The perineum is located between the symphysis pubis, the top of the coccyx, and the sciatic tubercles. The fibers of the levator ani muscle make up the main part of the perineal tissues. What exactly is the perineum? When is an episiotomy performed? What diseases of the perineum can affect men, and what can women face?

The perineumis formed from the urogenital septum that separates the urogenital sinus and the rectum. The perineum includes the soft tissues lying between the posterior commissure of the labia and the anterior edge of the anus. The line connecting the sciatic tubercles divides the perineum into two triangles: urogenital and rectal.

Perineum - perineal muscles

The muscles that make up the urogenital diaphragm are located between the branches of the ischial bones and the lower branches of the pubic bones. The superficial transverse muscle of the perineum runs in the intersphenoid line, stretched on both sides between the sciatic tumor and the tendon center of the perineum. This muscle shows great variability.

The tendon lies in the central part of the perineum. It is a connective tissue node located in the middle between the anus and the posterior edge of the urogenital diaphragm. It is made of intertwining fibers of connective and muscle tissue. It is the site of attachment of many superficial and deep transverse muscles of the perineum and bulbar spongy muscles, the muscle of the external urethral sphincter, the levator ani muscle and the external anal sphincter.

The bulbar-spongy muscle begins in the tendon center of the perineum and mainly in women is a flat muscle band in the extension of the external anal sphincter muscle. It covers the vestibule on both sides, adjacent to the vestibule from the outside and ends at the clitoris. Intertwining with the fibers of the anal sphincter, it runs in a figure eight around the natural openings.

In men, it starts at the tendon center of the perineum and covers the penis. It ends in the whitish membrane of the spongy body and the corpus cavernosum. The sciatic cavernous muscle begins on the sciatic tumor, runs along the limb of the penis or the clitoris, ends in men on the dorsal side in the whitish membrane of the cavernous body of the penis, in women on the clitoris.

Superficial perineal fascia

Fascias are the membranes made of fibrous connective tissue that surround individual muscles, groupsmuscles or even the entire body muscles.

Both pelvic diaphragms, as well as the inner surface of the pelvic cavity and the viscera inside it, are covered with fascia. The surface fascia of the perineum is present only in the front part of the pelvic floor.

At the back, it attaches to the posterior edge of the fascia of the genitourinary diaphragm. Moving forward, it covers the bulbospongous muscle and the sciatic cavernous muscles and becomes the deep fascia of the penis or clitoris.

Vessels and lymph nodes of the perineum and external genitalia

Lymph vessels of the perineum, skin of the penis and the scrotum, clitoris, labia majora, accompany mainly the external labia blood vessels and enter the horizontal band of the superficial inguinal nodes. They may partially reach the deep inguinal nodes.

The deep vessels of the penis, bypassing the inguinal nodes, also go to the internal iliac nodes.

The arteries supply the perineum with oxygen-rich and nutrient-rich blood. The main arterial vessel supplying the perineum is the internal labia artery. It departs from the internal iliac artery. It gives away branches: inferior rectal artery and perineal artery, atrial bulb artery.

The main arterial vessel divides into two terminal branches: the dorsal artery and the deep clitoral artery.

Inferior external external vulvar artery, which are branches of the femoral artery, also supply the perineal area - the greater labia vascularize. Deoxygenated venous blood is drained from the perineal area mainly through the branches of the external iliac vein.

The outflow from the cavernous bodies of the clitoris, which donate venous blood thanks to the deep clitoral vein, looks different, then to the peri-bladder venous plexuses and the external vulva. Ultimately, the blood goes to the saphenous vein.

Perineal innervation

The genital nerve is mainly responsible for the innervation of the perineum, i.e. the possibility of experiencing pain or other ailments.

It comes out of the pelvis through the pinhole. It wraps around the sciatic spine and runs to the smaller sciatic opening. In the small pelvis, it goes along the inner surface of the sciatic tumor. It donates lower rectal and perineal nerves.

Branches of the vulva:

  • inferior rectal nerve - innervates the skin around the anus, as well as the rectal mucosa below the dorsal line and the anal sphincter
  • perineal nerve - supplies the muscles of the pelvic diaphragm, the urogenital diaphragm, the lower vagina and the posterior part of the labia majora
  • nervedorsal clitoris ends in the glans clitoris

Anterior labial ramifications of the ilioinguinal nerve along with the genitourinary nerve innervate the anterior part of the labia majora and the pubic mound.

Crotch incision

The most important purpose of an episiotomy is to protect the external anal sphincter muscle, the rupture of which is a common complication of a large baby. It is imperative to use the correct surgical technique in the perineal incision and to decide on this step only when it is absolutely necessary. Surgical incision of the perineum is to prevent spontaneous tissue rupture.

First degree fractures damage the back wall of the vagina and possibly the skin. When the muscles of the perineum are torn, but without damaging the external anal sphincter, we speak of a second degree tear. The most extensive tear of the perineum with damage to the rectal mucosa is a third degree tear.

According to some obstetricians, the episiotomy also protects the head of the fetus from rapid expansion when it leaves the genital tract, and therefore reduces the frequency of other perinatal injuries.

Properly performed perineal incision requires the selection of appropriate anesthesia and incision while stretching the tissues through the anterior part. The most common line of incision is in the medial lateral direction - around five or seven o'clock.

After suturing is complete, the doctor checks the suture line for bleeding. The patient should have a rectal examination to exclude the presence of a rectovaginal hematoma and to prevent the formation of a fistula.

Perineal pain in women

Perineal pain in pregnancy

Pain in the perineum in pregnancy occurs most often in the third trimester, close to the due date. Observed before delivery, it is associated with pressure on the baby's head. It may also be caused by loosening of ligaments under the influence of relaxin. Women usually experience pain when walking or sitting for long periods. Consult a doctor about all symptoms.

Pain during intercourse

Pain during intercourse may be associated with a too dry vagina, an intimate infection, an allergic reaction or vaginismus. Pain may also appear in women suffering from endometriosis, i.e. the growth of endometrial cells outside the uterine cavity.

Inflammation of the pelvis, which causes perineal pain, can be caused by a variety of factors. We distinguish:

  • chlamydiosis - the main symptoms are burning during micturition, pain during sexual intercourse, bleeding after intercourse, pain in the arealower abdomen
  • gonorrhea - this condition is characterized by purulent discharge from the urethra, pain and burning in the urethra, infection and itching around the anus
  • trichomoniasis - abundant discharge with an unpleasant smell, pain may appear
  • genital herpes, which is characterized by burning, blistering - when ruptured, it can ulcerate and be painful.
  • Vulva - structure, functions, diseases
  • The appearance of the genitals indicates sexual TEMPERAMENT
  • Labia: why labia hurt?

Male perineal abnormalities

Chronic prostatitis is a very common disease, most often it affects men aged 35-50. The diagnosis is made when the symptoms of prostatitis last longer than 3 months.

A characteristic symptom is pain usually felt in the perineum, the root of the penis, around the anus, and in the lower back. The symptoms of the disease are less severe than in the case of acute inflammation, which is dominated by severe pain in the lower abdomen and perineum, fever and nausea.

Pain also accompanies injuries to the scrotum. After the injury, the testicle may rupture, and there is a likelihood of a hematoma pressing against the gonad. In both of these cases, surgical intervention is necessary.

Testicular torsion is a condition involving twisting of the spermatic cord, i.e. blood vessels, nerves and the vas deferens as the testicle rotates around its axis. The torsion of the spermatic cord cuts off the blood supply to the testicle, resulting in pain, swelling, redness and, over time, the death of the testicle.

After 4 hours, irreversible necrotic changes in the testicle begin to form - a quick operation is needed, during which the testicle will be unscrewed. Time plays a major role - a twist lasting more than 24 hours will always result in the death of the testicle.

Testicular inflammation and epididymitis are usually acute diseases. Within a few days there is pain in the scrotum, usually unilateral, swelling, pain in the perineum. It may be accompanied by a urinary tract infection.

Testicular inflammation associated with viral parotitis, or mumps, is the most common form of testicular inflammation. Bacterial infections, on the other hand, are more common in older men and children.

Sexually transmitted diseases are another cause of inflammation. Common triggers are gonorrhea and chlamydia.

  • Male reproductive system: structure and functions
  • Genital diseases in men

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