Regional anatomy of the perineum

Regional anatomy of the perineumThe main topographical formations of the perineum. Fascia of the perineum. Ischioanal fossa
~ 2 min

Perineum (perineum) is a structure that covers the exit from the pelvic cavity. It has a rhomboid shape and has the following borders: the pubic symphysis anteriorly, the apex of the coccyx inferiorly, the lower branches of the pubis and ischium bones, as well as ischial tuberosities bilaterally.

In the center of the perineum, the so-called central tendon of the perineum (centrum tendineum) is located.

Central tendon (centrum tendineum) - male
Central tendon (centrum tendineum) – male
Central tendon (centrum tendineum) - female
Central tendon (centrum tendineum) – female

Median perineal raphe (raphe perinei) runs along the perineum in the anteroposterior direction.

Median perineal raphe (raphe perinei) - male
Median perineal raphe (raphe perinei) – male
Median perineal raphe (raphe perinei) - female
Median perineal raphe (raphe perinei) – female

The line that connects the ischial tuberosities divides the perineum into two important zones:

  • Urogenital diaphragm (regio urogenitalis)

  • Pelvic diaphragm / anal triangle (regio analis)

The perineal muscles are covered with several fasciae.

Fasciae
Fasciae

The superficial investing fascia of the perineum (fascia perinei superficialis) covers the superficial perineal muscles.

Superficial investing fascia (fascia perinei superficialis)
Superficial investing fascia (fascia perinei superficialis)

In men, it continues into the so-called superficial fascia of the penis.

In the posterior portion of the urogenital diaphragm, there is the inferior fascia of the pelvic diaphragm (fascia inferior diaphragmatis pelvis).

Inferior fascia of the pelvic diaphragm (fascia inferior diaphragmatis pelvis)
Inferior fascia of the pelvic diaphragm (fascia inferior diaphragmatis pelvis)

It fuses with the superior fascia of the pelvic diaphragm (fascia superior diaphragmatis pelvis), forming a thickening, the so-called tendinous arch of the levator ani muscle.

Superior fascia of the pelvic diaphragm (fascia superior diaphragmatis pelvis)
Superior fascia of the pelvic diaphragm (fascia superior diaphragmatis pelvis)

Deeper is the endopelvic fascia (fascia endopelvica), which has two sheaths: parietal and visceral.

The visceral sheath forms several thickenings or ligaments:

Endopelvic fascia (fascia endopelvica)
Endopelvic fascia (fascia endopelvica)

In men, these are the puboprostatic ligament (lig. puboprostaticum);

Puboprostatic ligament (lig. puboprostaticum)
Puboprostatic ligament (lig. puboprostaticum)

and the transverse ligament of the perineum (lig. transversum perinei). The deep dorsal vein of the penis passes through the latter.

In women, the fascia forms the pubovesical ligament (lig. pubovesicale).

Between the prostate gland and the bladder in front and the rectum in the back, men have a rectovesical septum (septum rectovesicale).

Rectovesical septum (septum rectovesicale)
Rectovesical septum (septum rectovesicale)

In women, such a septum is located between the rectum and the vagina and is called the rectovaginal septum (septum rectovaginale).

Rectovaginal septum (septum rectovaginale)
Rectovaginal septum (septum rectovaginale)

On the sides of the anus there is an ischiorectal (or anal) fossa (fossa ischiorectalis).

Ischiorectal (or anal) fossa (fossa ischiorectalis)
Ischiorectal (or anal) fossa (fossa ischiorectalis)

It is filled with fatty tissue, in which blood vessels pass. During defecation, it provides mobility of the pelvic diaphragm.

From above, it is delimited by the already mentioned tendinous arch. The lateral wall is formed by the obturator internus muscle and the ischial tuberosity.

The medial wall is formed by the levator ani muscle and the external anal sphincter

The posterior wall is formed by the posterior cords of the levator ani muscle and the ischiococcygeus muscle.

The ischiorectal fossa may be the site of inflammation.

Dictionary

Regional anatomy of the perineum

perineum
perineum
central tendon of the perineum
centrum tendineum
median perineal raphe
raphe perinei
urogenital diaphragm
regio urogenitalis
anal triangle
regio analis
superficial investing fascia of the perineum
fascia perinei superficialis
inferior fascia of the pelvic diaphragm
fascia inferior diaphragmatis pelvis
superior fascia of the pelvic diaphragm
fascia superior diaphragmatis pelvis
endopelvic fascia
fascia endopelvica
puboprostatic ligament
lig. puboprostaticum
transverse ligament of the perineum
lig. transversum perinei
pubovesical ligament
lig. pubovesicale
rectovesical septum
septum retrovesicale
rectovaginal septum
septum rectovaginale
ischiorectal fossa
fossa ischiorectalis
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