-
bony pelvis
- protects viscera
- trasfers weight
- withstands compression
- provides attachement for muscles
-
Hip bone
- ilium, ischium, and pubis
- held together by cartilage at the acetabulum prior to puberty
-
ilium
- ala- fan shape
- iliac crest- superior rim of ala
- ASIS/PSIS- projections off the iliac crest
- iliac fossa- anterior concave portion of ala
- body- "handle of fan", contributes to acetabulum
- auricular surface- articulates with sacrum
-
ischium
- body- contributes to acetabulum
- ramus- inferior margin of obturator foramen
- ishcial tuberosity- large posterioinferior protuberance
- ischial spine- small pointed projection
- lesser sciatic notch- b/t ischial spine and iscial tuberosity
- greater sciatic notch- superior to ischial spine
-
pubis
- superior ramus- forms part of acetabulum
- inferior ramus- anteromedial part of obturator foramen
- pubic crest- on anterior part of body of pubis
- pubic tubercle- bump on lateral edge of pubic crest
- pectin pubis - ridge lateral on superior ramus
-
sacrum
- fused
- initially 5 separate vertebra
-
coccyx
- fused
- initially 4 vertebra
-
pelvic girdle
- pubic symphysis- fibrocartilage
- -pubic arch- inferior pubic rami and ischial rami, forms subpubic angle
- sacroiliac joints- where hip bones articulate with sacrum
-
pelvis in anatomical position
- ASIS and pubic symphysis in same vertical plane
- pelvic canal curves obliquely posterior to abdominal cavity
-
pelvic inlet
- superior pelvic aperature, open to abdominal cavity
- bound by the pelvic brim: sacral promontory, ala, ilial arcuate line, superior pubic ramus and pubic symphysis
-
pelvic outlet
- closed by muscular pelvic diaphragm
- bound by: pubic arch, ischial tuberosities, sacrotuberous lig, tip of coccyx
-
greater pelvis
- "false pelvis"
- superior to pelvic inlet
- inferior portion of abdominal cavity
- contains abcominal viscera
-
lesser pelvis
- "true pelvis"
- b/t pelvic inlet and outlet
- contains pelvic viscera
-
male pelvis vs female pelvis
- male
- heavier, thicker
- narrow/deep lesser pelvis
- subpubic andle <60
- female
- wider, shallower
- round/oval pelvic inlet
- subpubic angle >90
-
pelvic fractures
- anteroposterior compression= pubic rami compressiosn
- lateral compression= acetabula and ilia fractures
- can occur from ligaments being riped away
- most likely cause damage to viscera
-
sacroiliac joint
- weight bearing b/t sacrum and ilium
- posterior syndesmosis
- anterior synovial joint
- movements: gliding and rotation
-
anterior sacroiliac lig
anterior part of capsule
-
interosseus sacroiliac lig
between tuberosities, responsible for weight transfer
-
posterior sacroiliac lig
draws ilia inward with axial weight, locks ilia and sacrum together
-
sacrotuberous lig
from lateral sacrum to ishcial tuberosity
-
sacrospinous lig
- from lateral sacrum to ischial spine
- limits upward movement of sacrum
-
lumbosacral joint
- anterior- IVD L5-S1
- posterior- zygapophyseal joints b/t L5-S1
-
iliolumbar lig
L5 TP to medial surface of ilial ala
-
sacrococcygeal joint
- fibrocartilage disc b/t apex of sacrum and coccyx
- strenthened by anterior and posterior sacrococcygeal ligs
-
pubic symphysis
- fibrocartilage disc b/t pubic bones
- thickend by pubic ligs
- superior pubic lig- pubic symphysis to pubic tubercles
- inferior pubic lig- surrounds subpubic angle
-
pelvic changes during pregnancy
- increased sex hormones and relaxin= freer movements
- sacroiliac jonit loosens
- interpubic disc relaxes
- pelvic diameter increases
-
anterior pelvic wall
bodies and rami of pubic bones and pubic symphysis
-
lateral pelvic walls
- hip bones with obturator foramen
- - closed by obturator membrane
-
obturator internus muscle
- O: internal surface of obturator membrane, ilium, and ischium
- I: greater trochanter of femur
- N: nerve to obturator internus (L5-S2)
- A: laterally rotates thigh, holds head of femur in place
- passes through lesser sciatic foramen
-
posterior pelvic wall
sacrum, coccyx, sacroiliac joints, ligaments
-
piriformis muscle
- O: 2-4th sacral segments and sacrotuberous ligs
- I: greater trochanter of femur
- thru greater sciatic foramen
- N: S1-2 rami
- A: laterally rotates and adducts thigh, fold femur in place
-
pelvic floor
- formed by pelvic diaphragm
- funnel shaped
- separates pelvic cavity from perineum
-
levator ani muscle
- supports abdominopelvic viscera
- N: S4 ventral rami and inferior rectal N
- A: raise pelciv floor, compress abdominopelvic contents
- made up of puborectalis M, pubococcygeus M, and iliococcygeus M
-
puborectalis M
- medial portion of levator ani M
- u-shaped ring from R/L pubic bones to anorectal junction
- surrounds urogenital hiatus
- creates perineal flexure
-
pubococcygeus M
- intermediate part of levator ani M
- from pubis to coccyx
-
iliococcygeus M
- posterolateral portion of levator ani muscle
- from posteior part of tendinous arch to coccyx
-
coccygeus muscle
- from ischial spine to inferior sacrum and coccyx, on pelvic surface of sacrospinous lig
- N: S4-5 rami
- A: contributes to levator ani actions
-
pelvic fascia
- CT between parietal peritoneum and muscular pelvic wall
- continuous wiht endoabdominal fascia
-
parietal pelvic fascia
- lines pelvic surface of muscles on pelvic floor and walls
- covers obtuator internus, piriformis, coccygeus, and levator ani
-
visceral pelvic fascia
- adventitial layer around pelvic organs
- accommodates for distension
- continuous with parietal fascia were pelvic organ penetrates floor
-
tendinous arch of pelvic fascia
- from pubis to sacrum
- in males: puboprostatic lig from prostate to pubis, sacrogenital lig from sacrum to prostate
- in females: pubovesical lig from bladder to pubis, sacrogenital lig from sacrum to vagina
-
Perineum
- inferior to pelvic outlet
- between mons pubis, proximal thigh, and gluteal folds
- subdivided by transverse line thru ischial tuberosities
-
anal triangel
- posterior to isch tub transverse line
- contains anus and 2 ischioanal fossa
-
urogenital triangel
- anterior to transverse line
- covered by perineal membrane
- contains genitalia
-
perineal body
- fibromuscular tissue at midpoint of transverse line
- -posterior to genitalia
- -anterior to anus
- attaches to posterior border of perineal membrane
- attachment point for superficial and deep transverse perineal Ms and external urethral sphincter
-
perineal membrane
- closes anterior opening in pelvic diaphragm
- attachment point for erectile bodies of genetalia
- perforated by urethra and vagina
-
superficial and deep transverse perineal mus
- spans posterior perineal membrane
- N: deep perineal N
- A: anchor perineal body, support pelvic floor
-
external urethral sphincter
- surrounds urethra superior to perineal membrane
- N: dorsal N of penis/clitoris
- A: constrict urethra
-
penis
male copulator organ (urine and sperm)
-
root of penis
- in superficial perineal pouch
- attached to perineal membrane
- contains crura and bulb of penis
-
crura of penis
- bilateral masses of erectile tissue
- attach to ischial ramus
- continuous with corpus cavernosa in penis
- surrounded by ischiocavernosus M
-
ischiocavernosus M
- surround crura of penis
- N: deep perineal N
- A: contraction forces blood from crus into corpus cavernosum causing an erection
- -also compresses deep dorsal V of penis
-
bulb of penis
- central mass of erectile tissue
- inferior to perineal membrane
- penetrated by spongy urethra
- continuous with corpus spongiosum in penis
- surrounded by bulbospongiosus M
-
bulbospongiosus M
- surrounds bulb of penis
- N: deep perineal N
- A: contraction moves blood from bulp into corpus spongiossu causing an erection
- -compresses deep dorsal V of penis
- -empties urethra
-
body of penis
- suspended from pubis by suspensory lig of penis
- contains no muscles
- contains 3 cylinders of erectile tissue
-
corpus spongiosum
- single column located ventrally in penis
- surrounds spongy urethra
- thinner tunica albuginia so urethra isnt constricted during erection
- expends distally to form glans penis
-
corpus cavernosus
- two dorsal columns in penis
- fused in midline
- surrounded by thick tunica albuginea
- dont extend into glans penis
-
glans penis
distal expansion of corpus spongiosus forming head of penis
-
corona of glans
expanded rim beyond corpus cavernosus
-
neck of glans
constriction between corona and body
-
prepuce
- foreskin, double layered skin covering glans
- held to glans by frenulum of prepuce
-
external urethral orifice
distal opening of urethra from glans
-
superficial penile fascia
- thin fascia layer adjacent to skin
- allows for mobility of skin on penis
- contains neurovasculature
-
deep penile fascia
- surrounds corpus cavernosum and spongiosum
- contains deep dorsal neurovasculature
-
suspensory lig of penis
- pubic symphysis to root of penis
- fuses with deep penile fascia
- anchor erectile bodies
-
arterial supply to penis
- internal pudendal A- to penile tissue
- - dorsal A of penis- b/t deep penile fascia and tunica albuginea, supplies fascial CT and penile skin
- - deep A of penis- thru center of prpus cavernosus, causes erection
- -A of bulb- supplies bulb, corpus spongiosus, and spongy urethra
- external pudendal A- proximal penile skin
-
Veins of penis
- deep dorsal V of penis- in deep penile fascia, drains erectile tissue
- superficial dorsal V of penis- in superficial fascia, drains skin
-
innervation of penis
- dorsal N of penis
- terminal branch of pudendal N
- parallels dorsal A and deep dorsal V
- sensory to skin and glans
- cavernosus N
- parasymphathetics from prostatic plexus
- innervate deep A, causes erection
-
Vulva
- includes mons pubis, labia majora, labia minora, clitoris, vestibule of vagina, bulb of vestibule, and greater vestibular glands
- Functions: sensory for sexual arousal/intercourse, directs flow of urine, prevents entry of foreign material
-
mons pubis
fatty prominance anterior to pubic symphysis
-
labia majora
- large skin folds on either side of pudendal cleft
- protect clitoris, urethral and vaginal orifices
- extends from mons pubis to anus
- round lig of uterus terminates here
-
labia minora
- folds of skin medial to labia majora
- surrounds vestibule of the vagina
- from clitoris to frenulum of labia minora
- homologus to penis skin
-
clitoris
- erectile tissue
- located at anterior meeting of labia minora
- root: 2 crura surrounded by ischiocavernosa M
- body: comprised of 2 corpus cavernosa
- glans: sole purpose = sexual arousal
-
vestibule of vagina
- b/t labia minora
- contains external urethral orifice and vaginal orifice
-
hymen
- mucous membrane covering vaginal orifice
- usually cresent shaped posteriorly
- obliterated after coitus
-
bulb of vestibule
- paired masses of erectile tissue deep to labia minora
- covered by bulbospongiosus M
- continuous with glans of clitoris
-
vestibular glands
- on each side of vestibule posteriolateral to vagina
- -bulbourethral glands
- surrounded by bulbospongiosus M
- open into vestibule near vaginal orifice
- secrete mucous during arousal
-
arterial supply to vulva
- external pudendal A- skin and superficial fascia
- internal pudendal A- erectile tissue in clitoris
- -branches to deep A of clitoris
-
venous drainage of vulva
internal pudendal V to internal iliac V
-
innervation of vulva
- somatic
- ilioinguinal N- anterior labial N
- genitofemoral N to anteriolateral perineum
- pudendal N- posterior labial N
- parasympathetics
- cavernous N from urovaginal N plexus, increase vaginal secretions, erection
-
female circumcision
- illegal/discourage
- removes prepuce, clitoris, and labia minora which inhibits sexual arousal/gratification
-
pudendal N block
- relieves pain during child birth
- injection to N across sacrospinous lig
- coupled with ilioinguinal N block
-
superficial perineal fascia
- fatty superficial layer continuous with camper's fascia
- females- into labia majora and mons pubis
- males- reduced, replaced by smooth muscle
- membransous deep layer= colle's fascia
- posterior attachement to perineal body
- laterally to fascia lata
- continous with darto's fascia
-
deep perineal fascia
- contains ischiocavernosus M, bulbospongiosus M, and superficial transverse perineal M
- laterally to ischiopubic rami
- fuses anteriorly with suspensory lig
-
superficial perineal pouch
- space between colle's fascia and perineal membrane
- female- crura, M, bulb of vestibule, M, greater vestibule glands, superiror transverse perineal M, internal pudendal A/V, pudendal N
- males- crura and bulb, Ms, spongy urethra, superior transverse perineal M, internal pudendal A/V, pudendal N
-
deep perineal pouch
- above perineal membrane
- open to ischioanal fossa
- contains: membranous urethra, bulbourethra glands, external urethra sphincter, deep transverse perineal M,
-
internal iliac A branches
- umbilical A
- obturator A
- inferior vesical A
- vaginal A
- middle rectal A
- internal pudendal A
- inferior gluteal A
- iliolumbar A
- lateral sacral A
- superior gluteal A
-
ovarian A
- from abdominal aorta
- retroperitoneal, anterior to ureter
- thru suspensory lig of ovary
- to ovary and uterine tubes
- anastomoses with uterine A
-
testicular A
- from abdominal aorta
- enters deep inguinal ring thru inguinal canal to scrotum
- to testis and epididymis
-
median sacral A
- off aorta b/t common ilia As
- caudal end of embryonic aorta
-
superior rectal A
- terminal branch of inferior mesenteric A
- to superior rectum
-
pelvic veins
- internal iliac V
- primary pelvic drainage
- to common iliac V
- pelvic venous plexus
- around rectum, urinary bladder, prostate, uterus, and vagina
- drains to internal iliac
- pathway for prostate/ovarian cancer
-
pelvic somatic nerves
- lumbar plexus Ns
- obturator N: from L2-4, enters along psoas major M, goes to obturator canal, splits into anterior and posterior divisions
- lumbosacral trunk: from L4-5, anterior to sacral ala to form sacral plexus
-
sacral plexus Ns
- sciatic N- L4-S3, thru greater sciatic foramen below piriformis, to posterior thigh, all of leg and foot
- pudendal N- S2-4, motor and sensory to perineum, becomes dorsal N of penis/clitoris
- Superior glueteal N- L4-S2, greater sciatic foramen, to gluteus medius, minimus, and tensor fascia lata
- inferior gluteal N- L5-S2, greater sciatic foramen, to gluteus maximus
- coccygeal plexus Ns- S4-5, on coccygeus M, to coccygeus and levator ani M
-
sympathetics (pelvis)
- sacral sympathetic trunk
- continuation of lumbar sympathetic trunks
- ganglion impar
- vasomotor, sudomotor, pilomotor
-
parasympathetics (pelvis)- pelvic splanchnic N
- S2-4 presynaptic
- motor to bladder and rectum
- produces erection
- visceral afferents
-
superior hypogastric plexus
- symps from lumbar splanchnic N= vasomotor
- parasymps from pelvic splanchnic N
- - connect superior and inferior hypogastric plexuses
-
inferior hypogastric plexus
- hypgastric and pelvic splanchnic Ns
- female- ovary, uterine tubes, uterus, vagina, clitoris erectile tissue
- male- prostate, seminal vesical, penile erectile tissue
- rectum and urinary bladder
-
ureter
- from kidney to bladder
- retroperitoneal
- enters bladdder obliquely on inferior surface
- A: female- uterine , male- inferior vesical
- V: same as arteries
- N: symps- T11-L2 renal, aortic, hypogastric plexuses
-
urinary bladder
- extraperitoneal, posterior to retropubic space
- A: superior vesical A to superior bladder
- male- inferior vesical A to fundus and neck
- female- vaginal A to fundus and neck
- N: parasymps- S2-4 pelvic splanchnics, motor to detrusor M, inhibit sphincter, stimulated by distension
- symps- T11-L2 splanchnic Ns, causes contraction of sphincter during ejaculation
-
structure of urinary bladder
- apex- anterior, points toward pubic symphysis
- body- central region
- fundus- posterior wall
- neck- inferior outflow region
-
detrusor N
- most of urinary bladder wall
- thickens at neck forming internal urethral sphincter
-
trigone
- trangle, 2 ureter openings and internal urethral opening
- uvula- rounded eminence in trigone
-
male retrovesical pouch
between bladder and rectum
-
female vesicouterine pouch
between bladder and uterus
-
female rectouterine pouch
between uterus and rectum
-
female urethra
- 4 cm long
- anterior and parallel to the vagina
- A/V: internal pudendal and vaginal
- N: autonaumics in pudendal N
- L: internal iliac and sacral nodes
-
male urethra
- 18 cm long
- semen and urine
- intramural urethra- in neck of bladder
- prostatic urethra- thru prostate
- membranous urethra- thru deep perineal pouch and perineal membrane
- spongy urethra- in penis
-
prostatic urethra
- urethral crest- median ridge, continuous with uvula
- prostatic sinus- grooves along crest, opening of prostatic ducts
- seminal colliculus- in middle of crest
- prostatic urtricle- slit in colliculus, vestigial vagina
- ejaculatory ducts- in/near prostatic utricle
-
ductus deferens
- tail of epididymis to duct of seminal vesical
- A: superior vesical or inferior vesical A
- V: prostatic venous plexus
- L: external iliac nodes
- N: symps- lumbar splanchnic and hypogastric plexus- contraction for expulsion of sperm
- parasymps- pelcic splanchnic and hypogastric plexus- unknown function
-
ejactulatory duct
- joining of ductus deferens and duct of seminal vesical
- ampulla= enlargement of ductus deferens
- convey sperm thru prostate to urethra in prostatic utricle
- A: inferior vesical A
- N: autonaumics via inferior hypogastric plexus
-
seminal vesicals
- between fundus of bladder and rectum, superior to prostate
- secretes thick alkaline fluid to form semen
- makes up 80% of semen volume
- lots of fructose for energy
- A/V: inferior vesical
- N: symps- lumbar splanchnic/hypogastric plexus- contracts during emission
- parasymps- pelvic splanchnic/hypogastric pleus- unknown function
-
prostate
- 2/3 glandular, 1/3 fibromuscular
- around prostatic urethra
- prostatic ducts- open into prostatic sinuses
- prostatic secretions- thin, milky, 20% of semen volume, enzymatic ability
- A: prostatic A off inferior vesical A
- N: symps- lumbar splanchnic/inferior hypogastric plexus- contraction during emission
- parasymps- S2-4 pelvic splanchnic, causes erection in erectile bodies
-
lobes of prostate
- anterior lobe- firbromuscular anterior to urethra, continuation of internal sphincter
- lateral lobes- along sides of urethra, glandular, most prone to cancer
- posterior lobes- posterior to urethra, inferior to ducts
- middle lobe- between prostatic urethra and ejaculatory ducts, prone to benine hypertrophy
-
prostate enlargement
- benign hypertrophy- common in middle age, obstructs urethra
- prostatic cancer- 55+ years old, usually posterior lobe, moves through lymph nodes
-
bulbourethral glands
- posterior to membranous urethra
- open into spongy urethra
- produce secretion during sexual arousal
-
vagina
- surrounds uterine cervix
- passes through puborectalis
- function: excretory duct for menstration, sex, birth cananl
- A: uterine A, vaginal A, internal pudendal A
- N: uterovaginal plexus- superior 80%
- - syps via lumbar splanchnic N
- - parasymps via pelvic splanchnic Ns
- visceral afferents- distension only- upper 80%
- somatic via deep perineal- touch/temp- lower 20%
-
vaginal sphincter muscles
- pubovaginalis
- external urethral sphincter
- urethrovaginal sphincter
- bulbospongiosus
-
vaginal fornix
- surrounds uterine cervix
- anterior, lateral, and postior (deepest) portions
-
uterus
- in anteverted and anteflexed position
- body
- superior 2/3, vesical surface and intestinal surface
- uterine cavity
- uterine horns- origins of uterine tubes
- fundus- body superior to uterine horns
- isthmis- below body, superior to cervix
-
cervix
- inferior uterus, protrudes into vagina
- supravaginal part- b/t isthmis and vagina
- vaginal part- surrounded by vaginal fornix, internal ox, cervical canal, external os
-
histology of uterus
- perimetrium- outer serosal covering
- myometrium- thickest, middle layer
- endometrium- changes during menstration
-
broad ligament of the uterus
- mesometrium- lateral to uterus
- mesovarium- ovar ovaries
- mesosalpinx- holds uterine tubes
-
round ligament of the uterus
- attaches to uterotubal junction
- thru inguinal canal into labia majora
-
ovarian ligament
uterus to ovary
-
suspensory ligament of ovary
- extension of brad ligament toward abdomen
- surrounds neurovasculature
-
cardinal ligament
- cervix, to lateral fornix, to lateral pelvis
- along inferior margin of broad lig
-
uterosacaral ligament
cervix to sacrum
-
pubocervical ligament
pubic bones to cervix
-
uterus
- A: uterine A (anastomoses with ovarian and vaginal As)
- V: uterine venous plexus
- N: uterogavinal plexus
- symps- lumbar splanchnic
- parasymps- pelvic splanchnic
-
anesthesia
- general- not common because knocks you out completely
- regional
- -spinal block- L3/4, cant readminister, headaches
- - caudal epidural- S2-4, via catheder
- - pudendal N block- S2-4 dermatomes
-
uterine tubes
- function: fertilization
- open to peritoneal cavity
- A: uterine A and ovarian A
- V: uterine venous plexus
- N: autonomics via inferior hypogastric plexus
-
parts of uterine tube
- infundibulum- distal end, abdominal ostium, fimbrae
- ampula- distal 2/3, site of fertilization
- isthmis- adjacent to uterine horn
- intramural segment- thru wall of uterus, uterine ostium
-
ovaries
- A: ovarian A
- V: pampiniform plexus in broad lig to ovarian V
- R drains to IVC
- L drains to L Renal V
- N: autonomics via ovarian plexus
- symps- T11-L1
- parasymps- pelvic splanchnic Ns
- regulate vasculature diameter
-
rectum
- retroperitoneal
- sacral flexure
- anorectal flexure- thru pelvic diaphragm, maintained by puborectalis M
- transverse rectal folds- 3 lateral flxures
- ampulla- supported by levator ani muscle
-
rectum continued
- A: superior rectal A- off inferior mesenteric
- middle rectal A- off internal iliac
- inferior rectal A- off internal pudendal
- V: superior rectal to hepatic portal V
- middle and inferior rectal to internal iliac V
- N: symps- lumbar splanchnic Ns- vasomotor?
- parasymps- pelvic splanchnic Ns- muscle fibers
- visceral afferent to S2-4- pain and distension
-
what areas allow for expansion of the rectum?
- males- retrovesical pouch
- females- retrouterine pouch
- 2 pararectal fossa
-
defication
- Ns thru pelvic splanchnic N
- 1. empy ampulla
- -internal sphincter contracted
- -external sphincter relaxed
- 2. sufficiently full ampulla
- -internal sphincter relaxes
- -external sphincter contracts
- 3. during defication
- -voluntary override of external sphincter contraction
- -parasymps increase peristalsis
-
rectal examination
- palpation of prostate, seminal vesicals, cervix, bony processes
- protoscope= camera in butt
-
boundries of ischioanal fossa
- lateral- ischium and obturator internus
- medial- anal canal
- posterior- sacrotuberous lig and gluteus maximus
- anterior- external utethral sphincter and deep transverse perineal M
-
pudendal canal
- lateral wall of ischioanal fossa
- contains internal pudendal A/V, pudendal N and N to obturator internus
-
internal pudendal A
- inferior rectal A- external anal sphincter
- perineal A- to scrotum, labia, bulb of penis/vestibule
- deep A of penis/clitoris- erectile tissue
- dorsal A of penis/clitoris
-
pudendal N
- inferior rectal N- external anal sphincter
- perineal N- superficial and deep perineal Ns
- dorsal N or penis/clitoris
-
anal canal
- pelvic diaphragm to anus
- normally collapsed
- internal anal sphincter- smooth muscle, involuntary control, normally contracted
- external anal sphincter- skeletal muscle, volunary control, blends with puborectalis, N: inferior rectal N
-
anal columns
- in inferior anal canal
- longitudinal ridges of mucosa
- anorectal junction- superior ends of anal columns
- anal valves- inferior ends of anal columns
- anal sinuses- recesses just superior to valves
- pectinate line- formed by anal valves
-
anal canal continued
- A: superior rectal A above pecinate line
- inferior rectal A below pectinate line
- V: hepatic portal system above pectinate line
- inferior rectal and internal pudendal below pectinate line
- N: autonomic above pectinate line= inferior hypogastric plexus
- symps to internal anal sphincter maintain tonus
- parasymps relax the internal anal sphincter
- somatic below pectinate line- inferior rectal N
- motor to external anal phincter
-
hemorrhoids
- dialated, prolapsed Vs
- internal- breakdown of muscularis mucosa
- external- covered by skin
-
sex differences in pelves
- males
- heavier and thicker
- narrow and deep lesser pelvis
- subpubic angle 60 degrees
- females
- wider and shallower
- larger pelvic inlet and pelvic outlet
- subpubic angle 90 degree
-
erection
- parasymps via cavernous N to deep A of penis
- -cause relaxation of tunic media in deep A of penis
- -increases blood flow into corpus spongiosus and cavernosum
- bulbospongiosus M and ischiocavernosus M contract
- -compresses venous plexuses reducing drainage from penis
- -erectile tisssue becomes engorged
-
emission
- sypathetics cause peristalsis in ductus deferens and accessory glands
- -sperm delivered to prostatic urethra
- -seminal vesicals and prostate add gluid to produce semen
-
ejaculation
- contraction of bulbospongiosus M expels semen through spongy urethra
- -internal urethral sphincter closes
- after ejaculation, symp cuase constriction of tunica media in deep A and things return to normal
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