Perineal membrane

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Perineal membrane
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Coronal section of anterior part of pelvis, through the pubic arch. Seen from in front. (Inferior layer labeled at bottom left.)
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Median sagittal section of male pelvis, showing arrangement of fasciæ. (Inferior layer labeled at center left.)
Details
Location Perineum
Identifiers
Latin membrana perinei
TA98 A09.5.03.002
TA2 2444
FMA 30514
Anatomical terminology

The perineal membrane is an anatomical term for a fibrous membrane in the perineum. The term "inferior fascia of urogenital diaphragm", used in older texts, is considered equivalent to the perineal membrane.

Contents

It is the superior border of the superficial perineal pouch, and the inferior border of the deep perineal pouch.

Structure

The perineal membrane is triangular in shape. [1] It attaches to both ischiopubic rami of the pelvis. It also attaches to the perineal body.

Female

The perineal membrane has two distinct portions that span the opening of the anterior pelvic outlet. [2]

The ventral (anterior) portion is associated with the compressor urethra and urethrovaginal sphincter muscles (previously called deep transverse perineal muscles), and is continuous with the insertion of the arcus tendineus fascia pelvis. [3] The apex is separated from the arcuate pubic ligament by an oval opening for the transmission of the deep dorsal vein of the clitoris.

The dorsal (posterior) portion consists of a sheet of dense fibrous tissue that attaches laterally to the ishiopubic rami and medially to the distal third of the vagina and to the perineal body. [3]

The perineal membrane provides support to the distal vagina and urethra by attaching these structures to the bony pelvis.

Male

Its apex is directed forward, and is separated from the arcuate pubic ligament by an oval opening for the transmission of the deep dorsal vein of the penis

Its lateral margins are attached on either side to the inferior rami of the pubis and ischium, above the crus penis.

Its base is directed toward the rectum, and connected to the central tendinous point of the perineum. The base is fused with both the pelvic fascia and Colle's fascia.

Relations

It is continuous with the deep layer of the superficial fascia behind the superficial transverse perineal muscle, and with the inferior layer of the diaphragmatic part of the pelvic fascia.

Perforations

Females

The vagina, including the opening of the urethra, divides the perineal membrane into two halves. [2] The artery to the bulb of the vestibule originates from the perineal artery and pierces the perineal membrane to travel towards the vestibule of the vagina. [4] The deep and dorsal artery of clitoris are the two terminal branches of the internal pudendal artery which pierce the perineal membrane to supply the clitoris. [5]

Males

In males, it is perforated, about 2-3 cm below the pubic symphysis, by the urethra. [6] The bulbourethral glands are present on either side of the membranous urethra and their ducts pierce the perineal membrane posterolateral to the urethra. The deep and dorsal artery of the penis arises from the internal pudendal artery and penetrates the perineal membrane to enter the corpora cavernosa in the crus of the penis. [7]

Contents

If the inferior fascia of the urogenital diaphragm is detached on either side, the following structures will be seen between it and the superior fascia:

Additional images

Related Research Articles

<span class="mw-page-title-main">Perineum</span> Region of the body between the genitals and anus

The perineum in mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is the region of the body between the pubic symphysis and the coccyx, including the perineal body and surrounding structures. The perineal raphe is visible and pronounced to varying degrees. The perineum is an erogenous zone. This area is also known as the taint or gooch in American slang.

<span class="mw-page-title-main">Pudendal nerve</span> Main nerve of the perineum

The pudendal nerve is the main nerve of the perineum. It is a mixed nerve and also conveys sympathetic autonomic fibers. It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well as the motor supply to various pelvic muscles, including the male or female external urethral sphincter and the external anal sphincter.

<span class="mw-page-title-main">Ischiocavernosus muscle</span> Sheet of fibrous tissue between the thigh and the front of the perineum

The ischiocavernosus muscle is a muscle just below the surface of the perineum, present in both men and women.

<span class="mw-page-title-main">Bulbospongiosus muscle</span> Superficial muscle of the perineum

The bulbospongiosus muscles are a subgroup of the superficial muscles of the perineum. They have a slightly different origin, insertion and function in males and females. In males, these muscles cover the bulb of the penis, while in females, they cover the vestibular bulbs.

<span class="mw-page-title-main">Urogenital diaphragm</span> Layer of the pelvis

Older texts have asserted the existence of a urogenital diaphragm, also called the triangular ligament, which was described as a layer of the pelvis that separates the deep perineal sac from the upper pelvis, lying between the inferior fascia of the urogenital diaphragm and superior fascia of the urogenital diaphragm.

<span class="mw-page-title-main">Internal pudendal artery</span> Blood vessel supplying blood to the external genitalia

The internal pudendal artery is one of the three pudendal arteries. It branches off the internal iliac artery, and provides blood to the external genitalia.

<span class="mw-page-title-main">Crus of clitoris</span> One of two erectile tissue structures of the human clitoris

The clitoral crura are two erectile tissue structures, which together form a "V" shape. Crus is a Latin word that means "leg". Each "leg" of the V converges on the clitoral body. At each divergent point is a corpus cavernosum. Together with the vestibular bulbs, they form the clitoral root. The crura are attached to the pubic arch, and are adjacent to the vestibular bulbs. The crura flank the urethra, urethral sponge, and vagina and extend back toward the pubis. Each clitoral crus connects to the rami of the pubis and the ischium.

<span class="mw-page-title-main">Perineal nerve</span> Nerve of the perineum

The perineal nerve is a nerve of the pelvis. It arises from the pudendal nerve in the pudendal canal. It gives superficial branches to the skin, and a deep branch to muscles. It supplies the skin and muscles of the perineum. Its latency is tested with electrodes.

<span class="mw-page-title-main">Internal pudendal veins</span> Set of veins in the pelvis enclosed by pudendal canal

The internal pudendal veins are a set of veins in the pelvis. They are the venae comitantes of the internal pudendal artery. Internal pudendal veins are enclosed by pudendal canal, with internal pudendal artery and pudendal nerve.

<span class="mw-page-title-main">Fascia of Colles</span>

The membranous layer of the superficial fascia of the perineum is the deeper layer of the superficial perineal fascia. It is thin, aponeurotic in structure, and of considerable strength, serving to bind down the muscles of the root of the penis. Colles' fascia emerges from the perineal membrane, which divides the base of the penis from the prostate. Colles' fascia emerges from the inferior side of the perineal membrane and continues along the ventral (inferior) penis without covering the scrotum. It separates the skin and subcutaneous fat from the superficial perineal pouch.

<span class="mw-page-title-main">Pelvic cavity</span> Body cavity bounded by the pelvic bones

The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet. Its lower boundary is the pelvic floor.

<span class="mw-page-title-main">Dorsal artery of the penis</span> Artery of the penis

The dorsal artery of the penis is a bilaterally paired terminal branch of the internal pudendal artery which passes upon the dorsum of the penis to the base of the glans penis, where it unites with its contralateral partner and supply the glans and foreskin.

<span class="mw-page-title-main">Superficial perineal pouch</span>

The superficial perineal pouch is a compartment of the perineum.

<span class="mw-page-title-main">Deep perineal pouch</span> Anatomic space enclosed partly by the perineum

The deep perineal pouch is the anatomic space enclosed in part by the perineum and located superior to the perineal membrane.

<span class="mw-page-title-main">Urogenital triangle</span> Anterior part of the perineum

The urogenital triangle is the anterior part of the perineum. In female mammals, it contains the vulva, while in male mammals, it contains the penis and scrotum.

<span class="mw-page-title-main">Membranous urethra</span> Narrowest part of the urethra

The membranous urethra or intermediate part of male urethra is the shortest, least dilatable, and, with the exception of the urinary meatus, the narrowest part of the urethra. It extends from the apex of the prostate proximally to the bulb of urethra distally. It measures some 12 mm in length. It traverses the pelvic floor. It is surrounded by the external urethral sphincter, which is in turn envelopped by the superior fascia of the urogenital diaphragm.

<span class="mw-page-title-main">Dorsal veins of the penis</span>

In human male anatomy, the dorsal veins of the penis are blood vessels that drain the shaft, the skin and the glans of the human penis. They are typically located in the midline on the dorsal aspect of the penis and they comprise the superficial dorsal veinof the penis, that lies in the subcutaneous tissue of the shaft, and the deep dorsal veinof the penis, that lies beneath the deep fascia.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Root of penis</span> Internal portion of the human penis

In human male anatomy, the radix or root of the penis is the internal and most proximal portion of the human penis that lies in the perineum. Unlike the pendulous body of the penis, which is suspended from the pubic symphysis, the root is attached to the pubic arch of the pelvis and is not visible externally. It is triradiate in form, consisting of three masses of erectile tissue; the two diverging crura, one on either side, and the median bulb of the penis or urethral bulb. Approximately one third to one half of the penis is embedded in the pelvis and can be felt through the scrotum and in the perineum.

<span class="mw-page-title-main">Vaginal support structures</span> Structures that maintain the position of the vagina within the pelvic cavity

The vaginal support structures are those muscles, bones, ligaments, tendons, membranes and fascia, of the pelvic floor that maintain the position of the vagina within the pelvic cavity and allow the normal functioning of the vagina and other reproductive structures in the female. Defects or injuries to these support structures in the pelvic floor leads to pelvic organ prolapse. Anatomical and congenital variations of vaginal support structures can predispose a woman to further dysfunction and prolapse later in life. The urethra is part of the anterior wall of the vagina and damage to the support structures there can lead to incontinence and urinary retention.

References

PD-icon.svgThis article incorporates text in the public domain from page 428 of the 20th edition of Gray's Anatomy (1918)

  1. Peschers, U; DeLancey, J. O. L. (2007). J. Laycock, J. Haslam (ed.). Therapeutic Management of Incontinence and Pelvic Pain: Pelvic Organ Disorders (2 ed.). London: Springer. pp. 9–20.
  2. 1 2 Stein, Tamara A.; DeLancey, John O.L. (March 2008). "Structure of the Perineal Membrane in Females: Gross and Microscopic Anatomy". Obstetrics and Gynecology. 111 (3): 686–693. doi:10.1097/AOG.0b013e318163a9a5. ISSN   0029-7844. PMC   2775042 . PMID   18310372.
  3. 1 2 Corton, Marlene M. (2009-09-01). "Anatomy of Pelvic Floor Dysfunction". Obstetrics and Gynecology Clinics of North America. Female Pelvic Medicine and Reconstructive Surgery. 36 (3): 401–419. doi:10.1016/j.ogc.2009.09.002. ISSN   0889-8545. PMID   19932407.
  4. "Artery of Bulb of Vestibule (Right) | Complete Anatomy". www.elsevier.com. Retrieved 2024-06-15.
  5. "Dorsal Artery of Clitoris (Right) | Complete Anatomy". www.elsevier.com. Retrieved 2024-06-15.
  6. Bolla, Srinivasa Rao; Hoare, Brittany S.; Varacallo, Matthew (2024), "Anatomy, Abdomen and Pelvis: Deep Perineal Space", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30855860 , retrieved 2024-06-15
  7. "Deep Artery of Penis | Complete Anatomy". www.elsevier.com. Retrieved 2024-06-15.