Contents of male and female perineal pouches

By

Dr. Abdul Waheed Ansari

(Prof. & chairperson of Anatomy, RAKCOMS)

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Perineum boundaries are

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An imaginary transverse line joining the anterior ends of the ischial

tuberosities divides the perineum into two triangles -

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The perineal body

Structurally perineal body is an irregular fibro muscular mass, containing both collagenous and elastic fibers and both skeletal and smooth muscles.

It is the site of convergence of several muscles:

1. Bulbospongiosus,

2. Superficial transverse perinea

3. Superficial part of external anal sphincter

4. Sphincter urethrae and

5. Deep transverse perinea,

6. Deep part of external anal sphincter and

7. Levator ani

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Perineal fascia• There are two fascia in perineum.

• The superficial fascia from anterior

abdominal wall extends into the

perineum and get attached to the bony

landmarks and free border of perineal

membrane.

• The levator ani muscle is present at the

pelvic outlet and forms pelvic

diaphragm.

• The levator ani muscle is covered by

fascia, superior fascia of perineum. This

fascia closes to the free border of

perineal membrane. Between perineal

membrane and superior fascia of

perineum, the space is called as deep

perineal space/pouch.

• Between perineal membrane and fascia

descending from anterior abdominal

wall, is the superficial perineal

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Male external genital organs The penis:

a. root of the penis: the fixed dorsal segment within the urogenital perineum, consists of two crura

and the bulb

b. penile body: the pendulous, mobile ventral segment suspended from the pubis

• 1. consists of two corpora cavernosa and one corpus spongiosum

• 2. The two corpora cavernosa fuse lying side by side, and insert into the glans

• penis to form the superior (dorsal) surface.

• 3. The thinner corpus spongiosum, containing the urethra, lies below the fused

• corpora cavernosa and forms the inferior (ventral) surface.

c. Over lining these structures are the related muscles: the ishiocavernosus & bulbospongiosus

d. Vessels and nerves of the penis

• 1. superficial dorsal vein empties into the superficial external pudendal veins

• 2. deep dorsal veins drain into the prostatic venous plexus and also make connection

• with the vertebral venous flow

• 3. two dorsal penile arteries from the internal pudendal artery

• 4. paired dorsal nerves arise from the pudendal nerve

e. Suspensory Ligament

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Contents of superficial

perineal pouch in male

1. Bulbospongiosus2. Ischiocavernosus3. Anal sphincter4. Deep Transverse Perineal5. Superficial Transverse Perineal6. Pelvic diaphragm / Levator Ani muscles7. Obturator Internus8. Perineal body9. Ano-coccygeal body 10. Sacrum and coccyx 11. Ischial tuberosities12. Sacrotuberous ligament

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External genitalia in both sexes

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Lymphatic drainage of male external genitalia

• The lymph vessels from the scrotum drain into the superficial inguinal lymph nodes.

• From most of the penis, lymph drains into the superficial inguinal lymph nodes.

• Vessels from the glans penis drain into the deep inguinal lymph nodes.

• Enlarged nodes are either due to disease in drainage areas or systemic disease.

• Drainage areas

Horizontal group:-

• External genitalia (Cancer Penis, Vulva)

• Anal canal (cancer Rectum)

• Gluteal region

• Lower third of vagina

Vertical group:

• Leg

• Systemic disease

• Lymphoma

• Tuberculosis

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Contents of superficial perineal pouch in female

1. Root (crura) of the clitoris and muscle associated with it (ischiocavenous)2. Bulbs of the vestibule and surrounding muscle (bulbospongiosus)3. Superficial transverse perineal muscles4. Branches of the internal pudendalartery5. Posterior labial branches of the perieneal branch6. Transverse perineal branches of the perieneal branch7. Posterior labial branch of Perineal branch of the pudendal nerves8. Perineal branch of posterior cutaneous nerve of thigh9. Greater vestibular glands

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The lymphatic drainage from femaleexternal genitalia• The vulva contains a very rich network of

lymphatic channels.

• Most lymph vessels pass to the superficial

inguinal lymph nodes and deep inguinal

nodes.

Grouping of inguinal lymph nodes

• Horizontal

• Vertical

Drainage area of inguinal lymph nodes

Horizontal

• Vulva

• Anus

Vertical

• Leg

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The deep perineal pouch/space

• It lies between the perineal membrane and fascia over inferior aspect of levator animuscle.

• It contains membranous urethra passing through the perineal membrane and sphincter urethrae and deep transverses perinei muscles.

• The urogenital diaphragm is a fibromuscular layer between the pelvic floor (levator animuscles) limited inferiorly by the perineal membrane.

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Contents of deep perineal pouch in female

1. Proximal part of urethra

2. External urethral sphincter muscle

3. Deep transverse perineal muscles

4. Related vessels and nerves

5. Deep artery of clitoris

6. Dorsal artery of clitoris

7. Artery to bulb of vestibule

8. Urethral artery

9. Dorsal nerve of clitoris

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Pelvic diaphragm

• The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the parietal pelvic fascia on their upper and lower aspects.

• It separates the pelvic cavity above from the perineal region below. • The right and left levatores ani lie almost horizontally in the floor of

the pelvis, separated by a narrow gap that transmits the urethra, vagina, and anal canal.

• The levator ani is usually considered in three parts: 1. pubococcygeus, 2. puborectalis, and 3. iliococcygeus. • The pubococcygeus, runs backward from the body of the pubis

toward the coccyx and may be damaged during parturition.

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The Puborectalis• The right and left

Puborectalis unite behind the anorectal junction to form a muscular sling.

• The Puborectalis fibers interdigitates with the sphincter ani externus.

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The coccygeus

• The iliococcygeus, the most posterior part of the levator ani.

• The coccygeus extends from the ischial spine to the lateral margin of the sacrum and coccyx.

• The pelvic diaphragm is supplied chiefly by the ventral rami of S3,S4.

• The diaphragm helps to support the pelvic viscera, resists increases in intra-abdominal pressure, and aids in micturition.

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References

• http://teachinganatomy.blogspot.ae/2013/06/perineum25_268.html

• http://anatomytopics.wordpress.com/2009/01/08/38-the-perineum-the-formation-of-the-placenta-the-structure-of-the-matured-placenta/

• http://download.videohelp.com/vitualis/med/male_ext_genitalia.htm

• http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/pstep43.htm

• http://web.uni-plovdiv.bg/stu1104541018/docs/res/skandalakis'%20surgical%20anatomy%20-%202004/Chapter%2028_%20Pelvis%20and%20Perineum.htm

• http://unanipathy.com/videos/pelvic-floor-part-1-the-pelvic-diaphragm-3d-anatomy-tutorial/

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