1. Anatomy of the female perineum and perineal pouches

2. Collectively called the Vulva which includes:
• Mons Pubis
• Labia Majora and Minora
• Clitoris
• Urethra
• Vaginal Orifice
• Vestibular Glands
Mons Pubis fatty, rounded area over the pubic symphysis
Labia Majora 2 fatty skin folds that are homologous with the male scrotum
Labia Minora smaller folds covered with mucosa and richly supplied with sebaceous glands enclose the region called the vestibule, which contains the clitoris, urethra and vaginal orifices

3. Greater Vestibular Glands (Batholin's Glands)
• equivalent to bulbourethral glands in males
• secrete mucus containing liquid for lubrication
• during sexual intercourse
Lesser Vestibular Glands
• also secrete mucus for lubrication
Clitoris
erectile tissue equivalent to glans penis
housed in a hood of tissue (prepuce) formed by the junction of labia minora
richly supplied by nerves and engorges with blood upon sexual arousal

4. Part of the adult female external genitalia
Mons pubis
clitoris
Urethral
orifice
Labia majora
Labia
minora
introitus
anus

5. The perineum Overlies the inferior pelvic aperture
The urogenital triangle s anterior to a line in front of the ischial tuberosities
The muscles are grouped as
Superficial –bulbospogiosus,ischiocarvenosus and superficial transverse perinei occupying the superficial perineal pouch

6. Superficial perineal pouch
Boundaries
Below-membranous layer of superficial fascia (Colle’s fascia)
Above-urogenital diaphragm
Laterally attached to margins of pubic arch
Anteriorly communicates with space btw sup. Fascia of ant abd. Wall & its muscles

7. The superficial perineal pouch
Contains structures forming the root of clitoris
Bulbospongiosus- sorrounds orifice of vagina & covers vestibular bulbs
Ischiocarvenosus-covers the crus of clitoris
Superficial transverse perinei

8. Perineal body-wedge shaped mass of ffibrous tissue situated btw lower end of vagina & anal canal
Giives attachment to perinei muscles, levatores ani & support posterior wall of vagina
Perineal branch of pudendal nerve supplies skin & muscles

9. Deep perineal pouch
Lies between the superior & inferior (perineal membrane) fascia of the urogenital diaphragm

10. Contents of the dep perineal pouch
Deep perinei muscles-deep transverse pernei
Part of the urethra
Part of the vagina
The sphincter urethrae (pierced by urethra and vagina)
Internal pudendal vessels & their branches
Dorsal nerves of clitoris

11. Female urethra
4cm long
Opens into vestibule 2.5cm below clitoris

12. Episiotomy
At childbirth the introitus may be enlarged by making an incision in the perineum
Starts at the fourchette and extends mediolateraaly to the right side for 3cm.
Structures encountered in an episiotomy include- skin, vaginal epithelium, subcutaneous fat, perineal body and superficial transverse perineal muscle

13. Episiotomy and perineal nerve block