1 / 26

ANATOMY OF THE FEMALE PELVIC FLOOR AND PERINEUM Dr. A. O. FAWOLE DEPT. OF OB-GYN UCH

ANATOMY OF THE FEMALE PELVIC FLOOR AND PERINEUM Dr. A. O. FAWOLE DEPT. OF OB-GYN UCH. Pelvic Floor and Perineum. Anterior perineum Posterior perineum Pelvic Floor. Perineum. Borders of pelvic outlet Anteriorly – ischiopubic rami Posteriorly – coccyx and sacro-tuberous ligament

eryk
Download Presentation

ANATOMY OF THE FEMALE PELVIC FLOOR AND PERINEUM Dr. A. O. FAWOLE DEPT. OF OB-GYN UCH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ANATOMY OF THE FEMALE PELVIC FLOOR AND PERINEUM Dr. A. O. FAWOLE DEPT. OF OB-GYN UCH

  2. Pelvic Floor and Perineum • Anterior perineum • Posterior perineum • Pelvic Floor

  3. Perineum • Borders of pelvic outlet • Anteriorly – ischiopubic rami • Posteriorly – coccyx and sacro-tuberous ligament • Division (ischial tuberosities) • Anterior perineum (urogenital triangle) • Posterior perineum (anal triangle) • Structures overly perineal membrane

  4. Anterior Perineum

  5. Structures of the Vulva • Mons • Labia • Clitoris • Vestibule • Erectile structures

  6. Vulva • Mons • Hair-bearing skin • Cushion of adipose tissue • Labia majora • Hair-bearing skin • Termination of round ligaments of uterus • Labia minora • Hairless skin fold • Lacks bed of adipose tissue • Forms prepuce/frenulum of clitoris

  7. Glands of the vulva • Labia majora – sebaceous gland • Sweat glands • Bartholin’s glands

  8. Superficial compartment Space between subcutaneous tissues and perineal membrane • Clitoris • Crura • Vestibular bulb/Bartholin’s gland • Ischicavernosus (from ischial tuberosity) • Bulbospongiosus (from perineal body) • Superficial transverse perineal muscle • Muscles contained in superficial perineal pouch

  9. The Perineal Membrane • Triagular sheet in anterior half of pelvic outlet • Dense fibromuscular tissue • Previously called urogenital diaphragm • Functions • Supports pelvic floor • Counteracts effects of raised intra-abdominal pressure • Counteracts effects of gravity

  10. The Perineal Membrane • Complete sheet in males • Arises from ischiopubic rami • Attachments • Urethra • Vagina • Perineal body • Limits downward descent

  11. Perineal Body • Mass of connective tissue • Synonym: central tendon of the perineum • Located between vagina and anus • Attachments • Perineal membrane • Superficial transverse perineal muscle • Bulbospongiosus • Levator ani • Coccyx (via external anal sphincter)

  12. Posterior Perineum

  13. Posterior triangle • Anus • Anal sphincter • Levator ani • Ischio-rectal fossa

  14. Ischio-rectal fossa • Lateral - Pudendal vessels/nerve (Pudendal canal) • Medial – Fascial covering of levator ani/external anal sphincter • Posterior – sacrotuberous ligament • Anterior – urogenital perineum • Floor – skin/ subcutaneous fat

  15. Pudendal Nerve/Vessels • Similar channels • Nerve arises from sacral plexus (S2- S4) • Sensory • Motor • Artery: anterior division of internal iliac artery • Branches • Clitoral • Perineal (largest branch: muscles/skin) • Inferior rectal

  16. Anal Sphincter • External anal sphincter • Superficial portion • Deep portion • Internal anal sphincter • Thickening of circular smooth muscle of anal wall • Important during repair of third (fourth) degree perineal laceration

  17. The Pelvic Floor • Demands of upright posture • Support for pelvic structures • Passage of fetus • Openings for waste elimination • Fibromuscular floor • Visceral ligaments/fascia

  18. Levator ani/Pelvic Wall • Levator ani most important muscle • Pubo-rectal • Pubo-coccygeal • Coccygeal • Origin: Posterior aspect of pubic bone, fascia of pelvic side wall, ischial spine • Insertion: Perineal body, anal sphincter, coccyx • Constitute pelvic diaphragm • Surfaces covered by fascia

  19. Pelvic Floor • Pubo-rectal and pubo-coccygeal most medial • Pelvic diaphragm forms U-shaped layer of muscle • Opening end of U directed anteriorly (urogenital sinus) • Urethra • Vagina • rectum

  20. Pelvic supports • Condensations of connective tissue or endopelvic fascia • Cardinal ligament • Uterosacral ligament • Pubocervical fascia

  21. Clinical significance Prolapse of pelvic structures • Damage • Weakness

  22. Cardinal ligament Transverse cervical/Mackenrodt’s ligament • Attaches lateral cervix/upper vagina to pelvic side wall • Connective tissue/involuntary muscle • Ureter in upper part

  23. Uterosacral ligament • Postero-lateral attachment of lateral vaginal fornix/cervix/isthmus to sacro-iliac joint/third piece of sacrum

  24. Pubo-cervical fascia • Extends between cardinal ligament and pubis • Lateral to the bladder • Significant in repair operation for cystocoele (anterior colporrhaphy)

More Related