PERINEUM

Perineum
It is the lowermost part of the trunk that includes the structures that occupy the pelvic outlet. Boundaries: It is diamond shape space which has the following boundaries;

Boundaries of the perineum

Anterior angle: inferior pubic ligament. Posterior angle: tip of the coccyx. Lateral angles: ischial tuberosities. Each side: pubic arch (ant.). sacrotuberous ligament and gluteus maximus (post.)

Divisions of the perineum:

Divisions of the perineum

1. 2. The perineum is divided by an imaginary line that connects the 2 ischial tuberosities into 2 triangles: Anal triangle (post.), contains the lower part of anal canal. Urogenital triangle (ant.), contains the lower part of urethra, external genital and their origin. This imaginary line passes through the center of perineum, this point contains the perineal body.

Perineal body
It is a tendinous mass that is present in the center of perineum just in front of anal orifice. The perineal body serves for attachment of 10 muscles including the urethral sphincter, anal sphincter and muscles that connected to the root of penis or clitoris.

Internal pudendal artery

Origin: One of the two terminal branches of the anterior division of internal iliac artery. Termination: By dividing into; 1. Deep artery of penis (or clitoris). 2. Dorsal artery of penis (or clitoris).

Internal pudendal artery

Branches: 1. To the muscles ---------- muscular branches. 2. To the anal canal -------- inferior rectal artery. 3. To the urethra ------------ urethral artery. 4. To external genitalia: scrotal (or labial artery). Perineal artery. Two terminal branches: deep and dorsal artery of penis or clitoris

Pudendal nerve (S2,3,4)

Origin: It is the smaller of the two terminal branches of sacral plexus. Termination: By dividing into 2 terminal branches: 1. Perineal nerve. 2. Dorsal nerve of penis (or clitoris).

Urogenital triangle
It is the anterior division of the perineum that contains the lowermost part of urethra, external genitalia and their root. The boundaries: Anterior; inferior pubic ligament. On each side; pubic arch. Posterior; an imaginary line that connects the 2 ischial tuberosities.

Urogenital triangle
Fascia of the urogenital triangle: No deep fascia. The superficial fascia is differentiated into superficial fatty layer and deep membranous layer.

Urogenital triangle
The urogenital triangle is divided by a transverse membrane (perineal membrane) into 2 pouches: 1. Superficial perineal pouch. 2. Deep perineal pouch.

Urogenital triangle
The superficial perineal pouch (space) is an open space that is continuous with the lower part of anterior abdominal wall while the deep perineal pouch (space) is a completely closed space. The perineal membrane that lies between the two pouches is pierced by the structures that descend from the deep to superficial perineal pouches.

Superficial perineal pouch:

Boundaries: Roof: perineal membrane. Floor: membranous layer of superficial fascia (colles fascia). Posterior and on each side: the roof and floor fuse together. Anterior: the space (pouch) is open and continuous with the space deep to membranous layer of superficial fascia.

Superficial perineal pouch: contents in male

1- root of penis (bulb and 2 crura). 2- superficial perineal muscles: Superficial transverse perinea. Ischio-cavernosus. Bulbo-spongiosus. 3- arteries: Internal pudendal artery, its 2 terminal branches and scrotal artery. 4- veins: Vein that drain the penis (deep dorsal vein of penis). 5- nerves: Dorsal nerve of penis. Scrotal nerve. 6- urethra.

Superficial perineal pouch: contents in female:

1- root of clitoris (2 bulb of vestibule and 2 crura). 2- superficial perineal muscles: Superficial transverse perinea. Ischiocavernosus. Bulbo-spongiosus. 3- arteries: Internal pudendal artery, its 2 terminal branches and labial artery. 4- veins: Vein that drain the clitoris. 5- nerves: Dorsal nerve of clitoris. Labial nerve. 6- Vagina 7- greater vestibular gland. 8- urethra

Deep perineal pouch (space):

Deep perineal pouch (space): Boundaries:

Roof: pelvic fascia. Floor: perineal membrane. Anterior, posterior and on each side: the roof and floor fuse together to close the space.

Deep perineal pouch (space): contents in male:

1. Membranous urethra. 2. Bulbourethral glands. 3. Muscles: Sphincter urethrae and deep transverse perinei. 4. Dorsal nerve of penis. 5. Internal pudendal artery.

Deep perineal pouch (space):

Deep perineal pouch (space): contents in female:

1. Membranous urethra. 2. Muscles: Sphincter urethrae and deep transverse perinei. 3. Dorsal nerve of clitoris. 4. Internal pudendal artery.

Perineal membrane:
It is a strong triangular fibrous membrane attached to the pubic arch and separates the superficial from the deep perineal pouches.

Structures piercing the perineal membrane:

1. Membranous urethra. 2. Internal pudendal artery. 3. Dorsal nerve of penis (or clitoris). 4. Artery of the bulb. 5. Vagina in female. 6. Ducts of bulbo-urethral glands in male.