This document discusses the anatomy of the groin region and development of the vulva. It describes the key structures in the groin including the inguinal ligament, inguinal canal, inguinal lymph nodes, femoral triangle, and spermatic cord. It also discusses Hesselbach's triangle. Regarding vulval development, it explains that the genital tubercle forms the clitoris, genital folds form the labia minora, and the labioscrotal swellings form the labia majora. The urogenital sinus forms the vestibule.

1. By Dr Sumitra Hota
3rd year PG
Department of O and G
ANATOMY OF GROIN AND
VULVAL DEVELOPMENT

2.  Inguinal region of the body(groin) is located on
the lower portion of the anterior abdominal wall
with the thigh inferiorly, pubic tubercle medially
and ASIS superolaterally.
 Important structures-inguinal ligament
-inguinal canal
- inguinal LN

3. Inguinal ligament
 Formed at the inferior
end of the external
oblique aponeurosis
 Most of the inguinal
ligament insert into
pubic tubercle directly
but some of them
form lacunar and
pectineal ligament
that attach to the
superior pubic ramus.

4. INGUINAL CANAL
 Tubular structure that runs inferomedialy and
contains the spermatic cord in males and the round
ligament in females,genital branch of genitofemoral
nerve and ilioinguinal nerve
 4cm in length extending from deep inguinal ring
downward to superficial inguinal ring medially and
runs parallel to inguinal ligament.

5.  Boundaries-
posterior wall-
transversalis fascia
laterally, conjoint
tendon medially
Anterior wall- internal
oblique muscle laterally
and aponeurosis of
external oblique
muscle
Roof- internal oblique
and transversus
abdominis muscle
Floor- inguinal ligament
and lacunar ligament

6. HESSELBACH’S TRIANGLE
 Important site for
direct hernia
 Boundaries-
-medial border of rectus
abdominus(medially)
-inguinal ligament
(inferiorly)
-inferior epigastric
vessels
(laterally)

7. Spermatic cord
 Starts at the deep
inguinal ring and ends
at the posterior part of
testes
 3 layers of fascia-
internal spermatic
fascia, cremasteric
fascia, external
spermatic fascia.

8. Inguinal LN
 Found in the femoral
triangle
 Grouped into deep and
superficial nodes
 Mean size 5.4mm.
over 10mm is generally
regarded as the cut off
value.
 The status of groin LN is
the most important
prognostic factor for
patients with invasive

9. Superficial inguinal LN
 3 groups
- Inferior -inferior of the
saphenous opening of
the legs, receive
drainage from lower
legs
- Superolateral -on the
side of the saphenous
opening ,receives
drainage from the
gluteal region and
lower abdominal wall
- Superomedial - located
at the middle of the
saphenous opening,
take drainage from
peritoneum and outer
genitalia.

10. Deep inguinal lymph nodes
 Arranged near and
along the femoral
veins of the leg and
connected to
superficial LN via
lymph vessels
 Drain the deep parts
of the lower limbs,
clitoris in female and
penis in males

11. Femoral triangle
 Bounded by
- superiorly- inguinal
ligament
- -medialy-medial border
of adductor longus
- -laterally- medial border
of sartorius
 Floor- pectineus &
adductor longus
medially and iliopoas
muscle laterally
 Roof-by fascia lata
except at saphenous
opening where it is
formed by cribriform

12. Contents of femoral triangle
 Lateral to medial
-femoral nerve and its
branches
-femoral sheath & its
contents
-femoral artery
-femoral vein and its
proximal tributaries
-deep inguinal LN and
associated lymphatic
vessels

13. Applied anatomy
 Coronary and peripheral angioplasty performed
by entering femoral artery at femoral triangle
 site for Femoral venipucture
 contains superficial and deep basins of the
inguinal LN & is the location targeted in an
inguinal lymphadenectomy. The basins are
separated by fascia lata.
 If palpable nodal disease, removal of superficial
and deep basins are recommended.
 If positive sentinal LN biopsy,only superficial
nodes are removed, unless Cloquet’s node is
clinically positive.

14. VULVA

16. DEVELOPMENT OF VULVA
 External genitalia
develop in the area
bounded in front and
above by body stalk and
below and behind by
the tail of embryo.
 By 4th to 5th week-
genital tubercle is
formed in front by fusion
of two mesodermal
thickening.
 From this the genital
swellings sweep
backwards on either
side with cloacal
membrane in between.

17.  The genital tubercle ultimately becomes the
phallus( penis in male and clitoris in female).
 The genital swellings develop into the scrotum in
the male and labia majora in female.
 The cloacal membrane breaks down in its centre
at 6th week to expose lower parts of urogenital
sinus which are destined to become
vestible,urethra and lower vagina.
 Meanwhile genital folds appear medial to genital
swellings, passing backwards from genital
tubercle,one on each side.In males they fuse to
form penile urethra and in female they remain
separate as labia minora.
 Bartholin’s glands and skene’s gland are

19. DEVELOPMENT
 VULVA is developed in the region of the cranial
aspect of ectodermal cloacal fossa
 Clitoris- from genital tubercle
 Labia minora – from genital folds
 labia majora- from labioscrotal swelling
 vestibule- from urogenital sinus