Urogenital triangle in female + Perineal pouches

1. Urogenital triangle in female +Perineal pouches Dr Rania Gabr

2. OBJECTIVES • 1. Describe the boundaries & contents of urogenital triangle in female. • 2. Recite the parts of the female external genital organs. • 3. Identify its parts and openings present in it. • 4. Discuss the features of each part • 5. Discuss the contents of the perinealpouches in female and male. • 6. Enumerate the structures piercing the perineal membrane.

3. Urogenital Triangle in female BOUNDARIES : Anteriorly : Symphysis pubis Posteriorly: Transverse line passing through the 2 ischialtuberosities. Laterally :Ischiopubic rami & ischialtuberosities. CONTENTS : • Lower part of urethra & vagina. • External genitalia (vulva). Urethra Vagina Vulva

4. Female External Genitalia (Vulva) • Mons pubis : a collection of fat overlying the pubis. • Labia majora.: Two folds of skin containing fatty tissue and covered with hair • Located on either side of the vaginal opening, extending from the mons pubis to the perineum

5. Labia minora.: • Two thin folds of tissue located within the folds of the labia majora • Extends from the clitoris downward toward the perineum • Clitoris.: • Short, elongated organ composed of erectile tissue • Located just behind the upper junction of the labia minora • Homologous to the penis

6. Vestibule of vagina: The interval between the two labia minora. • Vagina & urethra open into it through urethral orifice anteriorly and vaginal orifice (Also known as the vaginal introitus), posteriorly. • Bartholin’sglands • Located on either side of the vaginal orifice • Secrete a mucous substance that lubricates the vagina

9. It is the space between the deep membranous layer of superficial fascia and the perineal membrane. BOUNDARIES: Inferiorly: membranous layer of superficial fascia (Colle`s fascia). Superiorly: perineal membrane. Laterally:ischiopubicrami Superficial Perineal Pouch

11. Contents of Superficial Perineal Pouch in the female 1- Bulbs of vestibule: on each side of vaginal orifice. 2- Crura of clitoris. 3- Superficial perineal muscles: A-Bulbospongiosus muscle, surrounds orifice of vagina and covers vestibular bulb. B- Ischiocavernosus muscle, covers crus of clitoris on each side.

12. C- Superficial transverse perinealmuscles. • 4- Greater vestibular glands: on each side of vaginal orifice. • 5- Perinealbody • 6- Perinealbranch of pudendal nerve suppling muscles & skin. Ischiocavernosus Bulbospongiosus

13. Contents of Superficial Perineal Pouch in the male • 1- Root (bulb and crura) of the penis and associated muscles (ischiocavernosus and bulbospongiosus). • 2- Proximal (bulbous) part of the spongy urethra. • 3- Superficial transverse perineal muscles. • 4- Deep perineal branches of the internal pudendal vessels and pudendal nerves.

14. Bulbospongiosus Ischiocavernosus

15. Deep Perineal Pouch It is a completely closed space deep to the perineal membrane. BOUNDARIES: Inferiorly: Inferior fascia of the urogenital diaphragm (Perineal membrane) Superiorly: Superior fascia of the urogenital diaphragm Laterally: Inferior portion of obturatorinternus fascia

16. 1- Part of urethra . 2- Part of vagina. 3- Sphincter urethrae muscle, which is pierced by urethra & vagina. 4- Deep transverse perineal muscles 5- Internal pudendal vessels. 6- Dosal nerve of clitoris. Contents of Deep PerinealPouch in female

17. Contents of Deep PerinealPouch in male • 1- membranous part of the urethra, • 2- the sphincter urethrae, • 3- the bulbourethral glands, • 4- the deep transverse perineal muscles, the internal pudendal vessels and their branches, and • 5- the dorsal nerves of the penis.

18. Structures piercing the perineal membrane: • 1- In the centre: a- Membranous urethra in male b- urethra and vagina in female • 2- On both sides of the urethra: a- ducts of bulbourethral glands of male b- artery to bulb • 3- Anteriorly a-Deep and dorsal arteries of penis or clitoris b- Dorsal nerve of penis or clitoris • 4- Posteriorly: Scrotal or labial vessels and nerves

20. Anal Triangle BOUNDARIES: Anteriorly: Transverse line passing through the 2 ischialtuberosities. Posteriorly : coccyx. Laterally :ischialtuberosity & sacrotuberouslig.overlapped by gluteus maximus.

21. CONTENTS: • Lower part of Anal canal (upper part lies in pelvis). • Ano-coccygeal body (or raphe): • a fibrofatty mass that extends from anusto tip of coccyx. • Ischiorectal fossaon each side.

22. IschiorectalFossa • A fascial lined wedge-shaped space on each side of the anal canal. Boundaries: • Base: Skin of the perineum. • Medial wall: Levatorani & anal canal. • Lateral wall: Obturatorinternus, covered with pelvic fascia.

24. Contents: • Dense fat. • Pudendal nerve & internal pudendal vessels within the pudendal canal • Inferior rectal nerve & vessels crossing the fossa to reach anal canal. • PudendalCanal: • A fascial canal formed by obturator fascia, located on the lateral wall of the ischiorectal fossa, • on the medial side of the ischial tuberosity. • Contains pudendal nerve and internal pudendal vessels

25. Anococcygeal Body • The anococcygeal body is a complex musculotendinous structure situated between the anterior aspect of the coccyx and the posterior wall of the anorectal canal • Receives insertion of fibers of levatorani muscle

26. Thank You & Good Luck