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113 Cards in this Set

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where's the pelvis, what are its boundaries?
pelvis is bowl-shaped region deep within hip bones
is inferior and posterior to pelvic brim
has pelvic viscera including urinary bladder, rectum and uterus
floor - pelvic diaphragm which is composed of muscles
where's the perineum and its borders?
perineum is region superficial to pelvic diaphragm
contains anal canal in anal triangle and external genitalia in urogenital triangle
perineal should not be confused with peritoneal or with peroneal
peroneal is an old-fashioned adjective describing lateral aspect of leg
what do i need to know about the hip bones?
hip bones make up pelvic girdle, as do sacrum and coccyx

hip bones also known as coxal bones, innominate bones, and ossa coxae

formed by fusion during puberty of 3 bones: ilium, ischium, pubis
ilium, ischium, pubis meet near center of acetabulum, which is socket of hip joint

iliac crest, iliac fossa - know where these are

ilium articulates with the sacrum at broad iliosacral joints

inferiorly located ischium forms, with muscles, most of lateral walls of true pelvis

anteriorly, pubis formed from 2 rami and is part of anterior wall of true pelvis
left pubis and right pubis meet one another at pubic symphysis

pubic arch angle formed by pubic rami

anatomical position of bony pelvis is tilted anteriorly so plane of pelvic brim is at 45 degree angle to floor

opening into pelvis called pelvic inlet or superior pelvic aperture
size and shape of inlet often related to complications in childbirth

inferior pelvic aperture or pelvic outlet is opening defined posteriorly by coccyx, laterally by ischial tuberosities and sacrotuberous ligaments, anteriorly by inferior part of pubic symphysis
what are the differences between the male and femal bony pelvises?
is variation in shape of bony pelvis in individuals
exceptions to generalizations made about the bony pelvis can lead to complications during childbirth
pelvic assessment is used in pregnant woman to determine size and orientation of birth canal

1. angle of pubic arch in women is wide, men narrow
2. superior pelvic aperture in women is oval or rounded, in men heart-shaped
3. inferior pelvic aperture in women is large, in men partially obstructed
4. obturator foramen in women is oval, men is round
what are ligaments and foramena that i should know about the pelvis?
sacroiliac ligaments - strongest ligaments in body
bind hip bones to sacrum at sacroiliac joint

sacrospinous ligmaent goes from sacrum to spine of ischium, closes greater sciatic notch, forming greater sciatis foramen

sarotuberous ligament joins sacrum with ischial tuberosity, forming lesser sciatic formaen

obturator foramen between the ischium and pubis

sacral foramena

obturator membrane covers most of obturator foramen

obturator canal is a small gap in obturator membrane and is route followed by nerves and vessels into medial part of thigh

major route followed by vessels, nerves into anterior thigh is deep to inguinal ligament
what is the pelvic diaphragm, what forms it, what does it do, what pierces it?
inverted dome formed by muscular floor of true pelvis
formed anteriorly by levator ani muscles
formed posteriorly by coccygeus muscles
funnel-shaped group of muscles that support pelvic viscera

supports abdominal and pelvic viscera

pierced by urethra, rectum, and in women vagina
where do the levator ani muscles come from, where do they insert, what are the parts of the muscle?
origin: from or near pubis and tendinous arch of obturator internus muscle
insertion: pelvic viscera or coccyx at midline
3 parts:
1. puborectalis
2. pubococcygeus
3. iliococcygeus
what's the origin, insertion, function of coccygeus muscle?
origin: ischial spine and sacrospinous ligament
insertion: coccyx
formation: posterior part of pelvic diaphragm
what are the functions of the levator ani and coccygeus muscles?
1. support pelvic viscera
2. assist abdominal muscles in increasing abdominal pressure
3. support and anchor prostate and vagina

puborectalis muscles = puborectalis portion of pubococcygeus muscles
form puborectal sling - is part of external anal sphincter
when sling relaxed, it allows rectum to straighten, helping in defecation
what is a clinical correlate for the muscles of the pelvic diaphragm?
they can be injured during childbirth
can result in urinary incontinence, fecal incontinence, prolapse of uterus through vagina

kegel exercises (training) teach women to strengthen those muscles of pelvic diaphragm and to relax them during childbirth while they are increasing intraabdominal pressure with other muscles
sacral plexus - what is it? where is it? what are its major branches? what are their paths?
what it is:
weave-work of nerves
composed of lumbosacral trunk which is part of L4 and ventral rami of L5 + ventral rami of S1-S4

where:
on and in anterior surface of piriformis muscle

branches:
most leave true pelvis via greater sciatic foramen
EXCEPTIONS: nerves of piriformis muscle, nerves to muscles of pelvic diaphragm, some cutaneous nerves

major branches:
sciatic nerve = L4-S3
pudendal nerve = S2-S4
superior and inferior gluteal nerves

obturator nerve not derived from sacral plexus - is from branches of L2-L4
passes through obturator canal to medial thigh
what's the path of the pudendal nerve?
exits pelvis via greater sciatic foramen
returns to perineum via lesser sciatic foramen after looping around sarospinous ligament
what's a clinical correlate involving the sciatic nerve?
sciatica = painful
from compression of roots that make up sciatic nerve

compression of lumbosacral trunk or rami of L4, L5 by herniated nucleus pulposus or slipped disc

can also be caused by spasms in piriformis muscle, piriformis syndrome
common in athletic women
what's the blood supply to the pelvis?
near pelvic brim, common iliac artery divides into external and internal iliac arteries

external iliac artery will be principal blood supply of lower limb

branches of internal iliac artery supply pelvic viscera, perineum and gluteal region

lots of variation in branches of internal iliac artery
2 divisions: anterior or visceral and posterior or parietal
most constant vessels from anterior:
umbilical artery
obturator artery to medial thigh
inferior vesical artery in males
vaginal artery in females
uterine artery sometimes a branch of umbilical artery
middle rectal artery
internal pudendal artery to perineum
inferior gluteal artery to butt

major branches of posterior division:
superior gluteal artery, also to butt

beware: inferior gluteal artery often a branch of posterior division and not anterior division

umbilical artery has many branches, including superior vesical arteries, supplying bladder
umbilical artery becomes medial umbilical ligament as approaching the anterior abdominal wall
what's a clinical correlate relating to the uterine artery?
ureter can be injured when uterine artery clamped during hysterectomy
what are the boundaries of the gluteal region? what makes up the butt? what can you feel in there? what nerve innervates the muscles of the leg, where is the leg?
superior boundary of gluteal region: iliac crest
inferior boundary: gluteal fold

butt = gluteus maximus muscle + gluteus medius muscle + superficial fascia

ischial tuberosities can be palpated deep to gluteus maximus

leg is area between knee and ankle
all muscles of leg and foot innervated by branches of sciatic nerve
sciatic nerve enters lower limb deep to gluteus maximus muscle
what are the muscles of the gluteal region divided into?
1. the glutei = gluteus maximus, medius, minimus
2. short lateral rotators of thigh = piriformis
what kind of joint is the hip joint, what does this mean for its actions? what can the muscles of the gluteal region do to the thigh?
ball and socket joint

extension = moving thigh dorsally
flexion = moving thigh ventrally
adduction = moving thigh toward midline
abduction = moving thigh away from midline
rotation and circumduction are possible

muscles of gluteal region extend, rotate, abduct thigh
review the muscles of the glutei - what are their origins, insertions, innervations, actions?
gluteus maximus
origin: ilium, sacrum, sacrotuberous ligament
insertion: broad band of connective tissue running along lateral surface of thigh, called iliotibial band or tract
also runs along femur
innervation: inferior gluteal nerve
enters gluteal region through greater sciatic foramen
action: principal extensor of thigh

gluteus medius
origin: broad, from external surface of ilium
insertion: greater trochanter of femur
action: keeps pelvis from tilting from side to side while walking
location: superficial in superiolateral part of butt
covered by gluteus maximus in other places
innervation: superior gluteal nerve

gluteus minimus
location: deep to gluteus medius
innervation: superior gluteal nerve
action: assists gluteus medius in stabilizing pelvis and abduction of thigh
medial or internal rotator of thigh
what's a significant clinical correlate to know about the butt?
gluteus medius, not maximus receives intramuscular injections because injecting into maximus risks going deep to muscle and injuring underlying sciatic nerve

to test right gluteus medius, ask patient to stand on right foot
if left iliac crest dips down, right gluteus medius may be weak
this is a positive trendelenburg sign

left gluteus medius is tested by asking patient to stand on left foot
weak gluteus medius may indicate easly states of neuromuscular disease
what's the location, insertion, significance, innervation of piriformis muscle?
location: exits pelvis via greater sciatic forament
insertion: greater trochanter of femur
significance: is landmark of gluteal region
nerves and vessels are referred to as superior or inferior depending on their relation to piriformis
innervation: in pelvis by branches from sacral plexus
what are other short, lateral rotators of thigh? what are their origins, pathways, insertions?
numerous other short, lateral rotators of thigh, but i only need to know one other - obturator internus

origin: in pelvis
pathway: exits through lesser sciatic foramen
insertion: greater trochanter of femur

significance of finding obturator internus in gluteal region is that it will help me locate lesser sciatic foramen
what are the nerves i need to know in the gluteal region? where do they originate, if that's signficant? what are their passageways in gluteal region? what do they innervate?
sciatic nerve in gluteal region
largest nerve in body
composed of two nerves; tibial nerve and common fibular or peroneal nerve
these are wrapped together in common connective tissue sheath
pathway: enters gluteal region via greater sciatic foramen
passes inferiorly and deep to gluteus maximus
sciatic nerve does NOT supply muscles in gluteal region, but innervates muscles of leg, foot and posterior thigh

besides sciatic nerve:
pudendal nerve
internal pudendal artery
these both pass from pelvis through greater sciatic foramen, wrap around sacrospinous ligament, enter perineum via lesser sciatic foramen

nerve to obturator internus muscle follows similar course
what's another clinical correlate concerning the sciatic nerve and its splitting in the lower limbs?
another reason for targeting intramuscular injections away from gluteus maximus

sciatic nerve usually splits into tibial and common fibular in thigh
sometimes split is in gluteal region
if this happens, may be near greater sciatic foramen
this would mean that the common fibular nerve may pass through or even superior and superficial to priformis muscle
what should i know about the latin word for bladder and why?
latin for bladder is vesica
structures associated with bladder named with prefix vesico...
or suffix vesical
what are the parts of the bladder that i should know?
apex - top of bladder, most anterior
base - posterior surface of bladder
superior surface - top
two inferolateral surfaces - just the sides

umbilical ligament is attaching to apex
what flattens the base of the bladder?
vagina or rectum
what are in contact with the inferolateral surfaces of the bladder?
levator ani muscles
what does the full bladder look like compared to an empty one?
empty = iron
full = round
can extend up to umbilicus
what's the trigone part of the bladder?
only part of the inside of the bladder that's not corrugated

is triangular patch lining base
where do the ureters enter the bladder?
near superior angles of trigone
where does the urethra form in the bladder/
inferior angle of trigone
what's in the wall of the bladder? what does it form at neck of bladder?
smooth muscle
near neck of bladder where urethra begins, muscles form involuntary internal sphincter
what's the innvervation to the bladder?
parasympathetic
motor to smooth muscle
inhibitory to involuntary sphincter
when fibers stimulated by distension of bladder, they force bladder to contract, expelling urine into urethra
this can be controlled by higher brain centers
describe the urethra in the female - where is it located and where does it end?
is short, muscular tube
runs near anterior surface of vagina
ends at external urethral orifice in vestibule of vagina = space tween labia minora
what are the parts of the urethra in the male? what are they surrounded by?
urethra is longer than in female

3 parts:
1. prostatic urethra
2. intermediate or membranous urethra
3. spongy urethra

prostatic surrounded by prostate gland
posterior surface of prostatic urethra marked by many openings of prostatic ductules and openings of ejaculatory ducts

intermediate urethra is short stretch of tubing tween prostatic urethra and bulb of penis
surrounded by phincter urethrae muscle

spongy urethra in bulb of penis and corpus spongiosum of penis
what constitutes the male internal genitalia?
1. ductus deferens
2. seminal vesicles
3. ejaculatory ducts
what is the ductus deferens? where is it located, where does it end? what's an important clinical correlate related to it?
what it is:
also called vas deferens
is continuation of epididymis or epididymides
location:
enters abdomen in spermatic cord
enters true pelvis along lateral walls just deep to peritoneum
enlarges at posterior base of bladder into area called ampulla

ends:
ends at ampulla
ampulla fuse together and with duct of seminal vesicle to become the ejaculatory duct

clinical correlate:
deferentectomy or vastectomy involve ligation or removal of section of ductus deferens
is common method of sterilization
what do the seminal vesicles do, where are they? what's their relation to the ejaculatory ducts? where do the ejaculatory ducts lead?
location of seminal vesicles:
tween bladder and rectum

function:
not storage of semen, like name suggests
are principal source of seminal fluid

pathway:
empty into short duct that fusees with duct of ampulla to form ejaculatory ducts

pathway of ejaculatory ducts:
empty into prostatic urethra near orifice of prostatic utricle
prostatic utricle = tiny, vestigial developmental homolog of uterus
where is the prostate, how big is it? what does it do? what are its parts called?
location:
surrounds prostatic urethra tween bladder and urogenital diaphragm

size: is walnut-sized gland

function: approximately 20% of seminal fluid
fluid enters urethra through 20-30 ducts in posterior wall

base of prostate - vesicular surface
apex related to urogenital diaphragm
what's a clinical correlate to note for the prostate?
posterior surface of prostate near rectum, where can be felt

enlarges with age
can obstruct flow of urine
benign hypertrophy leads to nocturia = need to void at night and dysuria = pain during urination
80% of men over 80

prostatic carcinoma
30% of men over 75 years
early detection critical
don't confuse seminal vesicles with cancerous prostate
what is the prostrate? what is it made up of?
there are lobes seen in embryo, not obvious in adult

is collection of different glands that empty into urethra
central,
peripheral 70-75%,
radiate laterally from urethra
major site of prostatic carcinoma
periurethral, transitional both major sites of benign prostatic hyperplasia
what are the parts of the internal female genitalia that i should know?
1. vagina
2. uterus
3. uterine tubes
4. ovaries
5. uterine ligaments
what's the vagina? where is it? what parts does it have?
vagina is muscular tube

location:
from vaginal vestibule to cervix of uterus
posterior to bladder, anterior to rectum
through both urogenital diaphragm and pelvic diaphragm

parts:
fornix is recess formed around cervix
what's an important clinical correlate for the vagina?
posterior wall of fornix thin and formed by peritoneum partly

damage from trauma like a coat-hanger abortion can result in peritonitis

blood or ascites in peritoneum will pool in recctouterine pouch which can be detected by palpation

culdocentesis refers to putting a needle through wall of posterior fornix to draw a sample of perioneal fluid
where is the uterus, what parts does it have, what ligaments does it have, what are the pouches around it, and what are the layers of the uterine wall?
location:
near superior wall of bladder at right angle to vagina

parts:
2; body and narrow cervix
isthmus = where body meets cervix
fundus = superior part of body

surfaces of uterus - vesicle related to bladder and intestinal

ligaments:
broad ligament of uterus - folds of peritoneum
suspends body and allows it to move posteriorly as bladder fills

vesicouterine pouch = pocket-like projection of peritoneal cavity tween uterus and bladder

rectouterine pouch = tween uterus and rectum
extends inferiorly to posterior wall of vaginal fornix

3 layers to wall of uterus:
1. perimetrium
peritoneum and pelvic visceral fascia
2. myometrium = smooth muscle
3. endometrium = mucous coat sloughed off each month
what's the blood supply to the uterus?
to body - uterine arteries, branches of internal iliac artery
ovarian arteries, from aorta
what's another name for the rectouterine pouch?
pouch of douglas
what's an important clinical correlate for the uterus?
position of it determind by bimanual exm
retroverted uterus more likely to prolapse
during and after menopause, body of uterus shrinks until it's about same size as cervix
where are the uterine tubes,
what parts does it have?
location:
connect uterus with peritoneal cavity near ovary

parts:
1. uterine part
surrounded by myometrium of uterus
2. isthmus = short, thick-walled portion near uterus
3. ampulla - longest part, usually site of fertilization
4. infundibulum = distal, funnel-shaped part that opens to peritoneal cavity
5 abdominal osteum = opening surrounded by
6. fimbrae = finger-like projections that sweep up oocytes into abdominal osteum
what's a clinical correlate for the uterine tubes?
direct connection tween peritoneal cavity and outside world means that infections in vagina can spread to peritoneal cavity and result in peritonitis

infections in peritoneal cavity can also spread into uterine tubes
if zygote unable to pass into uterus after fertilization, can implant in walls of uterine tube
this results in an ectopic tubal pregnancy that would cause rupture of uterine tubes, which can be lethal
what do the ovaries look like,
where are they,
what are their relations,
what ligaments are they associated with,
appearance:
almond-shaped
atrophy following menopause
small in most female cadavers

location:
near lateral walls of true pelvis
in peritoneal cavity

ligaments:
mesovarium = fold of peritoneum actually, not ligament
attaches anterior surface of ovaries to posterior surface of broad ligament

suspensory ligament of ovary =
another fold of broad ligament
anchors ovaries to lateral walls of pelvis

suspensory ligament AND MESOVARIUM = carries ovarian vessels and nerves

ligament of ovary = band of connective tissue
anchors each ovary to uterus

fimbria ovarica - specialized fimbrium
anchors ovary to infundibulum of uterine tube
what's a clinical correlate we should know for the ovaries?
presence of enlarged lymph nodes can indicate infection or cancer

ovarian cancer progresses without early detection because lymph nodes of ovaries are deep within abdomen, near origins of ovarian vessels

care must be taken when clamping ovarian artery prior to their surgical removal so that nearby ureter is not damaged
what do i need to know about the broad ligament?
what anchors it to what?
what is it?
what parts does it have?
what does it cover?
mesovarium anchors ovary to broad ligament

broad ligament = sheet thrown over uterine tubes
mesosalpinx - part of broad ligament
tween ovary + its ligaments and uterine tube
mesometrium = broad ligament tween ovaries and uterus

broad ligament covers cords of connective tissue
ligamentum teres or round ligament of uterus
ovarian ligament
suspensory ligament of ovary
where is the ligamentum teres or round ligament of the uterus? where does it start and exit through pelvis?
origin - near fundus of uterus
path - lateral to wall of true pelvis, exits abdominal cavity through deep ring of inguinal canal
where's the ovarian ligament?
where does it start, where does it insert?
ovarian ligament - short
origin: near fundus
insertion: uterine surface of ovary
what are the remnants of the gubernaculum in the female?
ligamentum teres, or round ligament of uterus and
ovarian ligament
what's the gubernaculum do in the female?
is a cord-like structure that pulls ovaries into pelvis from posterior abdominal wall
IN EMBRYO ONLY
where's the suspensory ligmament of the ovary? what does it do?
attaches lateral surface of ovary to lateral walls of pelvis

also is conduit for ovarian vessels
what are the ligaments of the uterus?
1. broad ligament
2. ligamentum teres or round ligament of uterus
3. ovarian ligament
4. suspensory ligament
where is the perineum?
what does it look like?
what are its borders?
what's a major landmark of perinum?
location:
most inferior part of trunk found tween thighs and butt

appearance: shaped like diamond when thighs abducted
consists of two triangles; the urogenital and anal triangles

borders:
anterior - pubic symphysis
posterior - tip of coccyx
lateral points - ischial tuberosities

major landmark:
perineal body - tendinous center at midpoint of line tween ischial tuberosities
what are the most prominent components of the urogenital triangle?
terminal part of urethra, external genitalia
what is contained within the anal triangle?
anal canal, vessels and nerves, fascia
what does the perineal body DO?
is tendinous center of perineum
many muscles attach to it, including levator ani, transverse perineal muscles and bulbospongiosus
what's an important clinical correlate for the perineum?
perineal body can be damaged during difficult childbirth
this will result, if not repaired, in prolapse of pelvic viscera
what is the urogenital diaphragm?
what's the controversy surrounding it?
what composes it?
what do its parts DO?
what it is:
floor of true pelvis
is subflooring
thin sheet of striated muscle and fascia spanning pubic arch

parts of:
deep transverse perineal muscle, also called transversus perinei
sphincter urethrae muscle

deep transverse perineal muscle or transversus perinei assists pelvic diaphragm in supporting pelvic viscera

sphincter urethrae is voluntary sphincter of urethra and vagina

controversy is that this muscle does not actually exist
where's the anal canal?
most inferior part of large intestine
begins at angle formed by puborectal sling
ends at anus
what are anal columns?
what should i know about them?
where do they end,
what structure do they form?
what they are:
series of longitudinal folds on inner lining of superior part of anal canal

should know: they are highly vascularized

ending: have semilunar valves at end

pectinate line = undulating line formed by semilunar valves at ends of anal columns
what, again, is the pectinate line
is undulating line formed by semilunar valves at ends of anal columns
what is the embryological significance of the pectinate line?
what significance does it have for the anal canal?
origins (embryological):
where endoderm-derived hindgut met ectoderm-derived anal pit

significance for anal canal:
because of different embryological origins, either side of pectinate line has different blood supply, innervation, lymph drainage
what are internal hemorrhoids?
how do they feel?
contrast this with external hemorrhoids; what are they and how do they feel?
why is there this difference?
internal hemorrhoids:
varicosities or dilations of veins in anal columns SUPERIOR to pectinate line
mucosa here derived from endoderm, so is INSENSITIVE to pain
can be undetected for long time

external hemorrhoids
varicosities of veins in wall of anal canal INFERIOR to pectinate line
richly innervated by inferior rectal nerve, branch of pudendal nerve
VERY SENSITIVE to pain

differences tween two from their embryological origins
what's a major cause of hemorrhoids and why is this?
hemorrhoids result from weakening of anal canal from sitting too long
can also indicate increased pressure in valveless portal system (heart problems)

dilations of veins in anal columns caused by portal-caval anastomosis at anal wall
how does portal-caval anastomoses in anal wall happen?
apparently,
rectum and SUPERIOR part of anal canal blood drains into superior rectal vein which then goes into the inferior mesenteric vein, which drains into the PORTAL system

vs.

INFERIOR part of anal canal drains into inferior RECTAL vein which drains into inernal iliac vein which drains into IVC
what are the two sphincters surrounding the anal canal?
1. internal or involuntary sphincter and
ring of smooth muscle innervated by parasympathetic fibers from pelvic SPLANCHNIC nerves

2. external or voluntary anal sphincters
contains puborectal sling
supplied by inferior rectal nerve, branch off pudendal nerve
where's the rectum come from?
where is it located?
what surrounds it?
what shape does it take on?
what are some of its relations?
what does it DO?
part of pelvic viscera

origin:
continuation of sigmoid colon
begins at S3, deep to peritoneum

surrounding:
peritoneum around anterior and lateral walls of SUPERIOR THIRD of rectum

middle third - anterior surface only covered

inferior third - in pelvic fascia

shape:
right angle at puborectal sling (from puborectalis portions of levator ani muscles)
under that angle is anal canal
rectum = straight
also has 3 transverse rectal folds seen in coronal sections of rectum

function:
storage of the feces
inferior third of rectum highly distensible
called ampulla
what's an important clinical correlate of the rectum?
remember during a sigmoidoscopy that there are angles and folds in rectum so don't just push your way through
what the hell is the ischiorectal fossa
where is it?
what does it look like?
what is it made of and what does it do?
named for lateral and medial borders:
ischium and anal canal

is wide inferiorly, narrow superiorly
described as wedge-shaped

base covered with skin
apex bounded by ischium and inferior origins of muscles of pelvic diaphragm

anterior - goes up to urogenital diaphragm, where is called "ANTERIOR RECESS OF ISCHIOANAL FOSSA"

filled with fat, fibrous bands of ct

support anal canal and allow expansion during defection
where is the pudendal canal
what does the pudendal nerve do, what does it form depending on gender
composition:
in canal are pudendal nerve, internal pudendal artery and vein

location:
exit true pelvis through greater sciatic foramen
wrap around sacrospinous ligament
enters perineum via lesser sciatic foramen
in perineum, run through fibrous tunnels along lateral walls of ischioanal fossae = pudendal canals
can also think of pudendal canal running in deep fascia of obturator internus muscle near inferior margin

supplies most of perineum

males - forms dorsal nerve of penis
females - forms dorsal nerve of clitoris and perineal nerves
what's a clinical correlate involving the ischioanal fossa?
be careful of it
it spread laterally, involving contents of pudendal canal
spread too far and have debilitation?

inferior rectal nerve traverses ischioanal fossa from pudendal canal - DON'T INJURE IT when treating area for infections
what are the contents of the male urogenital triangle?
scrotum, penis, membranous urethra, superficial perineal muscles
what are the parts of the penis?
root, body, glans
what makes up the penis?
corpus spongiosum penis and
corpus cavernosum penis
where can the corpus spongiosum be found? what's in it?
corpos spongiosum expanded proximally in root of penis to form bulb of penis

urethra pierces bulb, continues in corpus spongiosum penis to external urethral orifice

found along ventral midline of body of penis

expands distally to form glans
where are the corpora cavernosa? what do they form and where?
2 of them

dorsally on either side of corpus spongiosum penis in body of penis

in root, corpora cavernosa separate into left and right crura
these are attached to inferior pubic rami
what's a clinical correlate of the penis?
erection caused by release of NO in erectile tissue
regulated by parasympathetic nerves
NO activates enzyme that converts GTP to cGMP
cGMP initiates signaling cascade that causes signaling cascade allowing smooth mucle in penis and clitoris to relax

this results in increased blood flow
cGMP broken down by enzyme called phosphodiesterase-5
drugs like sildenafil or viagra are phosphodiesterase-5 inhibitors
how many superficial perineal muscles are there and what are their names?
3
1. superficial transverse perineal muscles
2. bulbospongiosus muscles
3. ischiocavernosus muscles
describe the superficial transverse perineal muscles
they are thin strips of muscle arising from ischial tuberosity
inserting on perineal body anterior to anal canal
where is the bulbosponiosus muscle in men, what does it do? where is it in women, what does it do for women?
location in men:
associated with bulb of penis
contraction aids in expulsion of semen, urine from urethra
aid penile erection by inhibiting flow of blood through deep vein of penis

women:
on either side of vagina from perineal body to clitoris
act as vaginal sphincter
where are the ischiocavernosus muscles in men and women, what do they do?
in both men and women, they surround crura of penis and clitoris
contraction forces blood from root into body of clitoris or penis, helping to maintain erection
what innervates the superficial perineal muscles?
perneal nerves
what's a clinical correlate for the superficial perineal muscles in women?
kegel exercises strengthen them to assist pelvic diaphragm to support vagina and uterus
what's the name for the entire area of female external genitalia, and what makes it up?
vulva
composed of mons pubis,
labia majora,
labia minora,
vestibule of vagina,
clitoris,
bulb of vestibule,
greater vestibular glands,
associated superficial perineal muscles
what's and where's the mons pubis?
is eminence found superficial to pubic symphysis
covered with pubic hair
what do the labia majora look like? what are they? what do they do?
they are crescent-shaped folds of skin that cover and protect labia minora, vaginal orifice, urethral orifice
what's the pudendal cleft?
slit-like opening tween labia majora
what's the female homologue of the scrotum?
labia majora
what structures develop from the labioscrotal folds?
labia majora in women and scrotum in men
where are the labia minora, what do they do, what do they contain
deep to labia majora
cover vestibule of vagina and contain spongy tissue that becomes engorged with blood during sexual response
anteriorly, fuse to clitoral hood or prepuce
inferiorly, fuse as fold of skin called frenuum
where is the vaginal vestibule, what's in it?
tween labia minora

in it are
urethral orifice
vaginal orifice or introitus
openings of ducts of greater and lesser vestibular glands
what do the greater and lesser vestibular glands secrete?
mucus that lburicates labia and vestibule during sexual arousal
where are the bulbs of the vestibule? what are they composed of?
are deep to bulbospongiosus muscles on either side of vaginal orifice
partly within labia minora
composed of spongy tissue like that found in penis
what happens with the bulbospongiosus muscles during sexual response?
they contract
force blood from bulbs into crura of clitoris to help maintain erection
what's the clitoris? what composes it?
it's an erectile organ
composed of two corpora cavernosa that form crura along inferior pubic rami
bound together superiorly to form body of clitoris
distal end of body is small, rounded glans
what's a clinical correlate relating to the greater vestibular glands?
they're also called bartholin's glands (or used to be)
inflammation is stil called bartholinitis
inflamed greater vestibular glands can reach 2-5 cm in size
what nerves provide cutaneous sensation to vulva?
ilioinguinal nerve
genital branch of genitofemoral nerve
perineal branch of posterior cutaneous nerve of thigh
all above innervate mons pubis and lateral aspect of labia majora

principal nerves to vulva are branches of pudendal nerve
after exiting pudendal canal, pudendal nerve divides into several perineal nerves and dorsal nerve of clitoris
what's a clinical correlate related to treating pain during childbirth?
inject anesthetic agent into tissue surronding pudendal nerve near where it enters perineum through lesser sciatic foramen at ischial spine

doesn't block pain associated with contractions of uterus and dilation of cervix
what is the sexual response technicallly involve?
emotional, physiological processes
involves sensory, motor, autonomic nervous systems
what are three parts of sexual response in male
erection, emission, ejaculation
what causes erection for men?
parasympathetic innervation causes relaxation of smooth muscle
blood flow increases
outflow is clamped down resulting in erection
what's emission involve?
sperm transfer
from epididymis to prostatic urethra

sympathetic nervous system innervates smooth muscle in ductus deferens and seminal vesicles

initial phases of orgasm

preganglionic nerves involved from L1, L2

prostate gland:
sympathetic nervous system closes off neck of bladder so that movement is 1 way
what's ejaculation involve?
semen into spongy urethra
contractions of striated muscle (bulbospongiosus), not smooth, like in emission
what does point and shoot mean?
point and shoot
point = erection, parasympathetic
shoot = emission NOT ejaculation
sympathetic
what's an important clinical correlate relating to spinal nerve injuries and sexual function?
spinal cord levels involved in regulating erection, emissiona dn ejaculation are different
refexogenic erection = stroking perineum leading to erection without involvement of brain

this is more common in people with higher cord lesions above L1 since reflex arc remains intact below lesion

few spinal cord injured men father children
chance is better for people with lower cord lesions below L1 that for men with higher cord lesions

reason is that sympathetic innervation required for emission must be intact for sperm to get out of body