Superficial Perineal Pouch & Pudendum (Female)
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Pudendum
- Aka, vulva, refers to the external genitalia
- Comprises structures that are sexually responsive and/or protect the vaginal opening.
Key features:
- Vaginal orifice (aka, opening).
- Hymen caruncles surround vaginal orifice; they are remnants of the hymen, which, at birth, partially closes the vaginal orifice and over time is stretched and/or torn by physical activity, tampon use, intercourse, etc.
- Ducts of greater vestibular glands release lubricating secretions upon sexual arousal.
- Urethral opening
- Ducts of the paraurethral glands vary in number (aka, lesser vestibular glands, Skene's glands, female prostate gland); release mucous secretions, which may be a lubricating fluid, or may be involved in female ejaculation (which itself is a contentious topic).
- Glans clitoris is the "free" portion of the clitoris; the majority of the clitoris is deep to the skin.
- Labia minora:
- Comprise erectile tissues and rich vasculature.
- The right and left medial folds meet to form the frenulum of the clitoris; recall that a frenulum is a small fold of tissue that connects structures.
- The lateral folds meet at the prepuce (aka hood), which covers the body of the clitoris.
- Posteriorly, the folds merge to form the frenulum of the labia minora (aka, forchette).
- The area between the labia minora is the vestibule of the vagina.
- Labia majora:
- Comprise adipose and smooth muscle tissue; the overlying skin has hair follicles and sebaceous glands.
- Meet anteriorly at the mons pubis, which is the mound of fatty tissue superficial to the pubic symphysis.
- Posteriorly, the labia majora are separated by the posterior commissure, which overlies the perineal body.
Superficial perineal pouch
- Potential space deep to the skin of the pudendum.
- Lies between the superficial perineal fascia and the perineal membrane.
- Contains erectile tissues and their overlying muscles.
- Pubic rami anchor the soft tissues.
- Perineal membrane has openings through which the vagina and urethra pass
- Clitoris:
- Comprises the paired corpora cavernosa, which are erectile tissues.
- Anchored to the pubic symphysis via the suspensory ligament.
- Crus (plural = crura) the lateral "leg" that attaches to the pubic rami and perineal membrane.
- Body is the "free part" where the corpora cavernosa meet medially.
- Glans is the exposed end of the body.
- Average clitoral length is between 2-5 cm, with significant interindividual variation.
- Bulbs of the vestibule lie lateral to the opening of the vagina (deep to the labia minora) and are connected to the glans of the clitoris:
- They comprise erectile tissues and are rich in vasculature; in fact, some authors classify them as corpus spongiosum and/or as components of the clitoral root.
- Greater vestibular glands (aka, Bartholins' glands); they release lubricating secretions during sexual arousal
- Muscles that overlie the erectile tissues:
- Ischiocavernosus overlies the crura of the clitoris.
- Bulbospongiosus overlies the bulb of the vestibule and the greater vestibular gland.
- Force blood into the body and glans of the clitoris during sexual arousal.
- Superficial transverse perineal muscles arise from the ischial bones and meet at the perineal body, which they help to stabilize.
Clinical Correlation:
- Episiotomies are surgical cuts through the perineum between the vagina and the anus to widen the vaginal opening during childbirth.
- Current research shows that most women do not need episiotomies and that the risks, which include infection, increased tearing, and, therefore, longer recovery times, outweigh the benefits in many cases.