Handa 9781496386441 Full Sample Chap 1

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CHAPTER 1  Surgical Anatomy of the Female Pelvis

Obturator n. and vessels Superior vesical a.

Inferior epigastric vessels

Ovarian a. and v.

Ureteral a.

Round ligament of uterus

EIA

I

Ureter

IIA

Bladder

Uterine a. and vv.

Internal pudendal a. Inferior gluteal a.

Uterus

Rectum

FIGURE 1.11  Arteries and veins of the pelvis.

the canal can result in an indirect inguinal hernia or a hydrocele, which are rare conditions in women. Anterior to the pudendal cleft and below the mons, each labium majus joins to form the anterior commissure of the labia majora. The posterior commissure represents the ante- rior or upper part of the perineal body skin. The labia minora, vestibule, and glans of the clitoris can be seen between the two labia majora. The labia minora are hairless skin folds, each of which splits ante- riorly to run over, and under, the glans of the clitoris. The more anterior folds unite to form the distal end of the prepuce of the clitoris, which partially or completely covers the glans of the clitoris and is often called the hood of the clitoris; the posterior folds insert into the underside of the glans as the frenulum of the clitoris. Posteriorly, the labia minora join in the midline to form the frenulum of labia minora or fourchette.

VULVA AND ERECTILE STRUCTURES The pudendum or vulva is part of the female exter- nal genitalia and is found on the superficial pouch of the anterior perineal triangle ( FIGS. 1.12 to 1.14 ). The perineum can be divided into anterior and pos- terior triangles, which share a common base along a line between the ischial tuberosities (see FIG. 1.13 ). The outer boundaries of these triangles are those of the bony pelvic outlet: the pubic arch and ischiopubic rami anterolaterally and the sacrotuberous ligament and coccyx posterolaterally. The tissues filling the anterior triangle ( TABLE 1.2 ) have a layered structure similar to that of the abdominal wall. More specifically, there is a skin and subcutaneous tissue overlying a fascial layer (perineal membrane). The superior boundary of both anterior and posterior perineal triangles is the inferior fascia of the levator ani muscles. Subcutaneous Tissues of the Vulva The structures of the vulva lie on the pubic bones and extend posteriorly under the pubic arch ( FIG. 1.12 ). They consist of the mons, labia, vestibule, clitoris, and associated erectile structures and their muscles. The mons consists of hair-bearing skin over a cushion of adipose tissue that lies on the pubic bones. Extending posteriorly from the mons, the labia majora are composed of similar hair-bearing skin and adipose tissue, which contain the termination of the round ligaments of the uterus and the obliterated vaginal process (canal of Nuck). The round ligament can give rise to leiomyomas in this region, and the obliterated vaginal process can be a dilated embry- onic remnant in the adult. Incomplete obliteration of

Prepuce of clitoris

Glans of clitoris

Frenulum of clitoris

Skene duct opening External urethral opening

Labium majus

Labium minus Copyright © 2019 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Vagina

Hymen Forchette

Bartholin gland opening

Anus

FIGURE 1.12  External genitalia.

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