Pelvis and Perineum Hit List - Andrea Conway 09/17/06

1. posterior fornix of vagina

  • A recess formed by the lumen of the vagina fusing around the cervix of the uterus
  • Located at superior/posterior end of vagina
  • Deeper than anterior or lateral fornices
  • Wall is covered by peritoneum of the retrouterine pouch

2. central tendon (perineal body)

  • Area between the opening of the vagina and the anus
  • OR, area between the opening of the anus and the bulb of the penis

3. arcus tendineus

  • Facial specialization of obterator internus muscle
  • Strong band stretches from ischial spine to superior pubic ramus
  • Gives origin to levator ani muscles
  • Continues inferiorly to form arcus tendineus of pelvic fascia?

4. seminal vesicle

  • Simple tubular glands located posterior/inferior to urinary bladder in males
  • Secretes significant portion of what ultimately becomes semen
  • Ducts open into the vas deferens as it enters the prostate gland

5. Mesosalpinx

  • Portion of the broad ligament that stretches from the uterine tube to the level of the ovary

6. pampiniform plexus

  • Consists of 8-10 veins lying in front of ductus deferens
  • Formed by veins from the testicle and epididymus
  • Posterior portion of the testicle

7. bulbospongious muscle

  • In the female:
    • Attached posteriorly to perineal body
    • Fibers pass anteriorly around vagina and insert into copora cavernosa clitoris
  • In the male:
    • Origin is at central tendon (perineal body) and extension of median raphe
    • Posterior fibers end in connective tissue of fascia of UG diaphragm; middle fibers encircle bulb of penis and corpus spongiosum; anterior fibers spread over side of corpus cavernosum

8. deep dorsal vein of penis

  • Located on dorsal surface of penis within the deep fascia (Buck’s fascia)
  • Unpaired

9. detrusor muscle

  • Musculature of the bladder
  • Consists of interlacing network of smooth muscle bundles

10. interuretic fold

  • A ridge in the muscosa of the bladder between the two ureteric ostia
  • “base” of vesical trigone

11. pelvic splanchnic nerve

  • Parasympathetic innervation of the hindgut
  • Derived from S-2 to S-4 segments of the spinal cord
  • Enter the pelvic plexus (or inferior hypogastric plexus)

12. round ligament (ligamentum teres) of uterus

  • Fibromuscular band that passes retroperitoneally from the uterus to the deep inguinal ring
  • After traversing inguinal canal, ligament breaks up into fibrous strands that merge with connective tissue of labium majus

13. transverse rectal fold

  • Three “semilunar” folds that project into lumen of rectum from its lateral walls
  • Located in the depths of each lateral curvature

14. cremaster muscle and fascia

  • Continuation of internal oblique, carried along the spermatic cord to the scrotum
  • Located between external and internal spermatic fascia

15. inferior rectal artery

  • Branch of internal pudendal artery
  • Provides arterial supply to the anus, ischioanal fossa
  • Anastomoses with middle rectal artery and superior rectal artery

16. obturator internus muscle

  • Originates on internal surface of obterator membrane and margin of obterator foramen
  • Inserts on greater trochanter
  • Laterally rotates/abducts thigh
  • Leaves the pelvis by passing through lesser sciatic foramen

17. ovarian ligament

  • A band of connective tissue that connects the ovary to lateral surface of the uterus
  • Lies within the mesovarium
  • Remnant of the gubernaculum
  • Continuous with the round ligament of uterus at the lateral surface of the uterus

18. suspensory ligament of penis

  • Specialization of deep fascia connecting the proximal end of the penis to the pubis and pubic symphysis
  • Fundiform ligament is a specialization of superficial fascia (Scarpa’s) that lies superficial to the suspensory ligament

19. arcuate ligament (of the pubis?)

  • Located along the inferior border of the symphysis pubis
  • Located anterior to the deep dorsal vein of the penis or clitoris and posterior to the suspensory ligament

20. dorsal nerve of penis

  • Located on the dorsal shaft of the penis (paired), lateral to the dorsal arteries and deep dorsal vein within the deep fascia (Buck’s fascia)

21. perineal membrane

  • Stretches across urogenital triangle, attaching to both ischiopubic rami
  • Pierced by the urethra, vagina, and branches of pudendal neurovascular bundle
  • Membranous layer of the deep perineal fascia
  • Separates deep and superficial perineal pouches

22. piriformis muscle

  • Originates on anterior surface of sacrum
  • Inserts on upper border of greater trochanter
  • Laterally rotates and abducts the thigh
  • Leaves the pelvis by passing through the greater sciatic foramen

23. superior gluteal artery

  • Branch of internal iliac artery, posterior division
  • Provides arterial supply to the gluteus medius, gluteus minimus, and hip joint
  • Passes superior to piriformis muscle; passes through greater sciatic foramen
  • emerges between S1 and lumbosacral nerve roots

24. uterine artery

  • Branch of internal iliac artery, anterior division
  • Provides arterial supply to the uterus, uterine tube
  • Anastomoses with vaginal artery and ovarian artery
  • Passes superior to the ureter in the pelvis

25. anal column

  • Located in the anal canal, terminal part of the alimentary tract
  • Approximately halfway up the canal, the mucosa is raised into a row of 6-10 folds that encircle the canal => anal valves
  • At the meeting of adjacent valves, mucosa is raised into longitudinal folds that extend into upper part of the canal => anal columns

26. broad ligament (mesometrium)

  • Peritoneal fold extending from the pelvic walls to the uterus and uterine tubes
  • Mesometrium is the part below the junction of mesovarium and mesosalpinx; attaches the body of the uterus to the pelvic wall

27. iliococcygeus muscle

  • Originates from the arcus tendineus levator ani and the ischial spine
  • Inserts on the anococcygeal raphe and coccyx
  • Elevates the pelvic floor
  • Combination of puborectalis, pubococcygeus and iliococcygeus is called the levator ani muscle

28. internal pudendal artery

  • Branch of internal iliac, anterior division
  • Important branches of this artery include: inferior rectal artery, perineal artery, artery of the bulb of penis/clitoris, urethral artery, deep clitoral/penile artery, dorsal clitoral/penile artery
  • Provides arterial supply for the anus, muscles of superficial and deep perineal spaces, clitoris/penis, posterior aspect of the scrotum/labium majus
  • Primary blood supply to perineum

29. puboprostatic ligament

  • Strong ligament running from the posterior surface of the pubic bone (lateral to the pubic symphysis) to the prostate
  • Lends support to the prostate
  • Condensation of visceral pelvic fascia (lae2)

30. uvula of bladder

  • In the male; a smooth, small eminence at the inferior corner of the vesical trigone (2 ureteric ostia + internal urethral orifice) just above the internal urethral orifice
  • With advancing age, it becomes exaggerated due to enlargement of underlying median lobe of prostate

31. crus of clitoris

  • Lateral part of the corpus cavernosum which is attached to the ischiopubic ramus and the perineal membrane
  • Covered on its superficial surface by ischiocavernosus muscle

32. deep artery of penis

  • Branch of internal pudendal artery
  • Provides arterial supply to the corpus cavernosum of the penis
  • Deep and dorsal arteries of the penis are terminal branches of internal pudendal artery

33. efferent ductule

  • Connects the rete testis (duct system the seminiferous tubules discharge their contents into on posterior border of testis) to the epididymis
  • located near the superior pole of the testis

34. head of epididymis

  • Located on the superior pole of the testis
  • Made up of 10 to 20 lobules, each consisting of an efferent ductile that becomes highly convoluted after leaving the testis

35. inferior fascia of UG diaphragm

  • Covers the inferior surface of the urogenital diaphragm (muscle spanning the triangular space bordered on each side by conjoint rami of ischium and pubis)
  • Fuses with the superior fascia of UG diaphragm along the anterior and posterior margins of the muscle

36. inferior gluteal artery

  • Branch of internal iliac artery, anterior division
  • Provides arterial supply to the gluteus maximus muscle and hip joint (cruciate anastomoses)
  • Passes inferior to piriformis muscle to reach destination; passes through greater sciatic foramen

37. prepuce of clitoris

  • Fold of smooth skin extending over the clitoris
  • Anterior divisions of the labia minora combine to form the prepuce of clitoris

38. pudendal nerve

  • Branch of ventral primary rami of spinal nerves S2-S4 (sacral plexus)
  • Important branches include: inferior rectal nerve, perineal nerve, dorsal nerve of clitoris/penis
  • Motor supply: external anal sphincter, bulbospongiosus muscle, ischiocavernosus, superficial and deep transverse perineal muscles, sphincter urethrae muscle, urethrovaginalis sphincter,
  • Sensory: skin of anus, posterior scrotum/labium majus, clitoris/penis
  • Passes through pudendal canal

39. Buck's fascia

  • Deep fascia of the penis
  • At the root of the penis, attaches laterally to ischiopubic rami and posteriorly to the margin of the UG diaphragm
  • Does not descend into scrotum
  • Contains the deep dorsal vessels of the penis

40. crus of penis

  • Each crus is attached to ischiopubic ramus
  • Right and left crura join the corpus spongiosum in the region of the pubic arch
  • They come to lie side by side, forming the corpus cavernosum
  • Ischiocavernosus muscle invests the crura of corpus cavernosum

41. darto's tunic

  • Continuation of membranous layer of the superficial fascia from the abdominal wall into the scrotum
  • Devoid of fat, but contains smooth muscle fibers
  • Dartos extends inward as scrotal septum (partition between right and left halves of scrotum)
  • Continuous with superficial penile fascia and with superficial fascia of the perineum

42. deep dorsal vein of clitoris

  • An unpaired vein that runs between the two dorsal arteries of the clitoris deep to the deep fascia
  • It leaves the perineum through the gap between the transverse perineal ligament and the arcuate pubic ligament and joins the vesical plexus; it communicates with tributaries of the internal pudendal veins

43. ejaculatory duct

  • Pierces the posterior surface of the prostate and open into the prostatic urethra in the colliculus seminalis on each side of the utricle
  • duct formed by the union of the duct of the seminal vesicle and the ampulla of the ductus deferens
  • Less than 1 inch long

44. external pudendal vein

  • Part of the drainage of the superficial dorsal vein of the clitoris/penis
  • Deep external pudendal vein drains into the femoral vein; Superficial external pudendal vein drains into the great saphenous
  • Drains skin and superficial fascia, pubic region

45. external spermatic fascia

  • Derived from the fascias of external oblique
  • Contributes to fascial coverings of spermatic cord
  • Superficial to the cremasteric muscle/fascia and internal spermatic fascia
  • Continues into the scrotum enclosing the tunica vaginalis and testis (fusion makes the three layers difficult to separate)

46. fundiform ligament

  • see suspensory ligament of penis

47. inguinal ligament

  • A band running from the pubic tubercle to the anterior superior iliac spine
  • Forms the base of the inguinal canal
  • Formed by the external oblique aponeurosis and is continuous with fascia lata of the thigh

48. ischiococcygeus (Coccygeus)

  • Coccygeus is a thin triangular sheet of muscle continuous with the iliococcygeus muscle
  • Anteriorly it originates from the ischial spine and sacrospinous ligament
  • Inserts on lower sacral margin and coccyx
  • Combines with levator ani muscle to form the pelvic diaphragm

49. levator ani

  • Originates from the posterior surface of the body of the pubis, fascia of the obterator internus muscle (arcus tendineus levator ani), and ischial spine
  • Inserts on the anococcygeal raphe and coccyx
  • Elevates the pelvic floor
  • Arterial supply provided by the inferior gluteal artery
  • The combination of puborectalis, pubococcygeus & iliococcygeus is the levator ani muscle; coccygeus and levator ani combined form the pelvic diaphragm

50. mesovarium

  • Part of the broad ligament that forms a shelf-like fold supporting the ovary
  • Attaches ovary to mesometrium and mesosalpinx
  • Located perpendicular to the plane of mesometrium and mesosalpinx

51. obturator artery

  • Branch of internal iliac artery, anterior division
  • Important branches include: pubic, acetabular, anterior, posterior
  • Anterior and posterior branches pass on the anterior and posterior sides of adductor brevis muscle

52. pelvic diaphragm

  • Composed of muscle fibers from levator ani muscles anterolaterally and coccygeus muscle posteriorly
  • Its halves form the sloping floor of the pelvis, through which the urethra, vagina, and anal canal pass into the perineum
  • Anterior deficiency in the pelvic diaphragm is the urogenital hiatus
  • Important in providing support for pelvic viscera and maintaining continence of urine and feces

53. prostatic urethra crest

  • Located on the posterior wall of the prostatic urethra
  • Is presented as a longitudinal ridge raised up by a continuation of the trigonal muscle into the urethra
  • The crest is continuous above with the uvula of the bladder

54. pubococcygeus

  • Originates on the posterior aspect of the superior pubic ramis
  • Inserts on the coccyx
  • Elevates the pelvic floor
  • Arterial supply is from the inferior gluteal artery
  • the combination of puborectalis, pubococcygeus and iliococcygeus is called the levator ani muscle

55. pubovesical ligament

  • Ligament extends from the bladder neck to the inferior aspect of the pubic bones
  • Equivalent to the puboprostatic ligament in males
  • Blends medially with the visceral fascia of either the prostate, bladder, vagina, or cervix and laterally with superior fascia of the pelvic diaphragm

56. sacral plexus

  • Lower part of the lumbosacral plexus
  • Lumbosacral trunk and sacral anterior rami can be considered the roots of the plexus
  • Takes form on the posterior wall of the pelvis, just lateral to the pelvic foramina of the sacrum
  • Major part of the plexus lies on the anterior surface of the piriformis muscle
  • All larger branches pass through the greater sciatic foramen, most below the piriformis to appear in the buttock
  • Sends off the pudendal nerve, the chief somatic nerve of the perineum

57. ureter

  • Muscular tube that serves as the duct of the kidney to carry urine to the bladder
  • Continuous proximally with the renal pelvis
  • It passes over the pelvic brim medial to the testicular/ovarian vessels
  • Passes obliquely through the posterior wall of the urinary bladder, and drains at the posterolateral angle of the vesical trigone (ureteric ostia)

58. uterine tube

  • AKA fallopian tubes
  • Bilateral ducts that extend from the uterus to the ovary
  • Connect the uterine cavity to the peritoneal cavity
  • Four parts: Infundibulum (funnel or trumpet shaped lateral expansion), presents fimbriae; ampulla (wide, thin-walled); isthmus (more narrow as move towards uterus); and uterine part (traverses thick uterine wall and through uterine ostium enters uterine cavity)

59. vas deferens

  • AKA ductus deferens
  • Conveys spermatozoa and secretions produced by the testis to the ejaculatory ducts
  • Commences behind the lower pole of the testis as the continuation of the duct of the epididymis
  • Ascends in the scrotum behind the testis and then the spermatic cord
  • Enters the superficial ring of the inguinal canal and leaves through the deep ring
  • At the deep ring the duct bends medially and pursues course toward the prostate

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Comments and Suggestions

  • Andrea. This is a great resource. An enhancement might be if the order followed a theme. Thank you. -- LorenEvey - 17 Sep 2006 - 22:17
  • Dr. Evey. I agree with your suggestion. I'm already considering ways it could be rearraged to make anatomical sense/useful connections. We'll see if that gets done before the exam smile -- AndreaConway - 18 Sep 2006 - 14:55

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Topic revision: r1 - 19 Sep 2006, UnknownUser
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