Human Anatomy Part 1 - K. A. Dyubenko, A. K. Kolomiysev, Yu. B. Chaykovsky 2002

Special Section
Reproductive systems, systemata genitalia — Female reproductive system, systema genitale femininum
External female genitalia, organa genitalia feminina externa — Pelvic and perineal fasciae

The walls of the pelvic cavity, cavitas pelvis, and pelvic Organs are covered with fasciae. The following fasciae are distinguished:

- pelvic fascia, fascia pelvis;

- parietal pelvic fascia, fascia pelvis parietalis;

- visceral pelvic fascia, fascia pelvis visceralis;

- rectovesical septum, peritoneo-perinealis;

- superior Fascia of the pelvic Diaphragm, fascia diaphragmatis pelvis superior;

- inferior fascia of the pelvic diaphragm, fascia diaphragmatis pelvis inferior;

- superior fascia of the urogenital diaphragm, fascia diaphragmatis urogenitalis superior;

- inferior fascia of the urogenital diaphragm, fascia diaphragmatis urogenitatis inferior;

- superficial fascia of the Perineum, fascia perinei superficialis.

The pelvic fascia, fascia pelvis, is a continuation of the fascia iliaca and is divided into two layers: the parietal pelvic fascia, fascia pelvis parietalis, and the visceral pelvic fascia, fascia pelvis visceralis. The parietal layer lines the walls and floor of the pelvic cavity, while the visceral layer covers the pelvic Internal Organs. The parietal fascia, fascia pelvis parietalis, extends onto the superior surface of the pelvic diaphragm and covers the levator ani Muscle from above. This part of the parietal fascia is called the superior fascia of the pelvic diaphragm, fascia diaphragmatis pelvis superior; it extends onto the pelvic organs and is referred to as the visceral fascia of the pelvis, fascia pelvis visceralis. Extending onto the pelvic organs, the pelvic fascia gives off two processes located in the sagittal plane between the pubic bones and the sacrum. Thus, the pelvic organs are situated in a space bounded: anteriorly by the pubic bones; posteriorly by the sacrum and coccyx; and laterally by the sheets of the pelvic fascia. This space is divided by a partition located in the frontal plane into two compartments: anterior and posterior. The partition is formed by the rectovesical septum, fascia peritoneo-perinealis, or Denonvilliers' fascia, which separates the rectum from the Urinary Bladder and Prostate Gland.

Thus, in the anterior compartment of the space in males are located: the urinary bladder, prostate, Seminal Vesicles, and Ductus Deferentes; whereas in females, the urinary bladder and Vagina; the posterior compartment contains the rectum. The pelvic organs occupy a central position and are separated from these walls by Connective Tissue located in the retropubic space (spatium retropubicum) and retrorectal space (spatium retrorectale).

The Inferior surface of the pelvic diaphragm is covered by the inferior fascia of the pelvic diaphragm, fascia diaphragmatis pelvis inferior. Thus, the Muscles of the pelvic floor are bounded by the superior and inferior Fasciae of the pelvic diaphragm.

The superior and inferior fasciae of the urogenital diaphragm, fascia diaphragmatis urogenitalis superior et inferior, cover the deep transverse perineal muscle and sphincter urethrae muscle (m. transversus perinei profundus et m. sphincter urethrae) anteriorly and posteriorly, together forming the urogenital diaphragm, diaphragma urogenitale. Anteriorly, between the deep transverse perineal muscle and the symphysis, the fasciae form the fibrous part of the urogenital diaphragm known as the transverse perineal ligament (lig. transversum perinei). Anterior to this ligament run the dorsal artery of the Penis and the dorsal vein of the penis (or Clitoris) (a. dorsalis penis, v. dorsalis penis [clitoridis]).

The superficial fascia of the perineum, fascia perinei superficialis, covers the SUPERFICIAL MUSCLES OF the urogenital diaphragm: m. transversus perinei superficialis, m. bulbospongiosus, and m. ischiocavernosus, and together with the inferior fascia of the urogenital diaphragm forms the fascial sheath for the corpus spongiosum of the penis.

The ischioanal fossa, fossa ischioanalis, is located laterally in the perineal region of the rectum (see Fig. 331). The fossa is filled with loose connective and adipose tissue, known as the adipose body of the ischioanal fossa (corpus adiposum).

The ischioanal fossa, fossa ischioanalis, is bounded by the following walls: laterally by the obturator internus muscle and its fascia; medially by the levator ani muscle and its fascia; anteriorly by the superficial transverse perineal muscle; and posteriorly by the inferior margin of the gluteus maximus muscle and the external anal sphincter. On the lateral wall of the ischioanal fossa, within a split of the fascia, lies the pudendal canal, canalis pudendalis (Alcock's canal), through which passes the neurovascular bundle formed by the internal pudendal artery, vein, and nerve; this must be taken into account in surgical practice.

The Blood supply to the perineum is provided by the internal pudendal artery, a. pudenda interna, which enters the ischioanal fossa and branches out to the Skin and anal muscles. Near the inferior layer of the urogenital diaphragm, the internal pudendal artery divides into terminal branches that supply the penis. Venous drainage from the perineum is directed into the internal iliac vein.

Lymph from the perineum drains into the superficial inguinal Lymph Nodes (nodi lymphatici inguinales), paravaginal lymph nodes (nodi lymphatici paravaginales), pararectal lymph nodes (nodi lymphatici pararectales), inferior gluteal lymph nodes (nodi lymphatici glutei inferiores), and sacral lymph nodes (nodi lymphatici sacrales).

Innervation of the perineum is supplied by the pudendal nerve, n. pudendus, and its branches—inferior rectal nerves, perineal nerve, and scrotal (or labial) nerves—as well as by the Coccygeal plexus, plexus coccygeus.