Pelvic Floor.pptx

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Abdominopelvic Cavity
• Largest cavity
• Oval shape
• Upper extremity formed by the thoracic diaphragm
• Lower extremity is formed by pelvic diaphragm (levator ani
and coccygeus)
• Wider above than below
• Extends into the thoracic cage and into the pelvis.
• The funnel-shaped pelvic cavity is the inferoposterior part
of the abdominopelvic cavity.
• Separated from the each other by the superior aperture of
the lesser pelvis

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Pelvic Cavity
• Continuous with the abdominal cavity at the pelvic
inlet.
• Contains the terminal parts of the ureters, the
urinary bladder, rectum, pelvic genital organs,
blood vessels, lymphatics, nerves, an overflow of
abdominal viscera: loops of small intestine (mainly
ileum) and large intestine (appendix and
transverse and/or sigmoid colon).

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ANTERO-INFERIOR PELVIC WALL
• Bodies and rami of the pubic bones and the pubic
symphysis.
LATERAL PELVIC WALLS
• Formed by the right and left hip bones, obturator foramen
closed by an obturator membrane, obturator internus
muscles covered by obturator fascia
POSTERIOR WALL
• Sacrum and coccyx; and posterolateral walls, formed by the
anterior sacro-iliac, sacrospinous, and sacrotuberous
ligaments and piriformis.
• Deep to piriformis muscle are the nerves of the sacral
plexus.

Pelvic brim (pelvic inlet)
• Separates the pelvis into the false pelvis and the
true pelvis.
• Formed by the sacral promontory.
Pelvic outlet
• Bounded by the coccyx behind, the ischial
tuberosities laterally and the pubic arch anteriorly.
• True pelvis (pelvic cavity) lies between the inlet and
outlet.
• False pelvis is part of the abdominal cavity.
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Ligaments of the pelvis
• Sacrotuberous ligament
• Sacrospinous ligament
• These ligaments with sacro-iliac ligaments bind the
sacrum and coccyx to the os and prevent excessive
movement at the sacro-iliac joints.
• These ligaments create the greater and lesser sciatic
foramina with the greater and lesser sciatic
notches.

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GREATER SCIATIC FORAMEN
• Divided into the suprapiriformis recess and
infrapiriformis recess by the piriformis muscle.
• Greater sciatic foramen transmits the following
structures as they exit the pelvic cavity to enter the
gluteal and thigh regions: superior gluteal vein,
artery, and nerve; piriformis muscle; inferior
gluteal vein, artery, and nerve; sciatic nerve;
internal pudendal vein and artery; and pudendal
nerve.

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LESSER SCIATIC FORAMEN
• Internal pudendal vein, internal pudendal artery,
and pudendal nerve exit the pelvic cavity via the
greater sciatic foramen and then re-enter the pelvic
cavity through the lesser sciatic foramen and
proceed to the perineum.

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Pelvic Inlet (Pelvic Brim)
• Defined by the sacral promontory (S1 vertebra) and
the linea terminalis. The linea terminalis includes
the pubic crest, iliopectineal line, and arcuate line.
• Divides the pelvic cavity into two parts: the major
(false) pelvic cavity, lies above the pelvic inlet and
the minor (true) pelvic cavity, which lies below the
pelvic inlet and extends to the pelvic outlet.
• Oval shaped in females and heart shaped in males.

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Measurements of the pelvic inlet include the
following:
• True conjugate diameter - distance from the sacral
promontory to the superior margin of the pubic
symphysis, measured radiographically.
• Diagonal conjugate diameter - distance from the
sacral promontory to the inferior margin of the
pubic symphysis - measured during an obstetric
examination.

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Diagram shows the relationships
of the thoracic, abdominal,
and pelvic cavities.
B. The diameter of the pelvic inlet
is measured by the true conjugate
(TC) diameter and the diagonal
conjugate(DC) diameter.

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Pelvic Outlet
• Defined by the coccyx, ischial tuberosities, inferior
pubic ramus, and pubic symphysis.
• Closed by the pelvic diaphragm and urogenital
diaphragm.
• Diamond shaped in both females and males.
• Divided into the anal triangle and urogenital
triangle by a line passing through the ischial
tuberosities.

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The measurements of the pelvic outlet include the
following:
• Transverse diameter - distance between the ischial
tuberosities.
• Interspinous diameter - the distance between the
ischial spines.
• Ischial spines may present a barrier to the fetus during
childbirth if the interspinous diameter is less than 9.5
cm.
• TC, DC, and IS diameters are important during
childbirth, where the fetus must travel through the
birth canal, which consists of the pelvic inlet- minor
pelvis - cervix - vagina - pelvic outlet.

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C. The diameter of the pelvic outlet is
measured by the transverse diameter
and the interspinous (IS) diameter.

Pelvic Floor
• Formed by pelvic diaphragm
• Consists of the coccygeus and levator ani muscles
and their fascias.
• Levator ani and coccygeus muscles form the pelvic
floor, while piriformis covers the front of the
sacrum.
• Lies within the lesser pelvis
• Separates the pelvic cavity from the perineum.
• An anterior gap between the medial borders of the
levator ani muscles of each side—the urogenital
hiatus—gives passage to the urethra and, in
females, the vagina
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Levator Ani
• Consists of three parts
• Forms a floor for supporting the abdominopelvic viscera.
Puborectalis: medial part of the levator ani, forms a U-shaped
muscular sling (puborectal sling) that passes posterior to the
anorectal junction. This part plays a major role in maintaining
fecal continence.
Pubococcygeus: intermediate part of the levator ani, lateral to the
puborectalis; lateral fibers attach to the coccyx
- Shorter muscular slips of the pubococcygeus are named for
pubovaginalis (females), puboprostaticus (males),
puboperinealis, and pubo-analis.
Iliococcygeus: the posterolateral part of the levator ani, which
arises from the posterior tendinous arch and ischial spine.

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Functions
• Support the abdominopelvic viscera
• Assist in maintaining urinary and fecal continence.
• Contribute to the increased pressure (to aid
expulsion).
• Produces a sphincter action on the rectum and
vagina
• Helps to produce increase in intraabdominal
pressure during straining.

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Pelvic fascia
• Connective tissue covering levator ani and obturator
internus
• Continuous with the fascial layers of the abdominal wall
above and the perineum below.
• Endopelvic fascia is the loose connective tissue that
covers the pelvic viscera, condensed into ligaments
which include the:
- Cardinal (Mackenrodt’s) ligaments: pass from the cervix
and upper vagina to the pelvic side walls.
- Utero-sacral ligaments: pass from the cervix and vaginal
fornices to the fascia overlying the sacro-iliac joints.
- Pubocervical ligaments: extend from the cardinal
ligaments to the pubis (puboprostatic in the male).
- Pubovesical ligaments: from the back of the symphysis
pubis to the bladder neck.

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Broad ligament: is a double fold of peritoneum which
hangs between the uterus and the pelvic side walls, it
contains:
• Fallopian tube.
• Ovary.
• Ovarian ligament.
• Round ligament.
• Uterine and ovarian vessels.
• Nerves and lymphatics.
Round ligament: is a cord-like fibromuscular structure
which is the female equivalent of the gubernaculum in
the male.
• Passes from the lateral angle of the uterus to the
labium majus through the inguinal canal.

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Support of the Pelvic Organs (muscles and ligaments).
PELVIC DIAPHRAGM (FLOOR) - composed of:
- Coccygeus muscle
- Levator ani muscles, which consist of:
- Iliococcygeus
- Pubococcygeus
- Puborectalis.
UROGENITAL DIAPHRAGM - composed:
• Deep transverse perineal muscle
• Sphincter urethra muscle
TRANSVERSE CERVICAL LIGAMENT (CARDINAL LIGAMENT OF
MACKENRODT) - a condensation of endopelvic fascia that extends
laterally from the cervix to the side wall of the pelvis.
UTEROSACRAL LIGAMENT is a condensation of endopelvic fascia that
extends posteriorly from the cervix to the sacrum.
PUBOCERVICAL LIGAMENT is a condensation of endopelvic fascia
that extends anteriorly from the cervix to the pubic symphysis.

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Sex differences in the pelvis
The female pelvis differs from that of the male for the
purpose of childbearing.
1 Pelvic inlet is oval in the female. In the male the sacral
promontory is prominent, producing a heart-shaped
inlet.
2 Pelvic outlet is wider in females as the ischial
tuberosities are everted.
3 Pelvic cavity is more spacious in the female than in the
male.
4 False pelvis is shallow in the female.
5 Pubic arch is wider and more rounded in the female
when compared with that of the male.

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Clinical Considerations
• Pelvic Relaxation - weakening or loss of support of
pelvic organs due to damage of the pelvic diaphragm,
urogenital diaphragm, transverse cervical ligament
(cardinal ligament of Mackenrodt), uterosacral
ligament, and/or pubocervical ligament.
- Cystocele (prolapse of urinary bladder into the anterior
vaginal wall)
- Rectocele (prolapse of rectum into posterior wall of
vagina), or uterine prolapse (prolapse of uterus into
vaginal vault).
- Caused by multiple childbirths; birth trauma; increased
intra-abdominal pressure due to obesity, heavy lifting,
or chronic cough; or menopausal loss of muscle tone.

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Pelvic Ring
• Consists of the sacrum and the two coxal bones
with small degrees of movement between the
sacroiliac joint and the pubic symphysis.
- Stability depends on anterior and posterior
sacroiIiac ligaments, sacrotuberous ligament and
the sacrospinous ligaments.

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PUDENDAL NERVE BLOCK
- Provides perineal anesthesia during forceps childbirth
delivery by anesthetizing the pudendal nerve.
- Pain of childbirth is transmitted by the pudendal nerve
through sensory fibers of S2–5 spinal nerves which
passes out of the pelvic cavity through the greater
sciatic foramen, and re-enters it through the lesser
sciatic foramen.
- Pudendal nerve divides into the inferior rectal nerve,
perineal nerve, and dorsal nerve of the penis (or
clitoris).
- For a complete anesthesia of the perineal region, the
ilioinguinal nerve (which branches into the anterior
labial nerves), genitofemoral nerve, and perineal
branch of the posterior femoral cutaneous nerve are
anesthetized.

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Arteries of the pelvis
• Common iliac arteries L4: arise from the aortic
bifurcation to the left of the midline at the level of
the umbilicus and bifurcate into external and
internal iliac branches anterior to the sacro-iliac
joints.
• External iliac artery L5, S1: become the femoral
artery as it passes under the inguinal ligament at
the mid-inguinal point. Branches supply the
anterior abdominal wall: deep circumflex iliac artery
and inferior epigastric artery.
• Internal iliac artery L5, S1 : divide into anterior and
posterior trunks at the level of the greater sciatic
foramen.

INTERNAL ILIAC ARTERY
• Principal artery of the pelvis
• Supplies the gluteal region, medial thigh regions,
and the perineum.
• Approximately 4 cm long
• Separated from the sacro-iliac joint by the internal
iliac vein and the lumbosacral trunk.
• Ends at the superior edge of the greater sciatic
foramen by dividing into anterior and posterior
divisions (trunks).
• Anterior division are visceral supplying the bladder,
rectum, and reproductive organs and parietal
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Branches of the anterior trunk of ILA
• Obturator artery
• Umbilical artery: Gives rise to the superior vesical
artery which contributes a supply to the bladder.
• Inferior vesical artery: Gives off a branch to the vas
deferens (in the male).
• Middle rectal artery: anastomoses with the superior
and inferior rectal arteries to supply the rectum.
• Internal pudendal artery: is the predominant supply to
the perineum. It exits the pelvis through the greater
sciatic foramen and re-enters through the lesser sciatic
foramen to enter the pudendal canal with the pudendal
nerve.
• Uterine artery
• Inferior gluteal artery
• Vaginal artery.

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Branches of the posterior trunk of ILA
• Superior gluteal artery
• Ilio-lumbar artery.
• Lateral sacral artery.
Veins of the pelvis
• Right and left common iliac veins join to form the
inferior vena cava behind the right common iliac
artery at L5.
Nerves of the pelvis
• Sacral plexus

Pelvic Nerves
• Sacral spinal nerves
• Coccygeal nerves
• Pelvic part of the autonomic nervous system.
Piriformis and coccygeus muscles form a bed for the sacral
and coccygeal nerve plexuses.
LUMBOSACRAL TRUNK
• At the pelvic brim, L4 nerve unites with the L5 nerve to
form the lumbosacral trunk and joins the sacral plexus.
SACRAL PLEXUS
• Two main nerves arise from the sacral plexus are the
sciatic and pudendal nerves
• Pudendal nerve is the main nerve of the perineum and the
chief sensory nerve of the external genitalia. 36

COCCYGEAL PLEXUS
• Formed by the anterior rami of S4 and S5 and the
coccygeal nerves.
• Lies on the coccygeus and supplies this muscle, part
of the levator ani, and the sacrococcygeal joint.
• Anococcygeal nerves arising from this plexus supply
a small area of skin between the tip of the coccyx
and the anus.
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PELVIC AUTONOMIC NERVES
• Autonomic nerves enter the pelvic cavity via four
routes
- Sacral sympathetic trunks: provide sympathetic
innervation to the lower limbs, has four sympathetic
ganglia, converge to form the ganglion impar (coccygeal
ganglion).
- Peri-arterial plexuses: postsynaptic, sympathetic,
vasomotor fibers to superior rectal, ovarian, and
internal iliac arteries.
- Hypogastric plexuses: conveyed to the pelvic viscera.
- Pelvic splanchnic nerves: parasympathetic innervation
of pelvic viscera and descending and sigmoid colon.
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Four primary groups of nodes are located in or adjacent to the pelvis
• External iliac lymph nodes: along the external iliac vessels. They
receive lymph from the inguinal lymph nodes; pelvic viscera. These
nodes drain into the common iliac nodes.
• Internal iliac lymph nodes: around the anterior and posterior
divisions of the internal iliac artery and the origins of the gluteal
arteries. They receive drainage from the inferior pelvic viscera,
deep perineum, and gluteal region and drain into the common
iliac nodes.
• Sacral lymph nodes: lie in the concavity of the sacrum, adjacent to
the median sacral vessels. They receive lymph from postero-
inferior pelvic viscera and drain either to internal or common iliac
nodes.
• Common iliac lymph nodes: lie superior to the pelvic brim, along
the common iliac blood vessels, and receive drain age from the
three main groups listed above.
• Pararectal nodes along the branches of the internal iliac vessels.
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Contents of the pelvic
cavity
• Sigmoid colon
• Rectum
• Ureters
• Bladder

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Bladder
• Organ of the urinary system.
• Plays two main roles:
• Temporary storage of urine – a hollow organ with
distensible walls.
- Has a folded internal lining (known as rugae)
- Accommodates up to 400-600ml of urine in healthy
adults.
• Assists in the expulsion of urine – the musculature
of the bladder contracts during micturition, with
concomitant relaxation of the sphincters.

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Shape of the Bladder
• When full, it exhibits an oval shape, and when empty it is
flattened
External features are:
• Apex – superiorly, pointing towards the pubic symphysis,
connected to the umbilicus by the median umbilical ligament
(remnant of the urachus).
• Body – main part of the bladder, located between the apex
and the fundus
• Fundus (or base) – located posteriorly. It is triangular-shaped,
with the tip of the triangle pointing backwards.
• Neck – formed by the convergence of the fundus and the two
inferolateral surfaces. It is continuous with the urethra.
• Urine enters the bladder through the left and right ureters,
and exits via the urethra. Internally, these orifices are marked
by the trigone – a triangular area located within the fundus
and has smooth walls

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Musculature
• Plays a key role in the storage and emptying of urine.
• Bladder wall contains specialised smooth muscle – known as detrusor
muscle.
• Fibres are orientated in multiple directions.
• Innervated by both sympathetic and parasympathetic nervous systems.
• Fibers of the detrusor muscle often become hypertrophic in order to
compensate for increased workload of the bladder emptying, common in
conditions that obstruct the urine outflow such as benign prostatic
hyperplasia.
Two muscular sphincters located in the urethra:
• Internal urethral sphincter:
– Male – consists of circular smooth fibres, which are under autonomic
control. It is thought to prevent seminal regurgitation during ejaculation.
– Females – thought to be a functional sphincter (i.e. no sphincteric
muscle present). It is formed by the anatomy of the bladder neck and
proximal urethra.
• External urethral sphincter : skeletal muscle, and under voluntary control.

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Vasculature
Internal iliac vessels.
• Via the superior vesical branch. In males, this is
supplemented by the inferior vesical artery, and in
females by the vaginal arteries. In both sexes, the
obturator and inferior gluteal arteries.
• Venous drainage is achieved by the vesical venous
plexus, which empties into the internal iliac veins.
Lymphatics
• Superolateral aspect of the bladder drains into
the external iliac lymph nodes. The neck and
fundus drain into the internal iliac, sacral and
common iliac nodes.

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Nervous Supply
• Sympathetic – hypogastric nerve (T12 – L2). It
causes relaxation of the detrusor muscle, promoting
urine retention.
• Parasympathetic – pelvic nerve (S2-S4). Increased
signals from this nerve causes contraction of the
detrusor muscle, stimulating micturition.
• Somatic – pudendal nerve (S2-4). It innervates the
external urethral sphincter, providing voluntary
control over micturition.

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Bladder Stretch Reflex
• Primitive spinal reflex, in which micturition is
stimulated in response to stretch of the bladder wall.
• During toilet training in infants, this spinal reflex is
overridden by the higher centres of the brain, to give
voluntary control over micturition.
Reflex arc
• Bladder fills with urine, and the bladder walls stretch.
Sensory nerves detect stretch and transmit this
information to the spinal cord.
• Interneurons within the spinal cord relay the signal to
the parasympathetic efferents (the pelvic nerve).
• Pelvic nerve acts to contract the detrusor muscle, and
stimulate micturition.

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Clinical Relevance: Spinal Cord Injuries and the Bladder
Reflex Bladder – Spinal Cord Transection Above T12
• Afferent signals from the bladder wall are unable to reach
the brain, and the patient will have no awareness of
bladder filling. The external urethral sphincter is constantly
relaxed.
• A functioning spinal reflex, where the parasympathetic
system initiates detrusor contraction in response to bladder
wall stretch. The bladder automatically empties as it fills –
known as the reflex bladder.
Flaccid Bladder – Spinal Cord Transection Below T12
• Damage to the parasympathetic outflow to the bladder,
detrusor muscle will be paralysed, unable to contract.
• Bladder fills uncontrollably, becoming abnormally

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Clinical Relevance: Urine Retention
• Normal bladder emptying may be hampered by
obstruction. In males, the most common cause is
obstruction due to benigh prostate enlargement
(BPH). Other causes include obstruction by a stone
or large blood clot.
• Acute retention: bladder capacity is pushed to the
limit due to accumulation of urine in an acutely
obstructed reservoir; excruciating pain.
• Chronic retention due to incomplete obstruction of
the urine outflow; accumulation of residual urine in
the bladder may exceed 1-1.5 litres with
impairment of renal function.

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Urethra
• Transports urine from the bladder to an external
opening in the perineum.
• Lined by stratified columnar epithelium, protected
from the urine by mucus secreting glands.
Male Urethra
• Approximately 15-20cm long.
• Transports semen – a fluid containing spermatozoa
and sex gland secretions.

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Three parts (proximal to distal):
• Prostatic urethra (3cm):
– Continuation of the bladder neck and passes through the prostate
gland.
– Receives the ejaculatory ducts (containing spermatozoa from the
testes and seminal fluid from the seminal vesicle glands) and the
prostatic ducts (containing alkaline fluid).
– Widest and most dilatable portion of the urethra.
• Membranous urethra (2cm):
– Passes through the pelvic floor and the deep perineal pouch.
– Surrounded by the external urethral sphincter – which provides
voluntary control of micturition.
– Narrowest and least dilatable portion of the urethra.
• Penile (bulbous) urethra (15cm):
– Passes through the bulb and corpus spongiosum of the penis,
ending at the external urethral orifice.
– Receives the bulbourethral glands proximally.
– In the glans of the penis, it dilates to form the navicular fossa.

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Vascular Supply
• Prostatic urethra – inferior vesical artery (branch of the
internal iliac artery).
• Membranous urethra – bulbourethral artery (branch of
the internal pudendal artery)
• Penile urethra – branches of the internal pudendal
artery.
Nerve supply to the male urethra is derived from the
prostatic plexus.
Lymphatic Drainage
• Prostatic and membranous portions drain to the
obturator and internal iliac nodes, while the penile
urethra drains to the deep and superficial inguinal
nodes.

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Clinical Relevance: Male Catheterisation
• Urinary catheterisation - inserting a tube through
the urethra and into the bladder where urine
output needs to be monitored (such as sepsis), or
when the patient is unable to pass urine (urinary
retention).
• Note the three constrictions in the male urethra –
the internal urethral sphincter, external urethral
sphincter, and external urethral orifice.

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Female Urethra
• Relatively short (approximately 4cm).
• Begins at the neck of the bladder, and passes inferiorly through
the perineal membrane and muscular pelvic floor.
• Opens onto the perineum between the labia minora (vestibule).
• Within the vestibule, the urethral orifice is located anteriorly to
the vaginal opening, and 2-3cm posteriorly to the clitoris.
• Distal end is marked by the presence of two mucous glands that lie
either side of the urethra – Skene’s glands (homologous to the
male prostate).
Vascular Supply
• Internal pudendal arteries, vaginal arteries and inferior vesical
branches of the vaginal arteries. Venous drainage is given by veins
of the same names.
Nerve supply
• Vesical plexus and the pudendal nerve.
Lymphatic Drainage
• Proximal portion is to the internal iliac nodes, while the distal
urethra drains to the superficial inguinal lymph nodes.

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Clinical Relevance: Urinary Tract Infections
• Due to the short length of the urethra, women are
more susceptible to infections of the urinary tract.
This usually manifests as cystitis, an infection of the
bladder.
• Common symptoms of cystitis are dysuria (pain
upon urination), frequency, urgency, and
haematuria (blood in the urine).

Male Pelvic Organs
• Organs include the testes, epididymides, ductus
deferentes, seminal glands, ejaculatory ducts,
prostate, and bulbo-urethral glands.
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Testes
• Surrounded by the tunica vaginalis except posteriorly.
• Beneath the tunica vaginalis, the testes are surrounded
by a thick connective tissue capsule - tunica albuginea
• Beneath the tunica albuginea, the testes are
surrounded by a highly vascular layer of connective
tissue - tunica vasculosa.
• Responsible for spermatogenesis.
• Tunica albuginea projects septae toward the
mediastinum
- Divides the testes into about 250 lobules
- Each contains one to four highly coiled seminiferous
tubules which anastomose into a plexus termed the
rete testis.
- Septae converge and form the mediastinum.

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• Testes contain the seminiferous tubules, straight
tubules, rete testes, efferent ductules, and the
Leydig (interstitial) cells.
• Descent to an extraabdominal position favours
optimal spermatogenesis as the ambient scrotal
temperature is approximately 3°C lower than body
temperature.
• Efferent ducts connect the rete testis to the
epididymal head and transmit sperm from the
testicle to the epididymis.
• Upper poles of the testis and epididymis bear an
appendix testis and appendix epididymis (hydatid of
Morgagni), respectively.

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ARTERIAL SUPPLY
• Testicular arteries, which arise from the abdominal
aorta just inferior to the renal arteries.
• Collateral arterial blood supply from the internal
iliac artery via the artery of the ductus deferens,
inferior epigastric artery via the cremasteric artery,
and femoral artery via the external pudendal artery
VENOUS DRAINAGE
• Right testicular vein (empties into the inferior vena
cava) and the left testicular vein (empties into the
left renal vein).
• Testicular veins are formed by the union of the
veins of the pampiniform plexus.

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Epididymis
• Long (6m) and highly coiled duct
• Head, body, and tail (continuous with the ductus
deferens).
• Sperm maturation (motility) and storage
• Tunica vaginalis covers the epididymis except the
posterior border.
• In the tail, the muscular coat consists of an inner
longitudinal layer, middle circular layer, and outer
longitudinal layer of smooth muscle.
• Three layers contract during sexual excitation and force
sperm from the tail of the epididymis to the ductus
deferens.

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DUCTUS DEFERENS (vas deferens)
• Continuation of the duct of the epididymis.
• Thick muscular walls and a minute lumen.
• Begins in the tail of the epididymis, at the inferior pole of
the testis.
• Ascends posterior to the testis, medial to the epididymis.
• Primary component of the spermatic cord.
• Penetrates the AAW via the inguinal canal.
• Crosses over the external iliac vessels and enters the pelvis.
• Passes along the lateral wall of the pelvis, where it lies
external to the parietal peritoneum.
• Ends by joining the duct of the seminal gland to form the
ejaculatory duct.

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• Posterior to the bladder, it at first lies superior to the
seminal gland, then descends medial to the ureter and
the gland.
• Here the ductus deferens enlarges to form the ampulla
of the ductus deferens before its termination.
Arterial Supply and Venous Drainage.
• Artery to the ductus deferens arises from a superior
(sometimes inferior) vesical artery, and terminates by
anastomosing with the testicular artery, posterior to
the testis.
Veins
• Initial portion drain into the testicular vein, drain into
pampiniform plexus. Its terminal portion drains into the
vesicular/ prostatic venous plexus.

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SEMINAL GLANDS
• Elongated structure (approximately 5 cm)
• Lies between the fundus of the bladder and the rectum.
• Obliquely placed superior to the prostate and do not store sperms.
• Secrete an alkaline fluid with fructose (an energy source for sperms),
and a coagulating agent that mixes with the sperms.
• Superior ends are covered with peritoneum and lie posterior to the
ureters, where the peritoneum of the rectovesical pouch separates
them from the rectum.
• Inferior ends are related to the rectum and are separated from it only
by the rectovesical septum .
• Duct of the seminal gland joins the ductus deferens to form the
ejaculatory duct.
Arterial Supply and Venous Drainage
• Inferior vesical and middle rectal arteries, veins accompany the
arteries and have similar names.

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Ejaculatory ducts
• Slender tubes that arise by the union of the ducts of
the seminal glands with the ductus deferentes.
• Approximately 2.5 cm long near the neck of the bladder
• Converge to open on the seminal colliculus by tiny,
apertures on, or just within, the opening of the
prostatic utricle.
• Prostatic secretions do not join the seminal fluid until
the ejaculatory ducts have terminated in the prostatic
urethra.
Arterial Supply and Venous Drainage.
• Branches of the superior and inferior vesical arteries.
• Veins join the prostatic and vesical venous plexuses.

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Prostate
• 3 cm long, 4 cm wide, and 2 cm
• Largest accessory gland of the male reproductive system.
• Firm, walnut-size prostate surrounds the prostatic
urethra.
• Glandular part makes up approximately two thirds of the
prostate; the other third is fibromuscular.
• Dense, neurovascular fibrous capsule incorporating the
prostatic plexuses of veins and nerves, surrounded by the
visceral layer of the pelvic fascia
• Has a base related to the neck of the bladder.
• An apex that is in contact with fascia on the superior
aspect of the urethral sphincter and deep perineal
muscles.

70
• Anterior surface, features transversely oriented muscle
fibers, separated from the pubic symphysis by
retroperitoneal fat in the retropubic space.
• A posterior surface related to the ampulla of the
rectum.
• Inferolateral surfaces related to the levator ani.
Lobes of the prostate
• Isthmus of the prostate (commissure of prostate;
anterior “lobe”) lies anterior to the urethra,
fibromuscular, contains little glandular tissue.
• Right and left lobes of the prostate, separated
anteriorly by the isthmus and posteriorly by a
longitudinal furrow

71
• An inferoposterior (lower posterior) lobule that lies
posterior to the urethra and inferior to the ejaculatory
ducts.
• An inferolateral (lower lateral) lobule directly lateral
to the urethra, forming the major part of the right or
left lobe.
• A superomedial lobule, deep to the inferoposterior
lobule, surrounding the ipsilateral ejaculatory duct.
• An anteromedial lobule, deep to the inferolateral
lobule, directly lateral to the proximal prostatic urethra.
• The prostatic ducts (20–30) open into the prostatic
sinuses that lie on either side of the seminal colliculus
on the posterior wall of the prostatic urethra.

72
• Prostatic fluid, a thin, milky fluid, provides 20% of
the volume of semen (a mixture of secretions
produced by the testes, seminal glands, prostate,
and bulbo-urethral glands that provides the vehicle
by which sperms are transported) and plays a role
in activating the sperms.
Arterial Supply and Venous Drainage of Prostate.
• Prostatic arteries are branches of the internal iliac
artery, inferior vesical arteries, internal pudendal
and middle rectal arteries.
• Prostatic venous plexus, between the fibrous
capsule of the prostate and the prostatic sheath,
drains into the internal iliac veins.

73
BULBO-URETHRAL GLANDS
• Two pea-size bulbo-urethral glands (Cowper
glands) lie posterolateral to the intermediate part
of the urethra, largely embedded within the
external urethral sphincter.
• Ducts pass through the perineal membrane with
the intermediate urethra, and open into the
proximal part of the spongy urethra in the bulb of
the penis.
• Mucus-like secretion enters the urethra during
sexual arousal.

74
INNERVATION OF INTERNAL GENITAL ORGANS OF MALE
PELVIS
• Presynaptic sympathetic fibers originate from cell bodies in
the intermediolateral cell column of the T12–L2 (or L3)
spinal cord segments.
• Presynaptic parasympathetic fibers from S2 and S3 spinal
cord segments traverse pelvic splanchnic nerves, which also
join the inferior hypogastric/pelvic plexuses.

75
Female pelvic organs
• Vagina
• Uterus
• Fallopian tubes
• Ovary

76
OVARIES
• Almond-shaped female gonads in which the oocytes
develop.
• Endocrine glands that produce reproductive hormones.
• Suspended by the mesovarium which is a subdivision of the
broad ligament.
• In prepubertal females, the connective tissue capsule
(tunica albuginea of the ovary) comprising the surface of
the ovary is covered by a smooth layer of ovarian meso
thelium or surface (germinal) epithelium, a single layer of
cuboidal cells that gives the surface a dull, grayish
appearance, contrasting with the shiny surface of the
adjacent peritoneal mesovarium with which it is
continuous.
• After puberty, the ovarian surface epithelium becomes

77
Uterine tubes or fallopian tubes
• Conduct the oocyte peritoneal cavity to the uterine cavity.
• Provide the usual site of fertilization.
• Extend laterally from the uterine horns and open into the
peritoneal cavity near the ovaries.
• Approximately 10 cm long lie in the mesosalpinx.
• Divisible into four parts, from lateral to medial:
- Infundibulum: the funnel-shaped distal end of the tube
that opens into the peritoneal cavity, finger-like processes
of the fimbriae
- Ampulla: the widest and longest part of the tube
- Isthmus: the thick-walled part of the tube enters the
uterine horn
- Uterine part: the short intramural segment

78
Innervation of Ovaries and Uterine Tubes.
• Ovarian plexus, descending with the ovarian
vessels, and partly from the uterine (pelvic) plexus.
• Ovaries and uterine tubes are intraperitoneal and
are superior to the pelvic pain line.
• Visceral afferent pain fibers ascend to cell bodies in
the T11–L1 spinal sensory ganglia.
• Visceral afferent reflex fibers follow cell bodies in
the S2–S4 spinal sensory ganglia.

79
Uterus (womb)
• Thick-walled, pear-shaped, hollow muscular organ.
• Embryo and fetus develop in the uterus.
• Muscular walls adapt to the growth of the fetus and then
provide the power for its expulsion during childbirth.
• Non-gravid (non-pregnant) uterus lies in the lesser pelvis
• Adult uterus is anteverted and anteflexed
• Position of the uterus changes with the degree of fullness
of the bladder and rectum, and stage of pregnancy.
• 7.5 cm long, 5 cm wide, and 2 cm thick and
• Weighs 90 g.

80
• Divisible into two parts: the body and cervix.
• Body of the uterus, forms the superior two thirds of the
organ, includes the fundus of the uterus.
- Between the layers of the broad ligament and is freely
movable.
- Two surfaces: vesical and intestinal.
- Demarcated from the cervix by the isthmus of the
uterus.
• Cervix of the uterus
- Cylindrical, narrow inferior third of the uterus, 2.5 cm
long in an adult non-pregnant woman.
- Supravaginal part between the isthmus and the vagina
- Vaginal part, which protrudes into the superiormost
anterior vaginal wall.

81
Uterine cavity
• 6 cm in length from the external os to the wall of
the fundus.
• Uterine horns are the superolateral regions of the
uterine cavity, where the uterine tubes enter.
• Continues inferiorly as the cervical canal.
- A narrowing inside the isthmus of the uterine body,
the internal os, through the cervix, communicating
with the lumen of the vagina through the external
os.
• Uterine cavity (cervical canal) and the lumen of the
vagina constitute the birth canal, through which the
fetus passes at the end of gestation.

82
Wall of the body of the uterus consists of three layers:
• Perimetrium—the serosa or outer serous coat—consists of
peritoneum supported by a thin layer of connective tissue.
• Myometrium—the middle coat of smooth muscle—
becomes greatly distended (more extensive but much
• Endometrium—the inner mucous coat—is firmly adhered
to the underlying myometrium, actively involved in the
menstrual cycle
• Amount of muscular tissue in the cervix is less than in the
body of the uterus.
• Cervix is fibrous and is composed of collagen with a small
amount of smooth muscle and elastin.

83
Ligaments of Uterus.
• Attaches to the uterus postero-inferior to the
uterotubal junction.
• Round ligament of the uterus attaches antero-
inferiorly to the uterotubal junction, vestiges of the
ovarian gubernaculum
• Broad ligament of the uterus from the sides of the
uterus to the lateral walls and floor of the pelvis,
keeps the uterus in position.
• Peritoneum of the broad ligament is prolonged
superiorly over the vessels as the suspensory
ligament of the ovary.

84
• Ligament of the ovary lies posterosuperiorly and the
round ligament of the uterus lies antero-inferiorly.
• Cardinal (transverse cervical) ligaments extend from
the supravaginal cervix and lateral parts of the
fornix of the vagina to the lateral walls of the pelvis
• Uterosacral ligaments pass superiorly and slightly
posteriorly from the sides of the cervix to the
middle of the sacrum.

87
• Uterine tube lies in the broad ligament, within a
small mesentery called the mesosalpinx.
• Ovary lies within a small mesentery called the
mesovarium on the posterior aspect of the broad
ligament.
• Largest part of the broad ligament, which serves as
a mesentery for the uterus, is the mesometrium.
• Anteriorly, the uterine body is separated from the
urinary bladder by the vesico-uterine pouch, where
the peritoneum is reflected
• Uterine body and supravaginal part of the cervix are
separated from the sigmoid colon by a layer of
peritoneum, and the peritoneal cavity and from the
rectum by the recto-uterine pouch.

88
Relations
• Anteriorly : bladder
• Posteriorly: recto-uterine pouch containing loops of small
intestine and the anterior surface of rectum
• Laterally: the broad ligament and the cardinal ligaments on
each side of the cervix and vagina
Arterial Supply and Venous Drainage of Uterus.
• Uterine arteries, with potential collateral supply from the
ovarian arteries.
• Uterine veins enter the broad ligaments with the arteries
and form a uterine venous plexus on each side of the
cervix.
• Veins from the uterine plexus drain into the internal iliac
veins.

90
Vagina
• Distensible musculomembranous tube (7–9 cm long)
• Extends from the middle cervix of the uterus to the
vaginal orifice.
• Vaginal orifice, external urethral orifice, and ducts of
the greater and lesser vestibular glands open into the
vestibule of the vagina
• Vaginal part of the cervix lies anteriorly in the superior
vagina.
• Serves as a canal for menstrual fluid,
• Forms the inferior part of the birth canal,
• Receives the penis and ejaculate during sexual
intercourse,
• Communicates superiorly with the cervical canal and
inferiorly with the vestibule of the vagina.

91
• Usually collapsed toward the midline so that its lateral
walls are in contact on each side of an anteroposterior
slit.
• Lies posterior to the urinary bladder and urethra
• Lies anterior to the rectum, passing between the
medial margins of the levator ani (puborectalis)
muscles.
• Vaginal fornix, the recess around the cervix, has
anterior, posterior, and lateral parts .
• Posterior vaginal fornix is the deepest part and is
closely related to the recto-uterine pouch.
• Four muscles compress the vagina and act as
sphincters: pubovaginalis, external urethral sphincter,
urethrovaginal sphincter, and bulbospongiosus.

92
Relations:
• Anteriorly: fundus of the urinary bladder and urethra;
• Laterally to the levator ani, visceral pelvic fascia, and
ureters
• Posteriorly: anal canal, rectum, and recto-uterine pouch.
ARTERIAL SUPPLY AND VENOUS DRAINAGE
• Middle and inferior parts of the vagina derive from the
vaginal and internal pudendal arteries.
• Vaginal veins form vaginal venous plexuses along the sides
of the vagina and within the vaginal mucosa continuous
with the uterine venous plexus as the uterovaginal venous
plexus, and drain into the internal iliac veins through the
uterine vein.

93
INNERVATION OF VAGINA AND UTERUS
• Somatic innervation of inferior 1/5 part of the vagina is
from the deep perineal nerve, a branch of the pudendal
nerve Only this somatically innervated part is sensitive to
touch and temperature, cell bodies in the same (S2–S4)
spinal ganglia.
• Superior three quarters to four fifth is visceral. Nerves are
derived from the uterovaginal nerve plexus

95
Perineum
• Shallow compartment of the body
• Bounded by the pelvic outlet and separated from
the pelvic cavity by the fascia covering the inferior
aspect of the pelvic diaphragm.
Surface of the perineum
• Perineal region—is the narrow region between the
proximal parts of the thighs; when the lower limbs
are abducted, it is a diamond-shaped area
extending from the mons pubis anteriorly in
females, the medial surfaces of the thighs laterally,
and the gluteal folds and superior end of the
intergluteal cleft posteriorly.

96
Boundaries of the perineum are the:
• Pubic symphysis, anteriorly.
• Ischiopubic rami, anterolaterally.
• Ischial tuberosities, laterally.
• Sacrotuberous ligaments, posterolaterally.
• Inferiormost sacrum and coccyx, posteriorly.

97
• A transverse line joining the anterior ends of the
ischial tuberosities divides the diamond-shaped
perineum into two triangles.
• Anal triangle lies posterior to this line. The anal
canal and its orifice, the anus, constitute the major
deep and superficial features of the triangle, lying
centrally surrounded by ischioanal fat.
• Urogenital (UG) triangle is anterior to this line.
• In contrast to the open anal triangle, the UG
triangle is “closed” by a deep fascia, perineal
membrane, which stretches between the two sides
of the pubic arch, covering the anterior part of the
pelvic outlet.

98
Perineal membrane
• Fills the anterior gap in the pelvic diaphragm (the
urogenital hiatus)
• Perforated by the urethra in both sexes and by the
vagina of the female.
• The membrane and the ischiopubic rami to which it
attaches provide a foundation for the erectile
bodies of the external genitalia—the penis and
scrotum of males, and the pudendum or vulva of
females.

99
Perineal body
• Midpoint of the line joining the ischial tuberosities
• Contains collagenous and elastic fibers, skeletal and
smooth muscle.
• Lies deep to the skin, posterior to the vestibule of the
vagina or bulb of the penis and anterior to the anus and
anal canal.
• Site of convergence of several muscles, including the:
• Bulbospongiosus External anal sphincter.
• Superficial and deep transverse perineal muscles.
• External urethral sphincter, levator ani, and muscular coats
of the rectum.
• Anteriorly, it blends with the perineal membrane and
superiorly with the rectovesical or rectovaginal septum.

100
Perineal fascia (Superficial and deep layers).
• Subcutaneous tissue of the perineum consists of a superficial fatty
layer and a deep membranous layer, the (superficial) perineal
fascia (Colles fascia).
• Fatty layer of subcutaneous tissue makes up the labia majora and
mons pubis, and is continuous anteriorly and superior with the
fatty layer of subcutaneous tissue of the abdomen (Camper
fascia).
• Fatty layer is diminished in the urogenital triangle, replaced in the
penis and scrotum with dartos muscle, continuous between the
penis or scrotum and thighs with the fatty layer of subcutaneous
tissue of the abdomen.
• In both sexes, the fatty layer is continuous posteriorly with the
ischio-anal fat pad in the anal region.
• Membranous perineal fascia does not extend into the anal triangle

101
• Anteriorly in males, the perineal fascia is continuous
with the dartos fascia of the penis and scrotum
• Deep perineal fascia (investing or Gallaudet fascia)
• Invests the ischiocavernosus, bulbospongiosus, and
superficial transverse perineal muscles.
• Attached laterally to the ischiopubic rami.
• Anteriorly it is fused to the suspensory ligament of
the penis and is continuous with the deep fascia
covering the external oblique muscle of the
abdomen and the rectus sheath.
• In females, the deep perineal fascia is fused with
the suspensory ligament of the clitoris and, as in
males, with the deep fascia of the abdomen.

102
SUPERFICIAL PERINEAL POUCH
• Potential space between the perineal fascia and the perineal
membrane
Bounded laterally by the ischiopubic rami.
In males, it contains the:
• Root (bulb and crura) of the penis, ischiocavernosus and
bulbospongiosus.
• Proximal (bulbous) part of the spongy urethra.
• Superfi cial transverse perineal muscles.
• Deep perineal branches of the internal pudendal vessels and
pudendal nerves.
In females, it contains the:
• Clitoris and associated muscle (ischiocavernosus).
• Bulbs of the vestibule and surrounding muscle (bulbospongiosus).
• Greater vestibular glands.
• Superfi cial transverse perineal muscles.
• Related vessels and nerves (deep perineal branches of the internal
pudendal vessels and pudendal nerves).

103
DEEP PERINEAL POUCH
• Bounded inferiorly by the perineal membrane
• Superiorly by the inferior fascia of the pelvic diaphragm,
and laterally by the inferior portion of the obturator fascia
(covering the obturator internus muscle)
• It includes the fat-filled anterior recesses of the ischio-anal
fossae.
• The superior boundary in the region of the urogenital
hiatus is indistinct.
In both sexes, the deep perineal pouch contains:
• Part of the urethra, centrally.
• Inferior part of the external urethral sphincter muscle,
• Anterior extensions of the ischio-anal fat pads.

104
In males, it contains the:
• Intermediate part of the urethra.
• Deep transverse perineal muscles.
• Bulbo-urethral glands
• Dorsal neurovascular structures of the penis.
In females, it contains the:
• Proximal part of the urethra.
• A mass of smooth muscle in the place of deep
transverse perineal muscles on the posterior edge
of the perineal membrane, associated with the
perineal body.
• Dorsal neurovasculature of the clitoris.

105
Ischiorectal fossae
• On either side of the anal canal.
• Separated from the pelvic cavity by the levator ani muscle.
• Medial and lateral walls are the levator ani and anal canal and the
obturator internus, respectively.
• Anococcygeal body separates the fossae posteriorly.
• Contains pudendal (Alcock’s) canal is a sheath in the lateral wall of
the ischiorectal fossa.
• Conveys the pudendal nerve and internal pudendal vessels from the
lesser sciatic notch to the deep perineal pouch.
• Contains ischiorectal fat, inferior rectal nerves, inferior rectal artery
and vein, perineal branches of the posterior femoral cutaneous
nerve, and the pudendal
Muscles of the Anal Triangle
• Obturator internus, external anal sphincter, levator ani, and
coccygeus

107
CLINICAL CONSIDERATION.
• Episiotomy is an incision of the perineum made in
order to enlarge the vaginal opening during childbirth.
There are two types of episiotomies.
- Median episiotomy starts at the frenulum of the labia
minora and proceeds through the skin - vaginal wall -
perineal body - superficial transverse perineal muscle.
- The external anal sphincter muscle may be cut.
• Mediolateral episiotomy starts at the frenulum of the
labia minora and proceeds at a 45-degree angle cutting
through the skin- vaginal wall - bulbospongiosus
muscle.
• Higher risk of bleeding in comparison to a median
episiotomy but creates more room than a median
episiotomy.

108
Male Urogenital Triangle
• Includes the external genitalia (distal urethra, scrotum, and penis and
perineal muscles.
DISTAL MALE URETHRA
• Subdivided into four parts: intramural (preprostatic), prostatic,
intermediate, and spongy.
Intermediate (membranous) part of the urethra (intermediate and spongy parts)
• Begins at the apex of the prostate and traverses the deep perineal pouch
• Surrounded by the external urethral sphincter.
• Penetrates the perineal membrane
• Ends as the urethra enters the bulb of the penis. Posterolateral to this part
of the urethra are the small bulbo-urethral glands
• Slender ducts open into the proximal part of the spongy urethra.
• Spongy urethra begins at the distal end of the intermediate part of the
urethra and ends at the male external urethral orifice, which is slightly
narrower than any of the other parts of the urethra.

109
• Lumen of the spongy urethra is approximately 5 mm in
diameter
- It is expanded in the bulb of the penis to form the
intrabulbar fossa, and in the glans penis to form the
navicular fossa.
• On each side, the ducts of the bulbo-urethral glands
open into the proximal part of the spongy urethra
• Minute openings of the ducts of mucus-secreting
urethral glands into the spongy urethra.
Arterial Supply of Distal Male Urethra.
• Branches of the dorsal artery of the penis
Venous and Lymphatic Drainage of Distal Male Urethra.
• Veins accompany the arteries and have similar

110
Lymphatic vessels
• Intermediate part of the urethra drain into the internal iliac
lymph nodes whereas most vessels from the spongy urethra
pass to the deep inguinal lymph nodes and external iliac
nodes.
Innervation
• Autonomic (efferent) innervation via the prostatic nerve
plexus, from the inferior hypogastric plexus.
• Sympathetic innervation - lumbar spinal cord levels via the
lumbar splanchnic nerves
• Parasympathetic innervation - sacral levels via the pelvic
splanchnic nerves.
• Visceral afferent fibers follow the parasympathetic fibers
retrogradely to sacral spinal sensory ganglia.
• Dorsal nerve of the penis, a branch of the pudendal nerve,
provides somatic innervation of the spongy part of the
urethra.

113
SCROTUM
• Cutaneous fibromuscular sac for the testes and associated structures.
• Skin is thin, rugose and contains sebaceous glands.
• Situated postero-inferior to the penis and inferior to the pubic
symphysis.
• Longitudinal median raphe is visible in the midline.
• Bilateral embryonic formation of the scrotum is indicated by the
midline scrotal raphe
- Continuous anteriorly with the penile raphe and posteriorly with the
perineal raphe.
• Deep to the scrotal raphe, the scrotum is divided into two
compartments, one for each testis, by a prolongation of the dartos
fascia, the septum of the scrotum.
• Beneath the skin lies an involuntary dartos muscle.
• Contains spermatic cords, the testes and epididymes

114
Arterial Supply
• Anterior scrotal arteries, terminal branches of the external
pudendal arteries supply the anterior aspect of the scrotum.
• Posterior scrotal arteries, terminal branches of the super ficial
perineal branches of the internal pudendal arteries, supply the
posterior aspect.
• Cremasteric arteries (branches of the inferior epigastric arteries).
Venous and Lymphatic Drainage of Scrotum.
• The scrotal veins drain primarily to the external pudendal veins.
Lymphatic vessels
• Superficial inguinal lymph nodes
Innervation of Scrotum.
• Anterior aspect - lumbar plexus: anterior scrotal nerves, derived
from the ilio-inguinal nerve, and the genital branch of the
genitofemoral nerve.
• Posterior aspect - sacral plexus: posterior scrotal nerves, branches
of the superficial perineal branches of the pudendal nerve, and
the perineal branch of the posterior cutaneous nerve of thigh.

115
PENIS
• Male copulatory organ
• Provides common outlet for urine and semen
• Consists of a root, body, and glans.
• Composed of three cylindrical cavernous bodies of erectile
tissue: the paired corpora cavernosa dorsally and the single
corpus spongiosum ventrally.
• In the anatomical position, the penis is erect; when the penis
is flaccid, its dorsum is directed anteriorly.
• Each cavernous body has an outer fibrous covering, the
tunica albuginea.
• Superficial to the outer covering is the deep fascia of the
penis (Buck fascia)
• Deep perineal fascia forms a covering for the corpora
cavernosa and corpus spongiosum, binding them together.

116
• Corpus spongiosum contains the spongy urethra.
• Corpora cavernosa are fused with each other in the
median plane, except posteriorly where they separate
to form the crura of the penis
• Internally, the corpora cavernosa is separated
incompletely by the septum penis.
• Root of the penis, the attached part, consists of the
crura, bulb, and ischiocavernosus and bulbospongiosus
muscles.
- Located in the superficial perineal pouch.
• Crura and bulb of the penis consist of erectile tissue.
• Body of the penis is the free pendulous part that is
suspended from the pubic symphysis.
- Has no muscles except for a few fibers of the
bulbospongiosus near the root of the penis and the
ischiocavernosus that embrace the crura.

117
• Consists of thin skin and darkly pigmented,
connective tissue, blood and lymphatic vessels,
fascia, corpora cavernosa, and corpus spongiosum.
• Corpus spongiosum expands to form the glans
penis, or head of the penis.
• Corpora cavernosa forms the corona of the glans.
• Corona overhangs the neck of the glans, which
separates the glans from the body of the penis.
• Opening of the spongy urethra, the external
urethral orifice is near the tip of the glans penis.
• At the neck of the glans, the skin and fascia of the
penis are prolonged, the prepuce (foreskin)

121
• Frenulum of the prepuce is a median fold that
passes from the deep layer of the prepuce to the
urethral surface of the glans.
• Suspensory ligament of the penis is a condensation
of deep fascia that arises from the anterior surface
of the pubic symphysis and anchors the erectile
bodies of the penis to the pubic symphysis.
• Fundiform ligament of the penis is a condensation
of collagen and elastic fibers of the subcutaneous
tissue that descends from the linea alba to the
pubic symphysis.
• The ligament splits to surround the penis and
blends with the dartos fascia to form the scrotal
septum.

122
Arterial Supply - branches of the internal pudendal arteries.
• Dorsal arteries of the penis
• Deep arteries of the penis – supply the cavernous spaces in the erectile tissue of
the corpora cavernosa and involved in the erection of the penis. When the penis is
flaccid, these arteries are coiled, restricting blood flow; they are called helicine
arteries of the penis
• Arteries of the bulb of the penis
• Superficial and deep branches of the external pudendal arteries supply the penile
skin.
Venous Drainage.
• Deep dorsal vein of the penis in the deep fascia.
• Superficial dorsal vein, drains into the superficial external pudendal vein. Some
blood also passes to the internal pudendal vein.
Innervation
• S2–S4 spinal cord segments and spinal ganglia.
- Dorsal nerve of the penis, terminal branch of the pudendal nerve, supplies both the
skin and glans penis.
- Branches of the ilio-inguinal nerve supply the skin at the root of the penis.
- Cavernous nerves, innervate the helicine arteries of the erectile tissue.

123
In the male
• External urethral sphincter lies deep to the perineal
membrane within a fascial capsule termed the deep
perineal pouch.
• Two glands of Cowper are also contained within the
deep pouch.
• Ducts from these glands drain into the bulbous
urethra.
• Inferior to the perineal membrane is the superficial
perineal pouch which contains the:
- Superficial transverse perineal muscles
- Bulbo-spongiosus muscle
- Ischio-cavernosus muscle

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