The Anatomy of the Perineum

By David Terfera and Shereen Jegtvig from Clinical Anatomy For Dummies
http://www.dummies.com/how-to/content/the-anatomy-of-the-perineum.html
Perineum: The area between the anus and the scrotum in the male and between the anus and the
vulva (the labial opening to the vagina) in the female. An episiotomy is a surgical procedure to widen
the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum.

The perineum is the region between the thighs inferior to the pelvic diaphragm. The
boundaries of this region are the same as that for the pelvic outlet, namely the pubic
symphysis, ischiopubic rami, sacrotuberous ligaments, and coccyx. The perineum has a
roof formed by the pelvic diaphragm and a floor of fascia and skin. It also contains the
muscles and neurovasculature associated with urogenital structures and the anus.
When the legs are abducted, the perineum forms a diamond shape that can be divided
into two triangles by drawing a line connecting the ischial tuberosities: the urogenital
triangle and the anal triangle.

Urogenital triangle: The urogenital triangle makes up the anterior portion of the
perineum. The female urogenital triangle is home to the opening of the vagina, the
urethra, and the clitoris.
The perineal fascia of the urogenital triangle includes superficial and deep layers.
The superficial perineal fascia has a fatty layer and a deeper membranous layer
(Colles fascia). The fatty layer makes up the thickened areas of the labia majora
and mons pubis. In males, the fatty layer is much thinner and is absent in the penis
and scrotum.

Anal triangle: The anal triangle contains the anus and the ischioanal fossae,
which are two wedge-shaped spaces between the skin around the anal canal and
the pelvic diaphragm. They contain fat and loose connective tissue, which helps
support the anal canal but is pliable enough to allow for expansion during bowel
movements.

Hemorrhoids are painful, swollen veins in the anal canal or anus. Internal hemorrhoids
occur in the anal canal, but they may not be painful because the rectum doesnt have
many nerves that sense pain. External hemorrhoids affect the anus and are easy to see
and palpate by inspecting the anus. More sensory nerves are located around the anus,
so external hemorrhoids may be quite painful. They may also result in itching and
bleeding. Topical medications may help shrink hemorrhoids, and dietary changes may
prevent their occurrence; however, surgery may be indicated when reoccurrences are
frequent.
The anal region is innervated by the inferior hypogastric plexuses and the inferior rectal
nerve. The blood supply to the anal area is provided by the superior and inferior rectal
arteries. Blood is retuned by their accompanying veins. Lymph drains into the pararectal
nodes and superficial inguinal nodes.

The male perineum

The male perineum includes the penis, scrotum, and the perineal muscles in the
urogenital triangle, along with the anal triangle.

The scrotum is the fibromuscular sac that houses the testes. Its located behind and
below the penis. On the surface, you can see the scrotal raphe, which is a ridge that
runs along the midline of the scrotum. It continues on the penis as the penile raphe.
Internally, the scrotum is divided by a septum of the scrotum.

The female perineum

The female perineum includes the external genitalia, orifices of the urethra and vagina,
and the perineal muscles. Pelvic examinations begin with the inspection of these areas.
The external genitalia are collectively referred to as the vulva. They include the mons
pubis, the labia majora, the labia minora, and the clitoris:

Mons pubis: This rounded, fatty eminence is anterior to the pubic symphysis.

Labia majora: These prominent folds of fat and skin help to protect the orifices
of the urethra and vagina. The labia majora are separated by the pudendal cleft.

Labia minora: Inside the pudendal cleft you find these two folds of skin, but they
dont contain fat. The anterior portions of the labia minora unite to form laminae that
become the frenulum and prepuce of the clitoris.

Clitoris: This small erectile organ corresponds with the male penis. Its located
where the labia minor meet at the front of the vulva. The root of the clitoris is made
up of the bulb of the vestibule and the left and right crura of the clitoris. The body of
the clitoris contains two corpora cavernosa and ischiocavernosus muscles. The
glans of the clitoris is a mass of erectile tissue that has many nerve endings. The
blood supply is provided by the branches of the internal pudendal arteries and
veins.

Vestibule: This feature is a space between the labia minora. You can find the
external urethral orifice there, along with the vaginal orifice. Greater vestibular
glands and lesser vestibular glands lie on either side of the vestibule posterior to the
vaginal orifice. The vestibular glands secrete slippery fluids during sexual arousal.

The anterior vulva is innervated by anterior labial nerves (branches of the ilioguinal and
genital branch of the genitofemoral nerves). Posterior (labial) nerves supply the labia
minora, vagina, and clitoris (via a branch called the dorsal nerve of the clitoris). Blood
flow to the vulva is provided by external and internal pudendal arteries. Blood is
returned by the labial and internal pudendal veins. Lymph drains into the superficial
inguinal lymph nodes, deep inguinal nodes, and internal iliac nodes.

Perineum: The area between the anus and the scrotum in the male and between the anus and the
vulva (the labial opening to the vagina) in the female. An episiotomy is a surgical procedure to widen
the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum.