 The cavity of the pelvis is divided by the pelvic diaphragm into the main pelvic

cavity above & perineum below

 The perineum is the diamond-shaped area medial to thighs & buttocks of both males
and females that contains the external genitals & anus.
 It is bounded:
 Anteriorly by the pubic symphysis
 Laterally by the ischial tuberosities
 Posteriorly by the coccyx.

 A transverse line drawn between the ischial tuberosities divides the perineum into:
 Anterior urogenital triangle, which contains the external genitalia.
 Posterior anal triangle, which contains the anus.

 The anal triangle is bounded behind by the tip of coccyx & on each side by ischial
tuberosity and the Sacrotuberous ligament, overlapped by the border of the gluteus
Maximus muscle.
 The lower opening of the anal canal lies in the midline, and on each side is the fat-
filled

 It is about 4 cm long and passes downward & backward from the rectal ampulla to the
anus.
 Posteriorly: anococcygeal body (a mass of fibrous tissue lying between anal canal &
coccyx)
 Laterally: ischiorectal fossae
 Anteriorly:
 Male: perineal body, urogenital diaphragm, membranous part of urethra & penis bulb.
 Female: perineal body, urogenital diaphragm & the lower part of vagina

1
 Upper half of anal canal:
 The mucous membrane is derived from hindgut endoderm.
 It is lined by columnar epithelium.
 It is thrown into vertical folds called anal columns- joined together at their lower ends by
small semilunar folds called anal valves
 Nerve supply: the same of rectal mucosa and is derived from autonomic hypogastric plexuses.
It is sensitive only to stretch
 Arterial supply: superior rectal artery, a branch of inferior mesenteric artery (hindgut)
 Venous drainage: superior rectal vein, a tributary of inferior mesenteric vein, & portal vein
 Lymphatic drainage: mainly upward along the superior rectal artery to the pararectal nodes &
then to inferior mesenteric nodes

 Lower half of anal canal:

 The mucous membrane is derived from ectoderm.
 It is lined by stratified squamous epithelium, no anal columns
 Nerve supply: from the somatic inferior rectal nerve; it is sensitive to pain, temperature, touch
& pressure.
 Arterial supply: inferior rectal artery, a branch of internal pudendal artery
 Venous drainage: inferior rectal vein, a tributary of internal pudendal vein, which drains into internal iliac vein
 Lymph drainage: downward to medial group of superficial inguinal nodes

 The pectinate line indicates the level where the upper half of the anal canal joins the lower
half

 Muscle Coat is divided into an outer longitudinal & an inner circular layer of smooth
muscle.
 The anal canal has internal sphincter & external sphincter.
 Involuntary Internal sphincter:
 It is formed from a thickening of smooth muscle of circular coat at the upper end of anal
canal.
 It is enclosed by a sheath of skeletal muscle that forms the external sphincter
 Nerve supply: sympathetic fibers from the inferior hypogastric plexuses

2
 Voluntary External sphincter can be divided into three parts:
 Subcutaneous part: encircles the lower end of anal canal & has no bony attachments
 Superficial part: attached to the coccyx behind &perineal body in front
 Deep part: encircles the upper end of anal canal & has no bony attachments
 Nerve supply: inferior rectal nerve, a branch of the pudendal nerve and the perineal
branch of the fourth sacral nerve.

 The puborectalis fibers of the two levatores ani blend with the deep part of external
sphincter & form a sling around the junction of the rectum & anal canal
 Anorectal ring: at the junction of the rectum and anal canal, the internal sphincter, the
deep part of the external sphincter, and the puborectalis muscles form a distinct ring,
which can be felt on rectal examination.

 Filled with dense fat, which supports the anal canal & allows it to distend during
defecation.
 Pudendal canal (Alcock canal): on the lateral wall of ischiorectal fossa & on the medial
side of ischial tuberosity. It contains pudendal nerve & internal pudendal vessels.
 Pudendal Nerve: branch of sacral plexus that leaves the main pelvic cavity through
greater sciatic foramen. After a brief course in the gluteal region of lower limb, it enters
the perineum through lesser sciatic foramen. It then passes forward in the pudendal
canal. Branches:
 Inferior rectal nerve: runs medially across the ischiorectal fossa & supplies external
anal sphincter, mucous membrane of the lower half of anal canal & perianal skin
 Dorsal nerve of the penis (or clitoris)
 Perineal nerve: supplies the muscles in urogenital triangle & the skin on the posterior
surface of scrotum (or labia majora)

 Internal Pudendal Artery: branch of internal iliac A that passes from the pelvis through
greater sciatic foramen & enters the perineum through lesser sciatic foramen. Branches:
 Inferior rectal artery: supplies the lower half of anal canal
 Branches to the penis in male & to labia and clitoris in female.
 Internal Pudendal Vein: receives tributaries that correspond to the branches of internal
pudendal artery.
3
 The urogenital triangle is bounded in front by the pubic arch & laterally by the ischial
tuberosities
 In females, the urogenital triangle contains the roots of external genitalia, clitoris, orifices of
urethra & vagina.
 In males, the urogenital triangle contains the penis & scrotum.

 The fatty layer (fascia of Camper):

 Continuous with the fat of ischiorectal fossa & superficial fascia of thighs.
 In the scrotum, the fat is replaced by smooth muscle, Dartos muscle.

 The membranous layer (Colles’ fascia):

 Attached posteriorly to the posterior border of urogenital diaphragm
 Attached laterally to the margins of the pubic arch
 Anteriorly it is continuous with the membranous layer of superficial fascia of anterior
abdominal wall (Scarpa’s fascia).
 The fascia is continued over the penis (or clitoris) as a tubular sheath

 Triangular musculofascial diaphragm situated in the anterior part of perineum, filling in

the gap of pubic arch
 It is formed by the sphincter urethrae & the deep transverse perineal muscles, which are
enclosed between a superior and an inferior layer of fascia of the urogenital diaphragm.
 Laterally, the layers of fascia are attached to the pubic arch.
 Anteriorly, the two layers of fascia fuse, leaving a small gap beneath the symphysis pubis.
 Posteriorly, the two layers of fascia fuse with each other, the membranous layer of
superficial fascia & perineal body

4
 Boundaries:
 Inferiorly by the membranous layer of superficial fascia
 Superiorly by inferior fascia of urogenital diaphragm (perineal
membrane)
 Posteriorly, it’s closed by the fusion of its upper & lower walls.
 Laterally, it’s closed by the attachment of its upper & lower walls to the
margins of pubic arch
 Anteriorly: the space communicates freely with the potential space lying
between the superficial fascia of anterior abdominal wall & anterior
abdominal muscles

 Root of the clitoris: 3 masses of erectile tissue, bulb of vestibule &

right and left crura.
 Bulb: covered by the bulbospongiosus muscles.
 Crura: is covered by an ischiocavernosus M

 Bulbospongiosus muscles (2):

 Surrounds the orifice of vagina & covers the vestibular bulbs.
 Its fibers extend forward to gain attachment to corpora cavernosa of clitoris.
 Reduces the size of vaginal orifice & compresses the deep dorsal vein of clitoris,
thereby assisting in the mechanism of erection.

 Ischiocavernosus muscles (2): covers the crus of clitoris & its contraction assists
in the erection of clitoris.

 Superficial transverse perineal muscles (2):

 Lie in the posterior part of superficial perineal pouch.
 Each arises from the ischial ramus and is inserted into the perineal body.
 Function: fix the perineal body in the center of perineum
 All muscles of superficial perineal pouch are supplied by the perineal branch
of pudendal N

5
 Perineal body: larger than that of male
 Wedge-shaped mass of fibrous tissue situated between the lower end of vagina & anal
canal
 Point of attachment of many perineal muscles including the levatores ani muscles.

 Perineal branch of pudendal nerve: terminates in the superficial perineal pouch by

supplying the muscles & skin
 Greater vestibular glands (Bartholin’s):
 Pair of small mucus-secreting glands that lie under cover of the posterior parts of bulb of
vestibule & labia majora
 Each drains its secretion into vestibule by a small duct, which opens into the groove
between hymen & posterior part of labium minus
 Secrete a lubricating mucus during sexual intercourse

 Structures forming the root of the penis

 Bulbospongiosus muscles
 Ischiocavernosus Muscles
 Superficial Transverse Perineal Muscles
 Perineal Body
 Perineal Branch of the Pudendal Nerve

 Closed space that is bounded superiorly by levator ani & its fascia and inferiorly by perineal
membrane
 Contents of DPP in Female:
 Part of the urethra & Sphincter urethrae
 Part of the vagina
 Deep transverse perineal muscles
 Internal pudendal vessels & their branches
 Dorsal nerves of the clitoris.

6
 Contents DPP in Male
 Membranous part of the urethra & Sphincter urethrae
 Bulbourethral glands
 Deep transverse perineal muscles
 Internal pudendal vessels & their branches & Dorsal nerves of penis

 Root of the Penis:

 3 masses of erectile tissue: bulb & right and left crura.
 Bulb is situated in the midline & is attached to the undersurface of urogenital
diaphragm. It is traversed by urethra and is covered by the bulbospongiosus
 Bulb is continued forward into the body of the penis & forms the corpus spongiosum
 Each crus is attached to the side of pubic arch & is covered on its outer surface by
ischiocavernosus.
 The 2 crura converge anteriorly and form corpora cavernosa.

 Body of the Penis

 3 cylinders of erectile tissue enclosed in a tubular sheath of fascia (Buck’s fascia).
 The erectile tissue is made up of 2 dorsally placed corpora cavernosa & a single corpus
spongiosum ventrally
 Corpus spongiosum expands distally to form glans penis
 The prepuce or foreskin is a hoodlike fold of skin that covers the glans.

 Blood Supply
 Arteries: corpora cavernosa> deep arteries of penis. Corpus spongiosum> artery of bulb
& dorsal artery of penis. All are branches of internal pudendal artery.
 Veins: internal pudendal veins.

 Lymph Drainage:
 The skin of penis is drained into the medial group of superficial inguinal nodes.
 The deep structures are drained into the internal iliac nodes.

 Nerve Supply: pudendal nerve & pelvic plexuses.