Presentation on theme: "Male and Female Urogenital Triangle"— Presentation transcript:
1Male and Female Urogenital Triangle Learning ObjectivesPerineum 2 LectureMale and Female Urogenital Trianglea. Describe the fascial reflections in the urogenital triangle and the relationship each layer has to the major subdivisions of the triangle (superficial and deep pouches).b. Understand the relationships between the fascial layers of the anterior abdominal wall with those of the urogenital triangle.c. Understand the possible routes for spread of fluid which might accumulate in the superficial and deep pouches.d. Describe the contents of the superficial and deep perineal pouches.e. Describe the course and distribution of the branches of the pudendal nerve and internal pudendal vessels in the urogenital triangle.f. Understand the position and importance of the muscles of the urogenital triangle.g. Describe the fundamental differences and similarities of the male and female urogenital triangles.h. Describe the role of the autonomic nervous system in sexual arousal.i. Be able to define vulva, vestibule, prepuce, hymen, episiotomy, circumcision, erection, emission, ejaculation and detumescence.
2Mons pubisLabium majusPrepuce of clitorisExternal orifice of urethraGlans of clitorisLabium minusVestibule of vaginaOpening of gr. vestibular glandScarpa’s fascia continues and after crossing pubic bone is called colles’ fascia.Mons pubis – deposition of SQ fat, which is usually coated with pubic hair and is lost after menopauseLabia majora – folds of skin impregnated with fat that start along the midline interiorly and meet along the midline posteriorly at the perineal body.In the lithotomy position the labia are together. They are covered by pubic hair on the inferior and lateral aspects.Labia minora – thin hairless skin folds with a core of erectile tissue that swell during sexual arousal. They are fatless and meet anteriorly and reflect to form the prepuce of the clitoris (clitoral hood or foreskin)Glans of clitoris may or may not be exposed, and it has a dense hood of sensory nervesBartholin’s glands (greater vestibular glands) – Mucous secreting glands that lubricates the vestibule and lower vagina during sexual arousal.Analogous to cowper’s glands (bulbourethral glands) in male.Paraurethral (lesser vestibular) – associated with urethra and female ejaculationVestibule of the vagina – space between labia minora, which contains:Glans of clitExternal orifice of female urethraVaginal orificeBartholin’s glandsParaurethral glandsHymen – fold of skin that guards the vaginal orifice.AnusPlate 356
3Left – hymen in a pre pubescent girl Left middle – hymen with tissue extension across it dividing it into two parts.Right middle –cribiform hymen (sieve-like)Right – hymen in woman who is sexual active. The only remnant of the hymen are a couple of tags.Imperforate hymen – complete membrane; treatment is to lacerate hymnPlate 377, 4th ed.
4Ischiocavernosus mBulbospongiosus m.Perineal bodyPerineal membraneExternal analSphincter m.Superficial transverseperineal m.Ischiocavernosus muscle covers the body of erectile tissue in the crus of the clitoris. Major difference between sexes in in the midline: in the female the bolbospongiosus muscles are truly two that flank the vestibule, and follow the contours of the labia minora. Just like in a male, these muscles do not extend into the shaft of the clitoris. Coat the bulb and the crura. There is also a superficial transverse muscle in the female.Plate 375
5Ischiocavernosus m.Bulbospongiosus m.Bulb of vestibuleGreater vestibular gl.Bolbus spongiosus is taken away on the left side, thus showing a body of erectile tissue called the bulb of the vestibule.The 2 bulbs of the vestibule flank the vestibule, come together anteriorly and end. They do NOT extend out into the clitoris, and thus the clitoris does NOT have a corpus spongiosum.The shaft of the clitoris is formed by the two crura, that are deep to the ischiocavernosus muscles.Greater vestibular gland (Bartholin’s gland) are situated deep to musculature. During sexual arousal, the bolbospongious mm contract and help secrete the contents of the vestibular gland.The vagina has no glands in its wall. Secretions that lubricate the vagina come from the cervix.Perineal membraneSuperficial transverseperineal m.Plate 358
6Bartholin Gland Cyst www.nucleusinc.com Bartholin gland cysts common. Usually because duct of gland becomes blocked. Bacteria enter and lead to an infection. They are quite painful, even to walk. Makes intercourse uncomfortable and painful. Usually associated with poor hygiene.
7Dorsal n. of clitorisBranching pattern of pudendal nerve are the same in both sex. Dorsal nerve of penis is analgous to the dorsal nerve of the clitoris.Perineal n.Inferior rectal nn.Plate 393
8Crus of clitorisDorsal a. of clitorisDeep a. of clitorisInternal pudendal a.Perineal a.The vasculature is the same. The course of the internal pudendal artery is the same.Same five structures on the dorsum of the clitoris as the dorsum of the penis.Internalpudendal a.Inferior rectal a.Plate 384
9Crus of clitorisBody of clitorisGlans of clotorisBulb of vestibulePerineal membrane (reflected)Sphincter urethrae m.Ischal cavernosus muscle has been removed from crus of cliterus. You can see the crus going into the shaft of clitorus.Bulb of the vestibule do not enter the shaft of the clitorus.Crus of the clitoris is substantially longer than illustrated. It extends twice the length shown here.Eternal urethral sphincter found in the deep pouch.Some of the muscles become part of the vagina.Kegal exercises tone the muscles of the pelvic floor and the muscles associated with the external genatalia.These muscles create a sphincteric muscles region around vaginal wallPerineal membraneVaginaDeep transverseperineal m.Greater vestibular glandPlate 358
10Urinary bladder in the pelvis, which is associated with pelvic floor because there is no prostate gland.Deep dorsal vein of clitoris drains into urinary bladder (plexus shown not labeled)Levator ani m.Crus of clitorisPerineal membraneIschiocavernosus m.Bulb of vestibuleColles’ fasciaBulbospongiosus mPlate 350
11Artist rendition of the periurethral glands Artist rendition of the periurethral glands. Some open at the urethral orifice, others open at the length of the female urethra. They play a role in keeping the urethra moist and lubricated. These are the glands typically associated with female ejaculation. Females, especially during an intense orgasm, a fluid is released into the perineum. The fluid has been analyzed, and it’s not urine. It has a composition similar to the male prostate. This is the equivalent of the ejaculate of the male.There is an area in the anterior vaginal wall that has a rich distribution of sensory nerve endings – the G spot.Netter 3rd ed.
12The female urethra is about four centimeters. The vagina is oriented backward towards the rectum.Episiotomy – increasing the dimensions of the vaginal orifice. In most case it’s probably not necessary. The role is to increase the wall of vagina to prevent tearing. The cut is into skin and superficial tissues. It can be midline or mediolateral. Mediolateral is the more frequently performed because you don’t want a fistula to form between the anal canal. You may cut the superficial transverse peritoneal muscle. Most will agree that loosing that muscle is inconsequential.Sphincter urethrae m.Deep dorsal vein ofclitorisBody of clitorisExternal analsphincter m.Perineal bodyLabium minusPerineal membranePlate 342Labium majus