Learning Objectives Pelvic Walls and Floor a.Understand the position, attachments and major divisions of the pelvic diaphragm. b.Define the difference.

Learning Objectives

Pelvic Walls and Floor

a. Understand the position, attachments and major divisions of the pelvic diaphragm.

b. Define the difference between levator ani muscle and pelvic diaphragm.

c. Understand how the pelvic and urogenital diaphragms close the pelvic outlet.

d. Describe the relationship of pelvic organs to the pelvic and urogenital diaphragms.

e. Describe the distribution of the branches of the internal iliac artery.

f. Describe the arrangement and distribution of pelvic autonomic nerves.

g. Describe the pelvic position of the sacral plexus and understand how the major nerves from this plexus exit the pelvic cavity.

Anorectal hiatus

Urethral hiatus

Tendinous arch

Piriformis m.

(Ischio)coccygeus m.

Iliococcygeus m.

Puborectalis m.

Pubococcygeus m.

Obturator internus m.

Plate 340

Superior fasca UG diaphragm

Plate 338

Urethra

Vagina

Rectum

Piriformis m.

Tendinous arch

Pubococcygeus m.

Iliococcygeus m.

(Ischio)coccygeus m.

Plate 338

Rectum

VaginaUrethra

Piriformis m.

Obturator internus m.

Tendinous arch

(Ischio)coccygues m.

Iliococcygues m.

Pubococcygeus m.

Puborectalis muscle

Moore et al; Fig. 3.12

Plate 372

Fat in ischioanal fossa

Obturator internus m.

Levator ani m. (iliococcyxageus)

Pudenal canal with pudendal n, internal pudendal a. and v.

Rectum

Anal canal

Plate 363

Superficial transverse perineal m.

Urethra

Deep artery of penisDorsal artery of penis

Deep dorsal vein of penis

Dorsal nerve of penis

Duct of bulbourethral gland

Artery of bulb of penis

Ischial tuberosity

Netter,Plate 487Levator ani m.

(Ischio)coccygeus m.

Pelvic splanchnic nn.

Gray rami communicantes

Sympathetic trunk

Sacralsplanchnic nn.

S4 nerve supply to muscles of pelvic diaphragm

Plate 382

L. Common iliac a.

L. Internal iliac a.

Uterine a.

Obturator a.

Umbilical a.

Sup. vesical aa.

Inf vesical aa.

Middle rectal a.

Internal pudendal a.

Inf. Gluteal a.

Sup. gluteal a.

Lateralsacral aa.

Iliolumbar a.

Plate 382

Rt. Internal iliac a.

Sup. gluteal a.

Piriformis m.

Inf. Gluteal a.

Internal pudendal a.

Middle rectal a.

Uterine a.

Umbilical a.

Obturator a.

Ureter

Plate 344

Supravaginal part of cervix

Ureter

URINARYBLADDER

Uterine artery in transversecervical ligament

Plate 383

Obturator a.

Umbilical a.

Prostatic venous plexus

Inf. vesical a.

IInternalpudendal a.

Inf. gluteal a.

Sup. gluteal a.

Plate 390

Pelvic splanchnic nn.

Ventral ramus, S1

Gray rami communicantesSuperior hypograstic plexus

Lumbar splanchnic nn.

Inferior hypogastric plexus

Prostatic plexus

Vesical plexus Pudendal n.

Prevertebral ganglia(sympathetic)

Left hypogastric n.

Plate 392

Rt. and left hypogastric nn. Superior hypogstric plexus

Inferior hypogastric plexusSacral splanchnic nn.

Pelvic splanchnic n

Lumbar splanchnic nn.

Gray ramus communicantes

Plate 388

Superficial inguinal nodes

Deep ingiunal nodes

External iliac nodes

Plate 386

MALE SEX RESPONSE

1. Erection (Parasympathetic)

a. Engorgement of erectile tissues b. Contraction of perineal muscles

2. Emission (Sympathetic)

a. Contraction of smooth muscle in ductus deferens, prostate gland, seminal vesicles

b. Contraction of internal urethral sphincter c. Release of secretions of testes, prostate gland,

seminal vesicles and bulbourethral glands

3. Ejaculation (Somatic) a. Rhythmic, spasmodic contraction of perineal

muscles, levator ani, external anal sphincter, gluteal muscles

b. Propulsion of semen along penile urethra c. Initiated by secretions entering penile urethra

4. Detumescence/Resolution (Sympathetic)

a. Return of erectile tissues to flaccid state b. Involves a refractory period

FEMALE SEX RESPONSE

1. Arousal/Excitement (Parasympathetic) a. Increased secretions; vestibular and vaginal b. Erection of clitoris

2. Plateau --minutes to hours (Sympathetic)

a. General vascular engorgement (clitoris, labia, breast, lower vagina)

b. Erection of nipples c. “Sex flush”; reddish vascular flushing of skin

over breasts, chest d. Dilation of upper vagina e. Uterine “tenting”

3. Orgasm (Somatic)

a. Rhythmic contractions of perineal muscles (~1 second intervals)

b. Number of and intensity of rhythmic contractions highly variable

c. Dilation of cervix d. Uterine contractions (due to release of oxytocin) e. Uterine “dipping”

4. Resolution (Sympathetic)

a. Return to pre-excitement stage b. No refractory period