of the perineal
body (central tendon of perineum-centrum
tendineum), the attachment point of several
perineal muscles
PERINEUM (continued)
Perineal body (continued)

• Perineal body is the site of convergence of several

perineal muscles
– Bulbospongiosus
– External anal sphincter muscle
– Superficial and deep transverse perineal muscles

• Located in the median plane anterior to the anal canal

and inferior to the inferior fascia of the urogenital
diaphragm (perineal membrane)
• Lies deep to the subcutaneous tissue
• Contains collagenous and elastic fibers, as well as
smooth and skeletal muscle fibers
Clinical note

Disruption of the perineal body

• Stretching and tearing of the perineal body is possible
during childbirth
• In such cases as the support to inferior part of the posterior
wall of the vagina is removed, prolapse of the vagina may
occur
Clinical note

Episiotomy
• During vaginal surgery or labor, surgical incision of the
perineum and lower part of the posterior wall of the vagina
is often made to enlarge the vagina and prevent jagged tear
of the perineal muscles
• The perineal body is the major structure incised in median
episiotomy
PERINEUM (continued)

• The transverse line joining the ischial

tuberosities divide the perineum into two
triangles
– Urogenital triangle (anterior)
– Anal triangle (posterior)
PERINEUM (continued)

Urogenital triangle

• Superficially contains the scrotum and root of

the penis in males

• Superficially contains the external genitalia in

females
PERINEUM (continued) Urogenital triangle (continued)

Layers of the urogenital triangle

(from superficial to deep)
1. Skin
2. Superficial perineal fascia (subcutaneous tissue of perineum)
– Fatty superficial layer
– Membranous deep layer (Colle’s fascia)
3. Superficial perineal pouch
4. Inferior fascia of the urogenital diaphragm (also called the
perineal membrane)
5. Deep perineal pouch (contains the urogenital diaphragm)
6. Superior fascia of the urogenital diaphragm
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

2. Superficial perineal fascia

Consists of two layers
– Fatty superficial layer
• In females anteriorly continues into the labia majora and mons pubis
• Continuous with the Camper’s fascia superiorly (fatty superficial
layer of the anterolateral abdominal wall)

– Membranous deep layer (Colle’s fascia)

• Continuous superiorly with the Scarpa’s fascia (membranous deep
layer of the anterolateral abdominal wall)
• Continuous inferiorly with the fascia lata of the thigh
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

3. Superficial perineal pouch

Lies between the Colle’s fascia and the inferior fascia
of the urogenital diaphragm
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

Contents of the superficial perineal pouch

• In both sexes
– The superficial perineal muscles
• Superficial transverse perineal muscle
• Ischiocavernosus muscle
• Bulbospongiosus muscle
– Deep perineal fascia (investing fascia – Gallaudet’s fascia)
» Invests the superficial perineal muscles
– Branches of the internal pudendal vessels and
pudendal nerves
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

Contents of the superficial perineal pouch (continued)

• In males
– Root of the penis
– Proximal part of the spongy urethra
• In females
– Root of the clitoris
– Bulb of the vestibule
– Greater vestibular glands
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

5. Deep perineal pouch

Lies between the inferior and superior fasciae of the
urogenital diaphragm
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

Contents of the deep perineal pouch

• In both sexes
– External urethral sphincter muscle Two muscles form the
– Deep transverse perineal muscles urogenital diaphragm

• Therefore the deep perineal pouch contains the

urogenital diaphragm in both sexes
 PERINEUM (continued) Urogenital triangle (continued)
Layers of the urogenital triangle (continued)

Contents of the deep perineal pouch (continued)

• In males
– Membranous part of the urethra
– Bulbourethral glands

• In females
– Proximal part of the urethra
– Part of vagina
PERINEUM (continued)

Anal triangle
Contains the following structures

• Anal canal
• Ischiorectal (ischioanal) fossa
• Pudendal canal
• External anal sphincter
PERINEUM (continued)
Anal triangle (continued)

Ischiorectal (ischioanal) fossa

• Laterally bounded by the obturator internus
muscles and fascia covering it
– Pudendal canal lies on this wall

• Medially bounded by the external anal sphincter

• Posteriorly bounded by the gluteus maximus
muscle
• Anteriorly bounded by the bodies of the pubic
bones