The anterior urogenital perineum Figs 98

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A line joining the ischial tuberosities passes just in front of the anus. Between this line and the ischiopubic inferior rami lies the urogenital part of the perineum or the urogenital triangle.

Attached to the sides of this triangle is a tough fascial sheet termed the perineal membrane which is pierced by the urethra in the male and by the urethra and the vagina in the female. Deep to this membrane is the external sphincter of the urethra consisting of voluntary muscle fibres surrounding the membranous urethra; these are competent even when the internal sphincter has been completely destroyed. In the female the superficial sphincter is also pierced by the vagina.

Enclosing the deep aspect of the external sphincter is a second fascial sheath (comprising areolar tissue on the deep aspect of levator ani), so that this muscle is, in fact, contained within a fascial capsule which is termed the deep perineal pouch. This pouch contains, in addition, the deep transverse perineal muscles and, in the male, the two bulbo-urethral glands of Cowper whose ducts pass forward to open into the bulbous urethra. Superficial to the perineal membrane is the superficial perineal pouch which contains, in the male:

Corpus spongiosum with urethra

Dorsal vein Corpus cavernosum

Perineal membrane

Penile

Coccyx

Crus

Bulb

Corpus spongiosum with urethra

Dorsal vein Corpus cavernosum

Perineal membrane

Coccyx

Crus

Bulb

Ischial Cavernosus Muscle

Superficial transverse perineal muscle

Ischiocavernosus

Bulbospongiosus

External sphincter ani

Gluteus maximus

Fig. 98 The male perineum—on the right side the muscles of the anterior perineum have been dissected away.

I Levator a ni

Superficial transverse perineal muscle

Ischiocavernosus

Bulbospongiosus

External sphincter ani

Gluteus maximus

Fig. 98 The male perineum—on the right side the muscles of the anterior perineum have been dissected away.

1 the bulbospongiosus muscle covering the corpus spongiosum which, in turn, surrounds the urethra (the distal corpus spongiosum expands into the glans penis);

2 the ischiocavernosus muscle on each side, arising from the ischial ramus and covering the corpus cavernosum. The urethra is thus enclosed in a spongy sheath supported by a cavernous tube on each side containing thin-walled venous sinuses which become engorged with blood when erection occurs;

3 the superficial transverse perineal muscle, running transversely from the perineal body to the ischial ramus. It is of no functional importance but is seen during perineal excision of the rectum.

In the female the same muscles are present although much less well developed and the bulbospongiosus is pierced by the vagina.

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