Perineum

From Wikipedia, the free encyclopedia

Not to be confused with peritoneum.

Perineum

The muscles of the female perineum

The muscles of the male perineum

System
Artery
Nerve
Lymph
Latin
TA
FMA

Details
Musculoskeletal system
Perineal artery, dorsal artery of the penis and
deep artery of the penis
Perineal nerve, posterior scrotal nerves,
dorsal nerve of the penis or dorsal nerve of
clitoris
Primarily superficial inguinal lymph nodes
Identifiers
Perineum, perinaeum
A09.5.00.001
9579
Anatomical terminology
[edit on Wikidata]

In human anatomy, the perineum (/prnim/;[1] Late Latin, from Greek - perineos[2])
is a region of the body including the perineal /prnil/ body and surrounding structures. There
is some variability in how the boundaries are defined.[3] According to some definitions, in
females it is located between the vagina and anus and in males between the scrotum and anus.
It is an erogenous zone for both males and females.[4] Perineal tears and episiotomy often occur
in childbirth with first-time deliveries, but the risk of these injuries can be reduced by preparing
the perineum, often through massage.[5]

Contents

1 Structure
o 1.1 Body
o 1.2 Fascia
o 1.3 Areas of the perineum
2 Clinical significance
3 Society and culture
4 Additional images
5 See also
6 References
7 External links

Structure
The perineum is generally defined[citation needed] as the surface region in both males and females
between the pubic symphysis and the coccyx. The perineum is below the pelvic diaphragm and
between the legs. It is a diamond-shaped area that includes the anus and, in females, the
vagina.[6] Its definition varies: it can refer to only the superficial structures in this region, or it

can be used to include both superficial and deep structures. The perineum corresponds to the
outlet of the pelvis.
A line drawn across the surface connecting the ischial tuberosities divides the space into two
triangles:

The anterior urogenital triangle, contains the vagina (females) or penis (males)
The posterior Anal triangle containing the anus

The formal anatomical boundaries of the perineum may be said to be:[7]

in front: the pubic arch and the arcuate ligament of the pubis
behind: the tip of the coccyx
on either side: the inferior rami of the pubis and ischial tuberosity, and the sacrotuberous
ligament
superiorly: pelvic floor[8]
inferiorly: skin and fascia

Body
The perineal body (or central tendon of perineum) is a pyramidal fibromuscular mass in the
middle line of the perineum at the junction between the urogenital triangle and the anal triangle.
It is found in both males and females. In males, it is found between the bulb of penis and the
anus; in females, is found between the vagina and anus, and about 1.25 cm in front of the latter.
The perineal body is essential for the integrity of the pelvic floor, particularly in females. Its
rupture during vaginal birth leads to widening of the gap between the anterior free borders of
levator ani muscle of both sides, thus predisposing the woman to prolapse of the uterus, rectum,
or even the urinary bladder.
At this point, the following muscles converge and are attached: 1. External anal sphincter 2.
Bulbospongiosus muscle 3. Superficial transverse perineal muscle 4. Anterior fibers of the
levator ani 5. Fibers from male or female external urinary sphincter 6. Deep transverse perineal
muscle

Fascia
The terminology of the perineal fascia can be confusing, and there is some controversy over the
nomenclature. This stems from the fact that there are two parts to the fascia, the superficial and
deep parts, and each of these can be subdivided into superficial and deep parts.
The layers and contents are as follows, from superficial to deep:

1) Foreskin
2) superficial perineal fascia: Subcutaneous tissue divided into two layers: (a) A
superficial fatty layer, and (b) Colles' fascia, a deeper, membranous layer.

3) deep perineal fascia and muscles:

Superficial perineal pouch

Contains superficial perineal muscles: transversus perinei

superficialis, bulbospongiosus, ischiocavernosus

Inferior fascia of urogenital

diaphragm, or perineal
membrane

A membranous layer of the deep fascia.

Contains the deep perineal muscles: transversus perinei

profundus, sphincter urethrae membranaceae
Superior fascia of the urogenital Considered hypothetical by some modern anatomists, but still
diaphragm
commonly used to logically divide the contents of the region.
Deep perineal pouch

4) fascia and muscles of pelvic floor (levator ani, coccygeus)

Areas of the perineum

The region of the perineum can be considered a distinct area from pelvic cavity, with the two
regions separated by the pelvic diaphragm. The following areas are thus classified as parts of the
perineal region:

Perineal pouches: superficial and deep (see above for details)

Ischioanal fossa a fat-filled space at the lateral sides of anal canal. It is bounded
laterally by obturator internus muscle, medially by pelvic diaphragm and anal canal. Its
base is the skin.
o Anal canal
o Pudendal canal contains internal pudendal artery and the pudendal nerve.

Clinical significance
Extensive deformations of the pelvic floor structures occur in the course of a vaginal delivery.
Approximately 85% of women suffer some extent of perineal trauma during a vaginal delivery
and in about 69% suturing is required.[9][10][11] Obstetric perineal trauma is a distressing event
significantly contributing to postpartum morbidity and frustration of women after delivery. In
many women the childbirth trauma is manifested in advanced age when the compensatory
mechanisms of the pelvic floor become weakened making the problem more serious among aged
population.[12][13]
The anogenital distance is a measure of the distance between the anus and the base of the penis
or vagina. Studies show that the human perineum is twice as long in males as in females.[14]
Measuring the anogenital distance in neonatal humans has been suggested as a noninvasive
method to determine male feminisation and thereby predict neonatal and adult reproductive
disorders.[15]