Fascia of the perineum
Last reviewed: 23.04.2024
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The superficial fascia of the perineum, the upper and lower fascia of the pelvic diaphragm, and the upper and lower fascia of the urogenital diaphragm are isolated.
The superficial (subcutaneous) fascia of the perineum (fascia perinei superficialis) is weakly expressed and is a continuation of the general subcutaneous fascia covering the adjacent parts of the body. This fascia comes from below (outside) to the superficial muscles of the urogenital diaphragm, fuses with their own fascia. In front of men, the superficial fascia of the perineum continues into the superficial fascia of the penis. On the sides it grows to the buttocks. In the posterior part of the perineum, under the superficial fascia of the perineum is the lower fascia diaphragm of the pelvis (fascia diaphragmatis pelvis inferior). This fascia fuses with its own fascia of the gluteus maximus and lines the sciatic-rectum fossa. In the fossa, the fascia covers the outer surface of the occlusal muscle, reaches the tip of the ischial-rectal fossa, and then passes to the outer surface of the muscle that lifts the anus. Passing to the outer surface of the external sphincter of the anus, the lower fascia of the pelvic diaphragm ends in the cellulose surrounding the anus. Front fascia reaches the posterior edge of the urogenital diaphragm, where it connects with its lower and upper fascia. Above (from the side of the pelvic cavity), the muscle lifting the anus is covered with the fascia diaphragmatis pelvis superior fascia. Thus, the muscle that raises the anus, as well as the external sphincter of the anus along with the underlying lower and upper fascia of the pelvic diaphragm form a muscular-fascial plate - the diaphragm pelvis.
In the anterior crotch, the lower fascia of the genitourinary diaphragm (fascia diaphragmatis urogenitalis inferior) is located between the superficial and deep muscles, covering the bottom (outside) the deep transverse muscle of the perineum, as well as the sphincter of the urethra. On top of these muscles lies the upper fascia of the genitourinary diaphragm (fascia diaphragmatis urogenitalis superior). Between the named fascia are bulbourethral (Cooper's) glands in men and large glands of the vestibule (Bartholin's) in women. The upper and lower fascia of the urogenital diaphragm fuse along the sides with the periosteum of the lower branches of the sciatic and pubic bones, and under the pubic symphysis - with each other, resulting in a transverse ligament of the perineum (lig. Transversum perinei). This ligament is in front of the membranous part of the urethra and does not reach the arcuate ligament of the pubis. Due to this, there is a narrow gap between the two ligaments through which the dorsal vein and the arteries of the penis or clitoris pass.
The superior fascia of the diaphragm of the pelvis is the lower part of the fascia pelvis (fascia pelvis). In the cavity of the small pelvis, between the organs located in it, there are bundles of connective tissue, connective tissue partitions, known as the visceral fascia of the pelvis. In front between the pubic symphysis and the lower part of the bladder, connective tissue bundles form in men paired pubic-papular (pubic-prostate) ligaments (ligg. Pubovesicales, s.puboprostatices). Between the bladder and rectum in men, connective tissue bundles form a frontal plate - the rectal-vesicle septum (septum rectovesicale). In women between the rectum and the vagina, bundles of connective tissue form a transversely lying rectum-vaginal septum (septum rectovaginale).
The female crotch has some characteristic features. Thus, the urogenital diaphragm in women is wider, through it passes not only the urethra, but also the vagina. The muscles of this region are weaker than the muscles of the same name in men. The paired surface transverse muscle of the perineum is often absent. The deep transverse muscle of the perineum is also weakly developed. Both fascia (upper and lower) of the urogenital diaphragm in women, on the contrary, are more durable. Muscular bundles of the sphincter of the female urethra cover the vagina, woven into its walls. The tendinous center of the perineum is located between the vagina and the anus, consisting of intertwining tendon and elastic fibers.
Sedamic and rectal (anal) fossa. In the perineal region, on each side of the posterior opening, there is a paired depression - the sciatic-rectum fossa (fossa ischiorectalis, s.ischioanalis). It has a prismatic shape, is filled with fatty tissue, widely open to the bottom and tapers upward, contains vessels and nerves. On a section drawn in the frontal plane, it looks like a triangle, the top of which is turned upwards, toward the pelvic cavity. The apex of the ischial-rectal fossa corresponds to the lower edge of the tendon arch of the pelvic fasciae (arcus tendineus fasciae pelvis). The lateral wall of the ischial-rectal fossa forms a fascia covered by the internal occlusive muscle and the inner surface of the ischial tuber. The medial wall of the fossa is limited by the external surface of the muscle, which raises the anus and the external sphincter of the anus, covered with the lower fascia of the pelvic diaphragm. The back wall of the ischial-rectal fossa is formed by the posterior fascicles of the muscle that raises the anus and the coccygeal muscle. The anterior wall of the ischial-rectal fossa is the transverse muscles of the perineum. Fatty tissue, filling the cavity of the sciatic-rectum fossa, serves as an elastic elastic cushion.
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