Presentation is loading. Please wait.

Presentation is loading. Please wait.

Male and Female Urogenital Triangle

Similar presentations

Presentation on theme: "Male and Female Urogenital Triangle"— Presentation transcript:

1 Male and Female Urogenital Triangle
Learning Objectives Perineum 2 Lecture Male and Female Urogenital Triangle a. 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.

2 Mons pubis Labium majus Prepuce of clitoris External orifice of urethra Glans of clitoris Labium minus Vestibule of vagina Opening of gr. vestibular gland Scarpa’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 menopause Labia 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 nerves Bartholin’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 ejaculation Vestibule of the vagina – space between labia minora, which contains: Glans of clit External orifice of female urethra Vaginal orifice Bartholin’s glands Paraurethral glands Hymen – fold of skin that guards the vaginal orifice. Anus Plate 356

3 Left – 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 hymn Plate 377, 4th ed.

4 Ischiocavernosus m Bulbospongiosus m. Perineal body Perineal membrane External anal Sphincter m. Superficial transverse perineal 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

5 Ischiocavernosus m. Bulbospongiosus m. Bulb of vestibule Greater 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 membrane Superficial transverse perineal m. Plate 358

6 Bartholin Gland Cyst
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.

7 Dorsal n. of clitoris Branching 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

8 Crus of clitoris Dorsal a. of clitoris Deep a. of clitoris Internal 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. Internal pudendal a. Inferior rectal a. Plate 384

9 Crus of clitoris Body of clitoris Glans of clotoris Bulb of vestibule Perineal 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 wall Perineal membrane Vagina Deep transverse perineal m. Greater vestibular gland Plate 358

10 Urinary 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 clitoris Perineal membrane Ischiocavernosus m. Bulb of vestibule Colles’ fascia Bulbospongiosus m Plate 350

11 Artist 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.

12 The 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 of clitoris Body of clitoris External anal sphincter m. Perineal body Labium minus Perineal membrane Plate 342 Labium majus

Download ppt "Male and Female Urogenital Triangle"

Similar presentations

Ads by Google