Chapter6Female Genital Organssurface is close to the loops of small intestine. TheThe female genital organs or female reproduc-lateralsurfaceisclosehelateralwallftheelvitive system is far more complicated than those of theyhurtblmale.They aredivided into the internal genital organsity,connects with the fimbria ofuterine tube.and the extermal genital organs. The intermal genitalThe inferior extremity is thinner and called theorganslieintheelvic cavity,inludingtheovariuterine extremity,which conncts with uterusbyand conveying ducts, theuterine tubes, uterus and va-gina.ovarian ligament. Anterior border is attached to theposterior surface of the broad ligament by the meso-Section 1Internalvarian, and the posterior border is free. At the middleportion of the anterior border there is the hilum ofGenital Organsovary through where blood vessels nerves and lym-phatic vessels pass.I.OvariesEach ovary is held in place within the peritonealcavity by several ligaments.Proper ligament ofovaryOvaries,the pairedfemale gonads,arethe primaryanchors the ovary medially to the uterus.The suspen-reproductive organs of the female, like tests in male.sory ligament of ovary anchors it laterally to the pel-They flank the uterus on each side, shaped like al-vic wall, and there is the mesovarium between them.monds and about twice as large. In the childhood,theThese fibrous ovarian ligaments are enclosed withinovaries are small with smooth surfaces.After pubertythe broad ligament. Both suspensory ligaments andthe ovary becomes progressively scarred due to ovu-the mesovarian are parts of the broad ligament. Thelation.In old women,the surfaces of theovaries areperitoneal fold covers the fundus and body of uterusmore scarred and pitted, showing that many oocytesand supports the uterine tubes, uterus, and vagina (Fig.have been released,and the ovaries become atrophyII-6-1).gradually as menstruation has ceased. Each ovary hasThe ovaries are served by the ovarian arteries andthe lateral and medial surfaces,anterior and posteriorhe ovarian branches of the uterine arteries. The ovariborders, superior and inferior extremities.The medialan arteries arise from the abdominal aorta and reachUreterSuspensoryLig.ofovaryUterinetubeOvaryFimbriae of uterine tubeRound ligamentofuterusUterusVesicouterinepouchRectouterine pouchUrinary bladder-PosteriorpartoffomnixofvaginaVaginaPubic symphysisRectovaginal septumGlans of clitorisExternalorificeofurethraAnuLesser lip of pudendumGreater lip of pudendumFig. II-6-1 The female pelvis (median sagittal section)·176·扫描全能王创建
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233 1 group2greubLChapter 6 Female Genital Organs ·177.margins of the broad ligament of uterus.Each uterinethe ovaries by travelling through the suspensory liga-tube is composed of 4 parts: a uterine part, an isth-ment of ovary.mus,an ampulla,andan infundibulum(Fig.II-6-2)Il. Uterine TubesUterine partThe uterine tubes are a pair of tortuous tubesIt lies inthewall of theuterus withthe lengthofwhich transmitting the ovum and oosperm.Each uter-lcm.And its diameter is about I.Omm.The uterineine tube is about 10-12cm long and extends mediallyorifice ofthe uterine tube opens intothe uterine cavity.from theregion of the uterus via a constricted regioncalled the isthmus. They are located on the upperOvarianaandy,Infundibulum of uterinetubeSuspensory lig.ofovaryFundus of uterusUterine orifice ofuterine tubeAmpulla ofuterine tubeOvarianfimbriaProperlig.Ovary/ofovaryIsthmus of uterinetubeFimbriaeofuterinetubeCavity of uterusctionofovaryBodyofuteruInternal orifice of canalIsthmus ofuterusofcervixofuterusRound lig.ofuterusCanal ofcervix of uterusOrifice ofuterusBroad lig ofuteruLateral part of fornixofvaginaRugae of vaginOrificeofuterus of nullipargOrifice ofuterusofmultiparaFig. II-6-2 The female internal genital organsthe uterine tube around the ovary superiorly and pos-2. Isthmus of uterine tubeteromedially.Ithas numerousfingers like projectionstermed fimbriae hat drape over the ovary.The fimbri-ae of uterine tube spreading over the medial surfaceIt is medial and the narrowest portion of the tube,of the ovary.One of them attaching to the superiorabout 2. 5cm long. This is the place where the lega-extremity of the ovary is considered to induce the o0-tion ofthe uterine tube is performed usuallycyte to enter the infundibulum of the uterine tube.Ampulla of uterine tube3.II.UterusIt is the longest and widest portion of the tube, be-The uterus is situated in the center of pelvic cavi-tween the isthmus and the infundibulum ofthe uterinety (Fig. II-6-1),between the urinary bladder and thetube.Fertilizationusuallyoccurs inthisregion.rectum.It is a hollow,thick-walled organ to receive,4. Infundibulum of uterine tuberetain, and nourish a fertilized ovum,to develop welluntil its birth. The uterus varies in shape, size, loca-tion and structures. These variation are dependent onItisanpn,funneshaped, andthlateralend口口扫描全能王创建E
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178·PARTSPLANCHNOLOGYandtheinferiorend abovetheischialspine.Theinferthe age andother circumstancefor example,proortionthuterieonncswihthinnancyand so on.Thueritubsaiesand itsorligant,andbroad ligaments ofuterusare onboth sideofthe uterus.1.Parts and featuresThe uterus lies the posterior part of thesuperiorsurface and the upper part of the base of the blad.The size and shape of the uterus is like an invert-der. When the bladder is empty, the uterus is tilteded pear.It is usually larger in women who have bornforward at an angle of about 90 degrees between thechildrenIt is composed of4parts: afundus,a bodylong axis ofthe uterus and vagina, named the antever.an isthmus,anda cervix.sion, The body of the uterus is bent downward atThemajor portion of the uterus is referred to asits junction with the cervixofthe uterusforming anthe body.There is a hollow portion in which is namedangle of about 170 degrees, called the antelex. Whenthe cavity of uterus.the bladder is full, the uterus extends upward andThebody has two surfaces,two borders.Theves-backward (retroversion).In some women, the uterusical surface,or superior surface,is near thebladder inis retroverted even when the bladder is empty and thefront and below the uterovesical pouch.The posteriorbodymaybebentbackward on the isthmus.surface, or intestinal surface,is separated from thesigmoid colon above and behind by the rectouterine3. Relations between the uteruspouch. The left and right borders are related to therespective broad ligaments,and to the structures conand peritoneumtained between the two layers of each ligament.Andthe anterosuperior rounded region of the body is theTheperitoneum is reflected from the posteriorfundus of uterus.aspect of thebladdertotheisthmus of theuterus,andThe isthmus is the constricted part of the uterus,then passes upperward on the vesical surface of theabout lcm or less in length,and between the bodybody of uterus. This reflection forms the uterovesicaland cervix.During pregnancy it becomes"lowerpouch. After passing around the fundus of the uterus,uterine segment"and is taken up by the body.the peritoneum passes downward on the intestinalThe cervix of theuterus is the narrow neck aboutsurface ofthe body,and on the back of the cervix and3cm long,and projecting into the vagina inferiorlyupper part of the vagina, from which it is reflectedThe cavity of the cervix is called the cervical canalonto the front of the rectum.There is a recess betweencommunicating with vagina via theexternal orifice,anduterus and rectum that is formed by this reflection,with cavity of theuterine body via the internal orifice.called rectouterine pouch (Fig. II-6-1).The cervical canal has mucosal lining with cervical glands that secrete a mucus to fill the cervicalcanal and covers the external orifice of uterus.The4. Fixing structures of the uterusmucus presumablyblocks the spread ofbacteriafromthe vagina into the uterus.The normal position of the uterus is maintainedThe lower end of the cervical canal has a roundby major muscles of the pelvic floor, neighboringopening,called theorifice ofuterus which is smoothorgans and connective tissues, and several ligaments.and round in the nullipara (Fig.II-6-2).Ifthese structures are damaged,uterus may displaceCervix cancer is a common among women be-downward,called prolepses ofthe uterus.tween the agesof30-50.Riskfactors usually includes1) Broad ligament It is enclosed by two layersfrequentcervical infammations,sexuallytransmitedof peritoneum. It extends from the lateral margin ofdiseases such as genital warts,and multiple pregnanthe uterus to the lateral wallofthe pelvis.The free su-cies.perior edge of the broad ligament encloses the uterinetube. Its inferior and lateral margins are continuous2.Location of uteruswith the peritoneum on the wall of the pelvis.Theposterior layer extends backward from the cervix ofIn normal condition, the uterus extends betweenthe uterus as the rectouterine fold. This fold formsthe bladder and the rectum in the pelvic cavity.Thethe lateral boundary of the rectouterine pouch. In thefundus of uterus is below the level of the pelvic inlet,broad ligament there are uterine tube, ovary, proper扫描全能王创建
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Chapter6Female Genital Organs.179-ligamnsryundligntuoothe subcutaneous tissue of the greater lip of puden-ssitssdum.The round ligaments maintain the uterus in theThe broad ligament is divided into three parts,antevertedposition.the mesosalpinx, the mesovarium and the mesome-3)Cardinal ligament(Fig.II-6-3)It isthevis-trium. Mesosalpinx is between the uterine tube andceral pelvic fascia at the side of the cervix and vagina,themesovarium and mesometrium.The mesovariumwhich is considerably thickened and contained nu-extends from the anterior border ofthe ovary to themerous smooth musclesfibers.Thepart of thisthick-posterior layer of the broad ligament.The mesome-ening passes laterally to merge with the upperfasciatrium is the part of the broad ligament below the me-of the pelvic diaphragm and is called the cardinalsosalpinx and mesovarium.ligament.The uterine artery runs on its upper aspect2) Round ligament They are a pair of narrow,At thebase of the broad ligaments,the cardinal liga-flat band of fibrous tissue attached to the uterus onmentsextendbetweenthepelvicwallandthecervixeach side just below and in front of the entrance ofofuterus.The ligaments fix the position of theuterusthe uterine tube.They contain connective tissue andtoprevent from droppingdown into thevagina.smooth muscle near the attachment. After passing4)Uterosacral ligamentsThey are also twolaterally and forward across the external iliac vessels,folds of theperitoneum containing a numerous fibrousthey transverse the inguinal canal and become lost intissue nd smooth muscular fibers.The uterosacral ligRetropubic spaceUrinary bladderVesicouterine lig.Neckofuten1tCardinal lig.ofuterusUterosacral ligRectumRetrorectal spaceNFig. II-6-3 The ligaments of uterusThe middle coat is termed myometrum, whichaments are, as well as, termed the rectouterine liga-ments that pass backward in the rectouteral fold andforms the greater part of the uterus wall. During par-aare attached to the front of the sacrum.The liga-turition, the normal function of the uterine muscula-ments hold the cervix of uterus in its normal positionture is one of the most factors important as well as theshape ofthebonypelvis and the size of thefetal headrelative to the rectum; they can be palpated via theThe muscle coat is continuous with the uterine tubesrectum.aboveandwithvaginabelow.Thebundlesof smoothmuscle from its superficial part are extended into the5. Structure of uterus wallvarious ligaments attached to the uterus.Its deeperThe wall ofuterus is composed of three layers.Thepart contains rich blood vessels and nerves. There is,iner layer is a mucous membrane, named the endomehowever,relatively lessmusclefibers butmore con-trium, which differs in structure with the stage of thenective tissue in the isthmus and cervix than that inmenstrual or uterine cycle. It also undergoes changesthe body and funds of uterus.during pregnancy. It contains numerous gland, whichThe outer serous coat is called the perimetrium,traverse the entire thickness of endometrial stroma. Itformed by the peritoneum.It is firmly attached to thegrows and breaks away during the menstrual cycle.fundus and body except at the lateral margins.It is口扫描全能王创建D
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·180·PARTIISPLANCHNOLOGYthereisfuid,suchasbloodorpusintherectouterineloosely attached to the back of the cervix.pouch, it can be aspirated ordrainaged through the6.Blood supplyposterior fornix of vagina.The vagina is a highly dilatable organ,especillyinthe upperpart abovethe pelvicdiaphragm.WhenThe main blood supply of the uterus comes fromthecavityotheagina ismptyitisshapedintransthe uterine arteries.The uterine arteries pass mediallyverse section.The anterior and posterior walls arefrom both sides of the cervix. They serve the cervixcontacted with each other below the entrance of theand the upper part of vagina.And they turn upward touterine cervix.The anterior wall is 7.5cm long andrun between the layers of the broad ligament, near theis in contact with the longer (9cm) posterior wall.Thelateral margins of the uterine body, and send branch-posterior wall extends above the cervix to the posteriores to both surfaces of the body.The uterine arteriesfornix.The cervix projects intothe slightly enlarged partbecome greatly enlarged during pregnancy,and aretortuous after parturition.ofthecavityofthevagina,and seperatesthetwo walls.The anterior wall is in contact with the base of thebladder and the terminal part of the urethra. The pos-V.Vaginaterior fornix is covered with peritoneum wall.The inferior portion of the posterior wall of vagi-The vagina (Fig.I-6-1, 2) is the female organ ofna is separated by only areolar tissue from the lowestthe copulation. It is also the lower part of the“birthpart of rectum.canal",and serves as a passage for the menstrualflow.The cavity of the vagina consists of three layers:In most virgins,the opening of thevagina into thevestibule is partially closed by a fold called the hy-mucous membrane,muscular coat and external coat.It is8-10cm long,extendingfrom the cervix ofthemen (details in section2)uterus to the vaginal vestibule. The upper portion ofSection 2Externalthe vagina lies above the pelvic floor and the lowerportion is narrow and opens into the vaginal vestibuleGenitaliathrough the vaginal orifice.The Female external genitalia or named femaleThe upper end of vagina surrounds the vaginalpudendum are the structures in the area of the vulvaportion of the cervixto forma circular recess,named(Fig.II-6-4).They are composed of the mons pubis,the fornix of vagina. Its posterior part is higher thanthe greater lip of pudendum, lesser lip of pudendum,that of ventral part and two lateral pasts. There arethe clitoris, the vaginal vestibule, hymen and greateronly the wall of vagina and a layer of peritoneum be-vestibular glands.tween the posterior past an the rectouterine pouch.IfMonspubisAnterior labial commissurePrepuce of clitorisFrenulum of clitorisGlansof clitorisGreater lip of pudendumExtermal orifice of urethraLesser lip ofpudendumIR8HymenVaginal orificeNVestibularfossa of vaginaOrifice ofgreatervestibularglandPosterior labial commissureFreulum of pudendal labiaAnusFig.I-6-4 The female external genital organs扫描全能王创建
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Chapter6Female Genital Organs ·1816.Hymen1.Mons pubisThe hymen is a thin, variable in size and shapeThe mons pubis is a fatty eminence, overlying thefold of mucous membrane in the virgins. It is usu-pubic symphysis. Ater puberty, this area is coveredally an annular or semilunar shape around the vag-with pubichair,There are two elongated,hair coveredinal orifice.Generallyit has one opening,howeverfatty skinfolds, called greater lips ofpudendum.maybe cribriform.In some cases,the opening isclosing,termedan imperforatehymen.Aftersexual2.Greaterlips of pudendumintercoursethe hymen is ruptured, small roundedfragments thehymen is ruptured, small rounded fragThey are two longitudinal prominences of skinments hymnal carunculae remaining at the site of itsfold onboth sides of thepudendumcleft.Thetwo lipsattached border of the vaginal orifice.are female counterparts which joined with each otherby the anterior labial commissure and posterior labialcommissure..Bulb ofvestibule3.Lesser lips of pudendumThe bulb of vestibule consist of two elongatedmasses of erective tissue on both sides of the vaginalThe lesser lips of pudendum are two thin,hair-orifice and urethra orifice.It is deep to the sphincterfree skin fold and fat with relativelyfew sweat glands,muscle of the vagina, as the homologous organ to theenclosedbythegreatlips of pudendum.Thelesser lipscavernous body of male urethra.enclose a recess called the vestibule, which containsthe external opening of the urethra more anteriorly8.Greater vestibular glandsfollowed by that of thevagina.At the anterior portion,they encircle the clitoris to form the prepuce of clitoris.They are the pea-size and lie in both sides of thevaginal orifice,posteriorto thebulb of vestibule4. Vaginal vestibuleThey aredeep to the sphincter muscles of the vaginaEach gland has a duct opening on the lesser lip ofThe vaginal vestibule is a cleft between the lesserpudendum.They are the homologous organs to thelipsofpudendum.Its twoendsarenarrow,whilemidbulbourethral glands of the male.dle portion is wider. Just anterior to the vestibule isSection3Mammarytheclitoris,a small protruding structure.The posteriorportion end at the frenulum of pudendal labia. ThereGlands in Femaleis a vaginal orifice in the center of the vestibule.There is an external orifice of urethra anterior toMen and women both have mammary glands.the vaginal orifice,2. 5cm inferoposteriorto the cli-In the men themammaehaveboth eminencenippletoris.There are the orifices of the greater vestibulararounded by areola of breast,whichare smallerthanglands on both sides ofthe vaginal orifice.those of women.The nipple is located on thefourthintercostal space.In female,the mammary glands begin to develop5.Clitorisand grow rapidly at puberty.During pregnancy andlactation they are developing and secreting the milkTheclitoris is a small,protruding structure,comto nourish the newborn baby.posed largely of erective tissue that is homologous tothe penis of the male.It is hooded by a skinfold namedL.Location and featurestheprepuceoftheclitoris,formedbythe junctionofthelabiaminorfoldsTheclitorisisrchly innervatedwith sensory nerveendings sensitive to touch, anditIn the young adult female, each mammary gland ismay become swollen areerect liking penis inmales.contained within a rounded skin-covered breast anterior-扫描全能王创建
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.182·PARTI SPLANCHNOLOGYating around and open at the nipple. The lobes aretothepectoralmuscles ofthethorax.Itextendsfromthepadded and separated from each other by fibrous con.thirdtoseventh ribs vertically,andfromthe parasternalnective tssue and fat.The interlobar connective tissueline to midaxillary line transversely.Thenipple is onforms suspensory ligaments attaching thebreasto thethe centerofthemamma and generally is at the levelofunderlying musclefascia and to the superior dermis.the fourth intercostal space.There are several orificesThe suspensory ligaments are termed the Cooper,softhelactiferous ducts at thewrinkled tipof the nipple.ligaments Cooper,which providenatural supportforAround the center of each breast there is a ring ofpig-the breasts, like a built-in brassiere (Fig. II-6-5)mented skin.named the areola of breast.On its surfaceWithin the lobes are smaller units called glandularthere are many small eminences of areolarglands.lobule,which contain glandular alveoli producingwhichproduce sebumto lubricatethenippleand reducethe chapping and cracking of the skin ofthenipple.milk when a woman is lactating.The lobule has anAutonomic nervous system controls smoothmus-excretory duct, termed the lactiferous duct. Just deepcle fibers in the areola, which cause the nipple erectto areolar, each lactiferous duct has a dilated regionwhen it is exposed to tactile or sexual stimulation andnamed lactiferous sinus. Milk accumulates in these si-exposed to cold.nuses during nursing.The outer end of the lactiferousducts is narrow and open on the nipple. The incisionStructureof the operation on mamma should bemade radicallyAto avoid cutting across a number of the lactiferousThe gland consists of 15 to 20 gland lobes radi-ducts (Fig. II-6-6)LobulesofmammaryglandPectoralismajorSuspensorylig.ofbreastAdipose tissueIntercostalesofbreastLactiferous ductMammaLactiferous sinusDeepfasciaofthoracicwalNipple-NippleAreolaofbreastLactiferous ductAdipose tissueofbreastLactiferous sinusFig. -6-5 The mamma of female(sagittal section)Fig.II-6-6 Themamma offemaleSun Ping(孙 平)扫描全能王创建
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Chapter 7PerineumIn the wide sense, the perineum is a diamond-of soft tissue structure between anus and the posteriorshaped region enclosing the inferior orifice of theend of the perineal cleft.pelvis.It includes all sof tissues between the pubicThe perineummay be divided into two parts,thesymphysis and coccyx. There are four borders. Itsanterior urogenital triangle and the posterior anal tri-anterior border is formed by the inferior border of theangle,by a transverse line drawing between the bothpubic symphysis. Each lateral margin is surroundedischial tuberosities.The external senital organs andby the inferior rami of pubis, rami of ischium, ischialthe urethra. Are in the urogenital triangle and anus istuberosities, sacrotuberous ligaments, and the posteri-in the anal triangle passing through anal region (Figor border is composed of the apex of coccyx.II-7-1, 2)Inthenarrow sense,thefemale perineum consistPenisBulbocavemosusIschiocavermosusInferiorfasciaofurogenitalPerineal central tendonSuperficialtransversem.ofperineumIschial tuberositySphincteraniextemusAnuIschioanalfossa (Ischiorectal fossa)LevatoraniAnococcygeal ligGluteus maximusFig.I-7-1The structuresinthe superficialperinealspace ofmalecltorisIschiocavernosuExtermal orificeofurethraBulbocavernosuVaginal orificeYLesser lip of pudendumBulb of vestibuleGreater vestibularglandBulbocavemosus-Inf.fascia ofurogenital diaphragmPerineal central tendontransverse m.of perineumObturator fasciaevatoraniGluteusmaximusAnusSphincter ani externusFig-2The structuresinthesuperfealperineal paeffmale183:扫描全能王创建口
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.184.PART II SPLANCHNOLOGYfemale, the muscles in two sides are separated andI.Urogenital Triangleended on the surface of bulb ofvestibule.The constrictionofthe muscles makesthevaginalopeningThis region is between the pubic arches of theconstricted,so they are also named sphincter musclesboth sides. Its apex is forward and the base is back-of vagina (Fig.II-7-2)The ischiocavernosus coversward.the crus ofpenisinthemaleandthecrusof clitorisin thefemale.Their constriction presses the root ofcavernous body to block the venous fow and causes1. Fasciae of urogenital trianglethe erection of penis or clitoris.In the deep perineal space, there are the deepThere are three layers of fascia in the urogenitaltransverse muscle of perineum and sphincter ofdiaphragm from the superficial to the deep, namedurethra. The former is between the rami of both is-superficial fascia, inferior fascia of urogenital dia-chiums.The latter lies anterior to the former and sur-phragm, and superior fascia ofurogenital diaphragm.rounds the membranous portion of urethra. It is alsoThe superficial fascia is also called superficialnamed the extermal sphincter of urethra in male andfascia of perineum, which attaches to the pubic archthe urethrovaginal sphincter in female.The superiorlaterally and continues with the dartos of the scrotum,and inferiorfasciae with the muscles in the deep per-superficial fascia of the penis and the deep layer ofineal space are collectively called the urogenital dia-the superficialfascia ofthe abdominal wall,as well asphragm. It is superficial to the pelvic diaphragm andcalled the Scarpa's fascia.closes the urogenital triangle.The deep fascia of urogenital diaphragm is divid-In the superficial perineal space,therearenervesed into two layers,the superficial fascia and inferiorand blood vessels to supply the perineum, the bulbfascia of urogenital diaphragm.They attach the ramiof urethra and the crus of penis in male, the bulb ofof pubis and ischium laterally.The anteriorand poste-vestibule,crus of clitoris andgreater vestibularglandsrior borders of these two layers are joined together.infemale.In thedeep perineal space,there are nervesThe superior and inferior fasciae of urogenitaland blood vessels distributing the penis,membranousdiaphragm, the deep transverse muscle of perineum,portion of the urethra, bulbourethral glands in maleand the urethral sphincter muscle form the urogenitaland the urethra and vagina in female.diaphragm, which encloses the urogenital triangle andsupport the pelvic organs. In male the urethra pass-es through it. In female the urethra and vagina passII.Anal Trianglethrough it. There is a space between the superficialfascia of perineum and the inferior fascia of urogen-In thistriangle there are thecevator ani, coccyges,ital diaphragm, named the superficial perineal spaceand external anal sphincters, as well as the superfi-(Fig.I-7-1,2)cial and inferiorfasciaeofpelvic diaphragm.Theanus passes through the center of the triangle.There2.Structures of urogenital triangleare two large spaces on both sides ofthe anal canal,termed the ischiorectal fossa (Fig. I-7-3).In the superficial perineal space there are some1.Levator animuscles, such as the superficial transverse muscle ofperineum,bulbocavernosus and ischiocavernousus,The superficial transverse muscles of perineum areThey are paired broad muscles to form the fun-apairof small muscles,originatingfrom the ischialnel-shaped floor of pelvis with a downward apex,tuberosities and inserting into the perineal centralwhich encloses the large portion of pelvic floor.tendon medially.The bulbocavemosus covers the sur-The levator ani originate from the fascia on theface of urethra bulb (Fig.II-7-1).Whose contractionlateral wallsofthepelvis.Theirfiberspass inferoposcauses excretion of urine and ejaculation in male.Interiorly to insert into the perineal central tendon,anal扫描全能王创建
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Perineum ·185Chapter7HipboneExtermal iliacObturatorintemusUreterFSuperiorfascia of pelvic diaphragmRectunLevatoraniInferiorfascia of pelvic diaphragmPudendal n.LOVIntemal pudendal a,v-PudendalcanalAIschioanal fossa多人Sphincterani intemusAnusSphincterani externusFig. II-7-3 The ischiorectal fossacanal, anococcygeal ligament and apex of coccyx.cialfascia anddeepfascia.There is a triangle cleft space named cleft foramenI) Superficial fasciaIt is a partion of the super-of pelvic diaphragm,enclosed by the urogenital dra-ficial fasciae of whole body. It is thin, and containsphragm inferiorlysome sweat glands.Thefunction oflevatorani isto suport pelvicfloor2) The deep fasciaeThe deep fasciae are theand organs in pelvic cavity.They also may contractcontinuation of thedeep fascia in the anal triangleandthe anus and vagina.gluteal fascia.Thesefasciae cover the levator ani andcoccygeus superiorly and inferiorly.2.CoccygeusThe fascia, covering the superior surface of thelevator ani and coccygeus,is named the superiorThey are posterior to the levator ani,and lies onfascia of pelvic diaphragm.The fascia, lying on thethe superior surface of the sacrospinous ligament.inferior surface ofthe levator ani and coccygeus,isThey originate from the ischial spine and insert intonamed the inferior fascia of pelvic diaphragm (Fig.the lateral border of the sacrum and coccyx.II-7-3, 4).The levator ani and coccygeus with the superior3. Sphincter ani externusand inferiorfascia of pelvic diaphragm form thepel-vic diaphragm to encloses the anal triangle.The anusItis aring-shaped fat muscle,which originatespasses through the centre of pelvic diaphragm.from thetip ofcoccyx and inserts into the perinealThere is a hiatus of the pelvic diaphragm anteriorcentral tendon.It is composedofskeletal muscle andto the perineal central tendon between the both le-is underthevoluntarycontrol.Itsrole istoconstrictvator ani.In the male the prostate extends into theanus.When the muscle is cut off in the operation ofhiatus and the urethra passes through its center. Intheanal canal, the bowel could not control.the female the urethra and the vagina pass throughthis hiatus. There is the urogenital diaphragm, the4. Fasciae of anal triangleinferiortohiatus,which is formedbythe superiorandinferior fasciae of the urogenital diaphragm and theThe fasciae of perineum are divided into superf-口口扫描全能王创建
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