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46 Cards in this Set

  • Front
  • Back

Urinary Bladder (Relations)

Extraperitoneal immediately posterior to the pubic symphysis

Trigone (triangular base) adherent to the pelvic floor

Neck anchored by ligaments to the pelvic floor and body of the pubis:

Puboprostatic (Male)

Pubovesical (Female)

Urinary Bladder (Anatomy)


Anterioinferior ends - Urethral opening

Posterolateral angle - Ureters enter


Composed of detrusor muscle

Urethral opening - internal sphincter (smooth muscle)

Urinary Bladder (Innervation)

Males: Sympathetic supply to the bladder neck to close during ejaculation

Micturition - Pelvic Splanchnics S2-4

Preganglionic sympathetic fibres: L1-2

Postganglionic fibres: Hypogastric plexus

Urinary Bladder (Blood Supply)

Internal Iliac artery --> Superior & Inferior vesicular arteries

Females - Uterine artery --> Vesicular branches (base of bladder)

Vesical plexus (base of bladder) --> Internal Iliac veins

Male - Prostatic venous plexus

Rectum (Path)

Starts anterior to S3

Downwards into the sacral concavity

Turns forwards at the coccyx as the ampulla (dilated)

Bends sharply backwards and passes through:

Pelvic diaphragm

Puborectal sling

Becomes the anal canal

Rectum (Blood supply)

Inferior Mesenteric artery --> Superior Rectal artery

Middle rectal artery - Supply to the muscular wall

Rectum (Innervation)



Hypogastric Plexus

Coeliac Plexus - Along inferior mesenteric and superior rectal arteries


Pelvis Splanchnic nerves (S2-4)

Prostate Gland

Urethra passes through

Posterior wall of the urethra pushes forward into the urethral lumen forming the seminal colliculus / verumontanum

Prostate gland adds secretions to seminal fluid via ducts - either side of the colliculus

Right & Left Puboprostatic ligaments - Connect to posterior Pubis

Blood Supply:

Inferior Vesical artery

Middle Rectal artery

Vas Deferens (Path)

Deep inguinal ring - Enters abdominal cavity

Crosses the medial surface of the external iliac vessels and the pelvic brim to enter the pelvic cavity

Posterosuperior border of the bladder - Turns medially

Posterior to bladder - Dilated to form Ampulla

Base of the Prostate Gland - Narrows

Unites with seminal vesicle duct to form the ejaculatory duct

2 Ejaculatory ducts pierce the prostate

Run obliquely

Opens onto the seminal colliculus

Vas Deferens and Seminal Vesicle (Blood Supply)

Vas Deferens

Superior Vesical artery --> Artery to the Vas (all the way to the lower pole of the Epididymis)

Seminal Vesicles

Branches of inferior vesicle artery

Vas Deferens (Innervation)

Intrapelvic - Same as bladder

In Spermatic Cord - Same as testis

Testis (Anatomy)

Suspended in the scrotum on the pedicles of the spermatic cords

Migrates through the inguinal canal so has a double layer of peritoneum (tunica vaginalis)

Residual connection to the peritoneum is obliterated - Processus Vaginalis

Covered by Tunica Alburginea - Aids movement of Spermatazoa into the epididymis


Head - Upper pole of testis

Body - Posterior to the testis

Tail - Continuous with the Vas Deferens

Testis (Supply)


Abdominal aorta --> Testicular artery

Pampiniform plexus --> Testicular veins --> IVC (right) or Left Renal vein (left)


Para-aortic Nodes


Visceral afferents run with sympathetic efferents of T10

Pain referred to Periumbilical region


Uterus (Anatomy)

Hollow, antiflexed organ with thick fibromuscular walls that is mobile

Fundus - Broad upper end covered by peritoneum

Body - Uterine tubes are attached at the cornua

Cervix - Projects into the Vagina. Upper end - Internal Os. Lower end - External Os (invaginated into the anterior wall of the vagina at a right-angle)

Fornix - Part of the vagina that envelops the cervix. Divided into anterior, posterior and 2 lateral fornices

Uterine tubes (Parts)

Interstitial part - Within the uterine wall

Isthmus - Half nearest to the uterus with a narrow lumen

Ampulla - Lateral to the isthmus and widens gradually

Infundibulum - Widens significantly and opens into the peritoneal cavity

Contains fimbriae (partly erectile), one connects to the ovary and grasps it during ovulation

Uterus (Supply)

Blood Supply

Uterine artery - Passes medially in the base of the broad ligament

Across and above the ureter

Abdominal Aorta --> Ovarian Arteries

Autonomic supply

Sympathtic: T10-L1 (hypogastric plexus)

Parasympathetic: Pelvic Splanchnic nerves (S2-4)

Uterus (Ligaments)

Visceral Peritoneum - Anterior, Superior and Posterior surfaces of the uterus and tubes

Broad Ligament - Inferior borders of the tubes & Lateral borders of the body. Anterior and Posterior tubes extend and attach to the pelvic floor and lateral pelvic wall

Round Ligament - From the junction of the uterus and tubes to the labium majus of the vulva

Runs in between layers of the broad ligament

Crosses the pelvic rim and goes through the inguinal canal

Pubocervical Ligament - Pubis around th bladder to the cervix

Cardinal Ligament - Connective tissue bands that run in the broad ligament

Lateral pelvic wall to the junction of the cervix and vagina

Uterosacral ligament - Uterine isthmus to the sacrum on both sides

Lateral to the rectum

Raises a visible ridge in the parietal peritoneum


Occupies ovarian fossa on the lateral pelvic wall

Bulges out form the posterior layer of the broad ligament

Mesovarium - attachment to broad ligament

Suspentory ligament of the ovary - Raised part of the broad ligament that contains the ovarian vessels

Ligament of the ovary - Between the layers of the round ligament to the uterus (level of the uterine tube)

Continuous with the round ligament

Ovarian artery (direct abdominal aorta branch)

Lymphatic drainage is to the para-aortic nodes

Sympathetics to T10 - pain reffered to the periumbilical region

No parasympathetic supply

Ovary (Relations)

Behind - ureter

Lateral - Obturator neurovascular bundle

Peritoneal Pouches in Females

Recto-uterine pouch - Visceral peritoneum on the posterior surface of the uterus continues to the posterior fornix of the vagina and turns backwards into the anterior side of the rectum

Vesicouterine pouch - Between the uterus and the bladder

Peritoneal pouches in Males

Rectovesical pouch - Rectum onto the base of the upper part of the bladder

In both the male and female pouches abnormal intraperitoneal material may collect in them

Internal iliac artery

Descends to the greater sciatic notch

Divides into anterior and posterior trunks that give parietal and visceral branches

Visceral branches:

Superior and inferior rectal arteries

Middle rectal artery

Uterine artery

Parietal branches:

Obturator artery

Internal pudendal artery

Superior and inferior you real arteries

Superior Hypogastric plexus

Continuation of the aortic plexus with branches from the 3rd and 4th lumbar vertebrae

Lies on the sacral promontory between common Iliac arteries

Gives branches to the following plexuses:



Common Iliac

Divides into the inferior hypogastric plexus

Inferior Hypogastric Plexus

Lies on each side of the rectum

Sympathetic (mostly postganglionic) - From Superior Hypogastric Plexus

Parasympatheetic (preganglionic) - From Pelvic Splanchnic nerves

Collectively known as the pelvic plexuses:



Prostatic (Male)

Uterovaginal (Female)

What is the pelvic wall made of?

2 inominate bones



Piriformis and its fascia

Obturator Internus and its fascia

What is the pelvic floor made of?

Levator Ani


Levator Ani

Origin: Pubic bone and Obturator Internus Fascia



Anococcygeal Raphe (between the anorectal junction and the coccyx)

Perineal Body (between the Anal Canal and the Prostate/Vagina)


Puborectalis - From the posterior pubis and forms a sling around the anorecatal junction

Pubococcygeus - Posterior pubis to Anococcygeal Raphae (compromises the puboprostaticus/pubovaginalis and puboanalis)

Iliococygeus - From the arcus tendineus on the obturator fascia and the ischium. Inserts into the anococcygeal raphae


Origin: Ischial spine

Insertion: Lower part of the sacrum and the coccyx

Innervation: S3&4 and pudendal nerve

Fibres lie parallel to the sacrospinous ligament, but the muscle is anterior to it

What is the Perineum?

Part of the pelvic outlet lying caudal to the pelvic floor


Anterior - Pubic Symphysis

Lateral - Ischial tuberosities

Posterior - Coccyx

What is the Perineum divided by?

Transverse line between the ischial tuberosities

Posterior - Anal triangle

Anterior - Urogenital triangle

Perineal Membrane

Fibrous sheet that fills the urogenital triangle

Lateral - 2 Ischiopubic rami

Posterior - Anchored to the Perineal body (midline) and Colles' fascia (continuation of Scarpas fascia - fibrous layer running throught eh subcutaneous tissue of the abdominal wall)

Membrane pieced by:



Foramina (for nerves and vessels)

Perineal Body

Fibromuscular mass of tissue

Midline between urogenital and anal triangles

Formed by:

Interdigiating fibres of puboprostaticus / pubovaginalis

Superficial and deep transverse perineal muscles

External Anal sphincter


Aka Central tendon of the perineum (important in maintaining the integrity of the pelvic floor and perineum)

Deep Perineal Pouch

Superior to the perineal membrane

Bounded by the inferior surface of levator ani


Membranous urethra and external urethral sphincter

Cowpers (bulbourethral) glands - male

Deep transverse perineal muscle

Anterior prolongations of the ischioanal fossa

Nerves and Vessels (Penis/Clitoris)

Superficial Perineal Pouch

Between Perineal Membrane and Colles' fascia


External genitalia



Superficial transverse perineal muscle

Greater vestibular / Bartholin's glands - Female

Anal Triangle

Contains Anal canal and ischioanal fossa (with its contents)


Lateral - Sacrotuberous Ligaments (Covered by the lower border of gluteus maximus)

Base - Line between the anterior parts of the ischial tuberosities

Apex - Tip of the coccyx

Anal Canal: Path and Lining

Start: From the Anorectal junction (at the puborectalis sling of levator ani)

Finish: Anocutaneous junction

Lining: Upper 2/3 - Mucus, Lower 1/3 - Skin

Mucocutaneous junction has a white line shows the embryological division of endoderm vs ectoderm

Blood supply - Superior vs Inferior rectal

Innervation - Autonomic vs Somatic

Lymphatic Drainage - Internal Iliac vs superficial inguinal nodes

Anal Canal: Sphincters

Internal Sphincter:

Smooth muscle covering the upper 2/3 of the anal canal

Thickening of the circular muscle of the rectum

Supplied by parasympathetics

External Sphincter:

Striated muscle covering the lower 2/3 of the anal canal

3 Parts - Deep (Fused posteriorly with puborectalis)

Superficial (Attached anteriorly to the perineal body)

Subcutaneous (Deep to the perineal skin)

Ischioanal Fossae

Anal canal is surrounded by fatty tissue (allows it to expand) - Space occupird is the ischioanal fossa

Both sides are continuous with each other anterior and posterior to the anal canal

Bounded by the ischial tuberosities and the anal canal

Anterior Recess - Fat extends forwards between the upper surface of the perineal membrane and lower surface of the pelvic diaphragm on the lateral sides of the external urethral sphincter


Pudendal tunnel - Fascial tunnel in the lateral wall of each fossa. Pudendal vessels and nerves run through this tunnel (They give the inferior rectal vessels and nerves)


Female external genitalia is made of:

Mons Pubis - fatty protuberance over the pubic symphysis

Labia Majora - Hair and extends posteriorly from the Mons

Labia Minora - No Hair and Inner folds united posteriorly at the fourchette

Vestibule: Space between the labia minora. Urethra opens anteriorly into it, Vagina posteriorly

Clitoris: Anterior to urethral opening

Ischiocavernosus muscles attach it to the ischiopubic ramus

Homologous to penis (2 corpora cavernosa and a small glans)

Vestibular Bulb: 2 erectile tissue masses (superficial to the perineal membrane on each side of the vaginal opening)

Covered by Bulbospongiosus

Posterior - 2 Greater Vestibular (Bartholin's) glands wheich drain anteriorly



Crura - Attaches to the perineal membrane (ischiopubic rami)

Suspentory ligament - Pubic symphysis


2 Lateral Corpora Cavernosa

Divide posteriorly to form the crura

Covered by Ischiocavernosus muscles

Intervening septum

Central Corpus Spongiosum

Starts at the Perineal membrane (as an enlargement of the bulb)

Runs in a groove on the inferior surface of the other 2 muscles

Surrounded by bulbospongiosus muscle


Expansion of the corpus spongiosum over the corpora cavernosa

External Urethral Meatus - Tip of glans

Prepuce - Foreskin attached to the glans by the frenelum

Frenelum - Fold of mucous membrane

Bucks Fascia - Covers the entire body of the penis

Continuous with the septum between the corpora carvenosum and the suspentory ligament

Male Urethra

From internal to external urethral meatus

15 - 20 cm long

Prostatic Part:

Widest part as it crosses through the prostate

Seminal colliculus (verumontanum) - evevation on the posterior wall

Ejaculatory duct - Opens onto its summit

Prostatic ducts - Opens into grooves on the side

Membranous Part:

Shortest and most rigid

Passes through the deep perineal pouch (surrounded by the external urethral sphincter)

Passes through perineal membrane

Bulbourethral glands - 2 embedded in the sphincter muscle and secrete a lubricant fluid

Spongy Part (Penile urethra):

Runs in the corpus spongiosum to the tip of the glans

Lumen is transverse (except at the external urethral meatus - transverse lumen to give a spiral stream of urine)

External urethral sphincter - Sheet of striated muscle (supplied by the perineal branch of the pudendal nerve). governs urinary continence


Suspended by the spermatic cord

Median raphae in the skin

Fibrous midline septum seperates the scrotum into 2 cavities

Dartos: A layer of smooth muscle that lies in the subcutaneous tissue. Contraction means wrinkling of the scrotum

Anterior 1/3: Branch of ilioinguinal nerve

Posterior 2/3: Scrotal branch of the pudendal nerve

Sacral Plexus

Formed from the lumbosacral trunk - from the anterior primary ramus of L5 (with a branch from L4), S1-S4

Posterolateral wall of the pelvic cavity

Function: Innervate the lower limb and muscles of the pelvis & perineum

Coccygeal Plexus

Formed from:

branch from S4

anterior primary rami of S5

coccygeal nerve

Posterolateral wall of the pelvic cavityFunction: Innervate the lower limb and muscles of the pelvis & perineum

Pudendal Nerve

Anterior rami of S2-S4

Supplies perineal muscles and skin

Leaves through the greater sciatic foramen (below the lower border of piriformis with the internal pudendal vessels) - Medial to the Sciatic Nerve

Winds over the sacrospinous ligament to pass through the lesser sciatic foramen to enter the perineum

Embedded in Pudendal (Alcock's) canal - fascial tunnel


Inferior Rectal Nerve - Arises in the posterior part of the pudendal canal

Passes medially over the roof of the ischioanal fossa

Branches to supply the external anal sphincter, perineal skin and levator ani

Perineal Nerve:

Divides into 3 branches

Scrotal (labial) branches - medial branch passes with the artery to supply the scrotum. Lateral branch gives a branch to the anus

Muscular branch - Supplies the transverse perineal muscles, ischiocavernosus, bulbospongiosus, external urethral sphincter, external anal sphincter and levator ani

Nerve to the bulb: Supplies the bulb of corpus spongiosum

Dorsal nerve of the Penis (Clitoris) - Continuation of the pudendal nerve

Runs in the ischioanal fossa and pierces the perineal membrane

Supplies the skin of the penis / clitoris and the glans

Innervation of the Penis / clitoris

Skin at the root: Anterior scrotal (labial) branch of the ilioinguinal nerve

Erectile bodies: Branches of the pelvic plexus