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Anatomy Quiz: Week 38
4/22/2013 3:25:00 PM
1. Describe and demonstrate the bony landmarks of the pelvis on an
articulated pelvis and on a plain film x-ray. Compare and contrast
the shape of the female bony pelvis with that of the typical male
bony pelvis.
I’m imagining that the following bony landmarks are eligible (from his list):
 Iliac fossae
 Iliopubic eminence
 Arcuate line
 Pectineal line
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Superior pubic ramus
Public symphysis
Pubic arch
Ischiopubic ramus
Obturator foramen
Ischial tuberosity
Ischial spine
Sacral promontory
Anterior sacral foramina
 Coccyx
I tried making a diagram and then I remembered that you all have books
too.
2. Demonstrate the boundary structures and content of the
urogenital and anal triangles on the bony pelvis.
Urogenital Δ
Boundaries: the vertices of the triangle are at the public symphysis
and the two ischiopubic rami. It is the anterior triangle of the
perineum.
Contents:
o Bulbospongiosus, ischiocavernosus, transversus perinei
superficialis mm.
o Crus of penis/ clitoral crura
o Urethra
o Bulbourethral gland (male)/ Bartolin’s gland (female)
o Penis bulb, (yup) / vestibular bulb
o Posterior scrotal or labial nerves
Anal Δ
Boundaries: the vertices are at the coccyx and the two ischiopubic
rami. Posterior triangle of the perineum
Contents:
o Sacrospinous & sacrotuberous ligaments
o Pudendal nerve
o Internal pudendal a/v
o Anal canal
o Muscles
 Sphincter ani externus
 Gluteus maximus
 Obturator internus
 Levator ani
 Coccygeus
o Ischioanal fossa
3. Describe the boundaries of the ischiorectal fossa from a posterior
approach and describe the construction, attachments and
functions of the components of levator ani in a female.
The ischiorectal fossae are fat-filled, wedge-shaped, fascia-lined spaces
between the pelvis diaphragm and the perianal skin. The boundaries are:
 Laterally; ischium, inferior obturator internus m., obturator fascia
 Medially; external anal sphincter, levator ani m.
 Posteriorly; sacrotuberous ligament, gluteus maximus
 Anteriorly; pubic bodies, inferior to the origin of puborectalis.
The female levator ani muscle
 Puborectalis
o Forms the sling for the rectum
o Originates from inferior public symphysis and insert on the
opposing puborectalis muscle
o It lets you hold in a load when it might not be socially
acceptable to dump it (wait, girls poop?)
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o N: S3, S4
Pubococcygeus
o Hammock-shaped muscle from pubis to coccyx and forms the
floor of the pelvic cavity
o Joins iliococcygeus in forming the anococcygeal raphe
o Controls urine flow, aids in childbirth, contracts during orgasm
o N: S3, S4
Iliococcygeus
o The most posterior of the group, from the ischial spine to the
anococcygeus raphe, via the tendinous arch of the obturator
fascia
o Pulls the coccyx side to side and elevates the rectum
o N: S3, S4
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4. Describe the spermatic cord fascial layers including their
embryological origin from the anterior abdominal wall structures.
3 Layers
External Spermatic Fascia
o derived from external oblique muscle
o outermost covering of spermatic cord (& testes)
Cremasteric Fascia
o derived from internal oblique muscle
Internal Spermatic Fascia
o derived from transversalis fascia
5. Contrast and compare the arrangement of erectile tissue in the
male and female genitalia.
Male: 3 cylindrical cavernous bodies
 Paired corpora cavernosa dorsally
 Single corpus spongiosum ventrally
The anatomical position for the penis is while erect. So dorsal is the side
that’s easiest for his owner to view.
Female: way more complicated than previously thought…
Clitoris
o At the anterior juncture of labia minora
o Composed of two crura, two corpora cavernosa, and glans
 Glans is highly innervated
 Crura attach the clitoris to the inferior pubic rami
 Body of clitoris is covered by prepuce
Bulbs of the Vestibule
o Paired elongated masses of erectile tissue along the vaginal
orifice, deep to the labia minora.
o Homologous to the male’s bulb of the penis
And, in conclusion, I present these schematics. Way more similar that I
imagined. Gravy.
6. Compare and contrast the course of the urethra in the male and
the female.
Male (18-22cm)
1. Intramural / Preprostatic
 1.5cm, vertically from the bladder, size depends on bladder status
2. Prostatic
 3-4cm, descends through anterior prostate, very distensible
3. Intermediate (membranous)
 1.0-1.5cm, through deep perineal pouch
4. Spongy
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Through the corpus spongiosum and out into the external
environment
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Length doesn’t matter, right?
Female (4cm long)
From the internal urethral orifice of bladder, descends posterior to
the pubic symphysis and then inferior to it, to the external urethral
orifice. This is located in the vestibule of the vagina.
7. Trace the fascial layers of the abdomen as they descend into the
pelvis.
Anatomy Quiz: Week 39
4/22/2013 3:25:00 PM
Compare and contrast the contours of the peritoneal lining of the
pelvic cavity in the male and the female
The pelvic peritoneum is thought to begin at the superior border of the pubic
symphysis. In the male, in the black and green picture, the pelvic
peritoneum continues posteriorly, covering the bladder and forming a broad
retrovesical pouch between the bladder and the rectum. It will cover the
rectum as it sweeps superiorly to meet the abdominal parietal peritoneum at
S3.
In the female, the peritoneum has to account for much more internal
genitalia than the male. So, instead of going from bladder to rectum in the
male, we go from bladder to uterus to rectum, (anterior to posterior). There
will be two pouches: the uterovesical pouch (between 4 & 3 above) and the
rectouterine pouch (pouch of Douglas). The uterovesical pouch is accessible
by the anterior fornix of the vagina. The pouch of Douglas, or cul-de-sac, is
accessible by the posterior fornix and from this location a procedure called a
culdoscentesis may be performed to collect intraperitoneal fluids.
Describe the arrangement of the internal female reproductive organs
in the pelvic cavity, including the morphological changes that occur
with pregnancy
The vaginal canal, which is oriented superiorly and posteriorly, begins with
the vestibule of the vagina and ends at the external os of the cervix. The
uterus itself is most commonly flopped anteriorly onto the superior vesical
surface. Other uterine orientations are possible. Most commonly, the angle
of the vaginal canal is 45° to the angle of the uterus.
 Anteflexion: the long axis of uterus is bent anteriorly relative to
that of the cervix
 Anteversion: the long axis of the cervix is bent anteriorly relative to
that of the vagina (see pic)
The cervix has length of a few and will terminate at the internal os. The
uterus is next, which continues in whichever direction it decided to go
(retro/anteflexed) to the fundus. At the fundus, the lumen of the uterus is
continuous with the fallopian tubes, ending in the fimbriae.
In pregnancy, the expanding 9 month
intrauterine growth will push the fundus
of the uterus superiorly with the head
under the sacral promontory and the
feet up past the belly button. In the
case of retroflexed uterus, the baby’s
orientation must be manipulated to
avoid a feet first delivery.
Describe the arrangement of the internal male reproductive organs
in the pelvic cavity
Internally, there are some extra things to your common knowledge of
penises and balls.
First, the ductus deferens. Beginning at the tail of the epididymis, the duct
enters the abdomen by the inguinal canal and the pelvis by crossing over the
external iliac vessels. It then travels along the lateral wall of the pelvis and
ends by joining the seminal gland to form the ejaculatory duct. In the
picture below, it’s the green tube coming from the scrotum.
Superior to the prostate and posterior to the fundus of the bladder, we have
the seminal glands. They are also closely related to the anterior wall of the
rectum. The duct of these glands join the ductus deferens to form the
proper ejaculatory duct.
The ejaculatory ducts are closely related now, as they travel through the
posterior prostate. The ducts terminate into one prostatic urethra. Next,
the Cowper’s, or bulbourethral glands. Lying posteriolateral to the postprostatic urethra and mainly embedded in the external anal sphincter
muscle. The content of the glands are emptied through tiny apertures in the
spongy urethra.
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Describe the blood supply to the pelvic cavity provided by the
internal iliac artery and compare and contrast the differences seen in
this blood supply between males and females
Anterior
The anterior division supplies the pelvic viscera, along with some to thigh
and butt regions. Their arrangement is variable.
 Obturator
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o Gives off nutrient branch to ilium
o Before leaving pelvis, gives off pubic branch
 Anastomosis with pubic branch of inferior epigastric
artery
Inferior gluteal
o Larger, terminal branch of anterior division
o Leaves pelvis via greater sciatic foramen, under piriformis
Umbilical artery
o Along lateral pelvic wall, ascends the anterior abdomen to the
umbilicus
Inferior vesical (male) or vaginal (females)
o To prostate (not females)
o to vagina, anterior and posterior branches
 often found as a branch of the uterine artery
Uterine
o Female only, additional branch that dudes don’t sport
 The male homolog is the branch to ductus deferens
o Gives off a small vaginal branch and larger ascending branch
at the side of cervix
Middle rectal
Internal pudendal
o Larger in males > females
o Goes for a ride out the greater sciatic foramen, under the
piriformis, passes around the ischial spine and re-enters the
pelvis via the lesser sciatic foramen to the ischioanal fossae
o Within the fossae, the artery divides into the perineal artery
and the dorsal artery of the penis/clitoris
Posterior
 Iliolumbar
o This shoots right back up to the iliac fossa and divides into an
iliac branch (iliacus & ilium) and a lumbar branch (QL &
psoas)
 Lateral sacral
o Pass medially and descend, giving off spinal branches through
the anterior sacral foramina to supply the sacral meninges
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o Some contribution to skin and erector spinae muscles
Superior gluteal
o Muscle to dem glutes
Outline the course of lymphatic flow from the organs of the pelvic
cavity; contrast the flow of lymph from the female and male pelvic
cavities
The word on the street is that the lymphatics for any region of the
pelvis/perineum will follow the venous drainage…EXCEPT for the gonads.
So, below you can see a number of regions highlighted that are named for
the venous flow that the lymph nodes are associated with.
The male pelvic viscera, (ejaculatory ducts, ductus deferens, inferior parts of
seminal glands drain to the external iliac nodes. The prostate and superior
seminal regions drain to the internal iliac. The ‘tip’ goes to the deep
inguinal.
The female, as always, is complicated. Ovaries drain to the lumbar lymph
nodes, aka the caval/aortic nodes. Same with the fundus and upper uterine
body. The uterine tubes and round ligament will drain to the superficial
inguinal nodes. The uterine body and cervix will drain to the external iliac
lymph nodes. Within the transverse cervical ligament, the uterine body will
also drain to the internal iliac.
Now the
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vagina has 3. Obv.
Superior – internal and external iliac
Middle – internal iliac
Inferior – sacral, common iliac
External – superficial inguinal nodes
Describe the course of the somatic nerves (lumbosacral plexus) in
the pelvic cavity
Lumbar
 Iliohypogastric (L1)
o Anterior to psoas major on lateral border to reach the anterior
QL. There it pierces the transversus abdominis to run above
the iliac crest, terminating near the inguinal ligament as an
anterior cutaneous branch
 Ilioinguinal (L1)
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o Runs at the level of the iliac crest, after splitting from the
iliohypogastric. Pierces lateral abdominal wall and runs above
the inguinal ligament to the pubic symphysis
Genitofemoral (L1, L2)
o In the male,
Lateral femoral cutaneous (posterior trunk) (L2, L3)
Femoral (posterior trunk) (L2, L3, L4)
Obturator (L2, L3, L4)
Sacral
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Superior gluteal (L4-S1)
o Above piriformis, leaves via greater sciatic foramen
Inferior gluteal (L5-S2)
o Below piriformis, leaves via greater sciatic forament
Sciatic (L4-S3)
o Large, forms and exits via greater sciatic foramen inferior to
piriformis to the gluteal region
Posterior femoral cutaneous (S2, S3)
Nerve to QL (L4-S1)
Nerve to Piriformis (S1, S2)
Nerve to obturator internus (L5-S2)
Perforating cutaneous (S2, S3)
Pudendal S2-S4
o Via greater sciatic foramen, between piriformis and coccygeus
muscles
o Hooks around ischial spine, (like the artery) to enter the
perineum via the lesser sciatic foramen
o Branches to levator ani, external sphincter, coccygeus
Coccygeal plexus
 S4-S5 anterior rami
 Arise on pelvic side of coccygeus muscle, supplying it, the levator
ani and the sacrococcygeal joint
 Anococcygeal nerves arise from here and supply sensation from the
skin between the tip of your coccyx and your anus
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