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Female Perineum and External Genitalia

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Female Perineum and External Genitalia Female perineum and external genitalia Reproductive block-Anatomy-Lecture 2 Editing file Color guide : Only in boys slides in Green Only in girls slides in Purple Objectives important in Red Notes in Grey At the end of the lecture, students should be able to: ● Boundaries of the perineum. ● Division of perineum into two triangles. ● Boundaries & Contents of anal & urogenital triangles. ● Lower part of Anal canal. ● Boundaries & contents of Ischiorectal fossa. ● Innervation, Blood supply and lymphatic drainage of perineum Perineum ● It is the region of the body below the pelvic diaphragm (The outlet of the pelvis) ● It is a diamond shaped area between the thighs Perineum Contents: 1. Lower ends of urethra. 4. Anococcygeal body 2. Vagina 5. Anal canal 3. Perineal body 6.External genitalia Relations Anterior Posterior Lateral ● Ischiopubic rami “anteriolateral” ● Ischial tuberosities Bony Boundaries Symphysis pubis Coccyx ● Sacrotuberous ligaments “Posteriolateral” Boundaries Mons pubis Inter gluteal folds Medial surfaces of the thighs By an imaginary line passing through two ischial tuberosities it divided into: Anteriorly: urogenital triangle Posterior: Anal triangle 3 Perineum Contents Anococcygeal Body Perineal Body Female External Genitalia (Vulva) ❏ It is a complex ❏ It is an irregular fibromuscular mass of variable size and 1. Mons pubis : a collection of fat musculotendinous structure consistency overlying the pubes. ❏ Located at midpoint of the line between the ischial tuberosities 2. Clitoris ❏ Located between the anterior ❏ Lies in the subcutaneous tissue, posterior to vaginal vestibule 3. Labia majora. aspect of the coccyx & the and anterior to the anal canal & anus 4. Labia minora. posterior wall of the ❏ Forms the central point of the perineum & blends anteriorly 5. Vestibule of vagina: The interval anorectal canal with the perineal membrane between the two labia minora. Function: 6. Vagina & urethra open into the Function: ❏ Gives attachment to perineal muscles vestibule through urethral orifice ❏ Receives insertion of ❏ Plays an important role in visceral support especially in anteriorly and vaginal orifice fibers of levator ani female posteriorly. muscle 4 Urogenital Triangle ● Anterior ➔ symphysis pubis ❖ Lower part of urethra ● Posterior ➔ transverse line passing & Vagina Contents Boundaries through the 2 ischial tuberosities ❖ External genitalia ● Lateral ➔ ischiopubic rami & ischial (Vulva) tuberosities Fascia of Urogenital Triangle (Perineal Fascia) ❏ is continuous anteriorly with the fascia of abdomen and Superficial fatty layer (Camper’s fascia) makes up consists of : the substance of mons pubis & labia majora and extends into the anal region 01 Superficial layer consists of 02 Deep layer Deep membranous layer (Colle’s fascia ): Does not ❏ Deep perineal fascia invests the muscles in the superficial extend to anal region. Becomes fused with the perineal pouch posterior margin of the perineal membrane Urogenital Diaphragm ● Composed of: Sphincter urethrae and the deep transverse ● A triangular musculofascial diaphragm located in the perineal muscles enclosed within the superior and inferior layers anterior part of the perineum (in the urogenital triangle). of fascia of the urogenital diaphragm ● Fills in the gap between the pubic arch. ● The inferior layer of the fascia is formed by perineal membrane 5 Perineal Pouches Superficial perineal pouches It is the space between the deep membranous layer of superficial fascia of perineum (Colle’s fascia) and the perineal membrane Superior ➔ perineal membrane Inferior ➔ membranous layer of superficial fascia Lateral ➔ ischiopubic rami Boundaries ❖ Bulbs of vestibule: on each side of vaginal orifice ❖ Crura of clitoris ❖ Superficial perineal muscles: I. Bulbospongiosus muscle, surrounds orifice of vagina and covers vestibular bulb II. Ischiocavernosus muscle, covers crus of clitoris on each side Contents III. Superficial transverse perineal muscles ❖ Greater vestibular glands: on each side of vaginal orifice ❖ Perineal branch of pudendal nerve supplying muscles & skin 6 Perineal Pouches Deep perineal pouches It is a completely closed space deep to the perineal membrane Superior ➔ superior fascia of the urogenital diaphragm Inferior ➔ inferior fascia of the urogenital diaphragm (perineal membrane) Lateral ➔ inferior portion of obturator internus fascia Boundaries ❖ Part of urethra ❖ Part of vagina ❖ Sphincter urethrae and Sphincter vaginae muscles, which is pierced by urethra & vagina ❖ Deep transverse perineal muscles Contents ❖ Internal pudendal vessels ❖ Dorsal nerve of clitoris (branch of Pudendal nerve) 7 Vagina ● is a muscular canal that leads from the uterus to the external orifice of the genital canal ● It measures about 3 in. (8 cm) long. ● It serves as the excretory duct for the menstrual flow & forms part of the birth canal. ● The vaginal orifice in a virgin possesses a thin mucosal fold, called the hymen, which is perforated at its center. It lies posterior to the urethral orifice. ● Vaginal artery: a branch of the internal iliac artery Arterial Supply ● Vaginal branch of the uterine artery Venous Drainage ● drain into the internal iliac veins. 8 Anal Triangle Anterior ➔ Transverse line passing Lateral ➔ ischial tuberosity & Boundaries: 1 2 3 Posterior ➔ coccyx through the 2 ischial tuberosities sacrotuberous ligament 2-Contents: A. Lower part of Anal canal B. Anococcygeal body C. Ischiorectal fossa on each side Anal canal ● A fascial lined wedge-shaped space on each side ● It is about 1.5 in. long, descending from of the anal canal the rectal ampulla to the anus. Boundaries: Relations (In female): ● Base ➔ Skin of the perineum ● Anteriorly ➔ Perineal body, urogenital ● Medial wall ➔ Levator ani & anal canal diaphragm, and lower part of vagina ● Lateral wall ➔ Obturator internus, covered with ● Posteriorly ➔ Anococcygeal body. fascia ● Laterally ➔ Ischiorectal fossae. Contents: Ischiorectal fossa Divided into: (by the pectinate line) ● Dense fat ● Upper half: derived from hindgut ● Pudendal nerve & internal pudendal vessels (endoderm) within the pudendal canal (A fascial canal ● Lower half: derived from the Proctodeum formed by obturator fascia, located on the (ectoderm) lateral wall of the ischiorectal fossa) The two parts have different blood supply, nerve ● Inferior rectal nerve & vessels crossing the fossa supply and lymphatic drainage to reach anal canal 9 Anal canal supply: Arterial supply Venous drainage Lymphatic drainage Nerves (sensitive to stretch) Para-rectal nodes Superior rectal vein Autonomic nerve Superior rectal a. drained into inferior drained into the inferior Visceral motor Upper half (continuation of the mesenteric lymph nodes mesenteric vein (portal (Inferior Hypogastric inferior mesenteric a.) and internal iliac lymph circulation) Plexus) (sympathetic & nodes parasympathetic) (sensitive to pain) Somatic motor & sensory nerves - Inferior rectal vein Inferior rectal a. (Inferior rectal nerve drained into the internal Superficial inguinal Lower half (branch of internal branch of pudendal pudendal vein (Systemic lymph nodes pudendal a.) nerve) supplies external circulation) sphincter muscle of the anus and the skin of the anal region 10 Pudendal Nerve Block ● It is used in providing analgesia for the second stage of labour and to provide anesthesia of the perineum in order to create and repair an episiotomy. ● Can be done by transvaginally or through perineal approach. it divided into Perineal method: The ischial tuberosity is Transvaginal method: The needle is palpated subcutaneously through buttock . passed through the vaginal mucous The needle is inserted on the medial side of membrane toward the ischial spine. the ischial After the needle is passed through the tuberosity to a depth of about 1 in. (2.5 cm) sacrospinous ligament, the anesthetic from the free surface of the tuberosity. The solution is injected around the anesthetic is injected around the pudendal pudendal nerve nerve. An episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor to prevent perineal tear. 11 Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 QUIZ B B A A D A D B Q1: which of the following bony boundaries is located in the anterior to perineum ? Q5: Crura of clitoris is one of the content of? A. Coccyx A. Deep perineal pouch B. Symphysis pubis B. Anal triangle C. Ischiopubic rami C.pudendal canal D. Ischial tuberosities D. Superficial perineal pouch Q2: Vagina & urethra open into the vestibule through urethral orifice … &vaginal orifice …. Q6: which of the following is posterior to anal canal? A. Laterally, posteriorly A.Anococcygeal body B. Anteriorly , posteriorly B.vagina C. Anteriorly. Laterally . C.ischiorectal fossae D.posteriorly , anteriorly D.perineal body Q3: In transvaginal method, the needle is passed through the ……….toward the …….. Q7: which of the following vein drains into inferior mesenteric vein? A. Vaginal mucous membrane, ischial spine A. Middle rectal vein B. Vaginal mucous membrane , ischial tuberosity B. Internal pudendal vein C. Buttock , ischial spine C. Inferior rectal vein D. Buttock , ischial tuberosity D. Superior rectal vein Q4: Which of the following is considered a landmark during a transvaginal pudendal n. Q8: which of the following boundaries is located in the base of Ischiorectal fossa? block? A. Levator ani A. Ischial spine B. skin of perineum B. Ischial tuberosity C. Pudendal nerve C. Pubic rami D. Obturator internus 12 Members board Team leaders ● Abdulrahman Shadid ● Ateen Almutairi Boys team: Girls team : ● Mohammed Al-huqbani ● Ajeed Al Rashoud ● Salman Alagla ● Taif Alotaibi ● Ziyad Al-jofan ● Noura Al Turki ● Ali Aldawood ● Amirah Al-Zahrani ● Khalid Nagshabandi ● Alhanouf Al-haluli ● Sameh nuser ● Sara Al-Abdulkarem ● Abdullah Basamh ● Renad Al Haqbani ● Alwaleed Alsaleh ● Nouf Al Humaidhi ● Mohaned Makkawi ● Jude Al Khalifah ● Abdullah Alghamdi ● Nouf Al Hussaini ● Danah Al Halees ● Rema Al Mutawa ● Maha Al Nahdi ● Razan Al zohaifi ● Ghalia Alnufaei Contact us: .
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