HOME

TheInfoList



OR:

The perineum in humans is the space between the
anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, de ...
and
scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum con ...
in the male, or between the anus and the
vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulval ...
in the female. The perineum is the region of the body between the
pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...
(pubic arch) and the
coccyx The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and other ...
(tail bone), including the perineal body and surrounding structures. There is some variability in how the boundaries are defined. The
perineal raphe The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). It is found in both males and females, arises from the fusion of the urogenital fold ...
is visible and pronounced to varying degrees. The perineum is an
erogenous zone An erogenous zone (from Greek , ''érōs'' "love"; and English ''-genous'' "producing", from Greek , ''-genḗs'' "born") is an area of the human body that has heightened sensitivity, the stimulation of which may generate a sexual response, suc ...
. The word perineum entered English from late Latin via
Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...
περίναιος ~ περίνεος ''perinaios, perineos'', itself from περίνεος, περίνεοι 'male genitals' and earlier περίς ''perís'' 'penis' through influence from πηρίς ''pērís'' 'scrotum'. The term was originally understood as a purely male body-part with the
perineal raphe The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). It is found in both males and females, arises from the fusion of the urogenital fold ...
seen as a continuation of the
scrotal septum The septum of the scrotum is a vertical layer of fibrous tissue that divides the two compartments of the scrotum. It consists of flexible connective tissue Connective tissue is one of the four primary types of animal tissue, along with epith ...
since masculinization causes the development of a large
anogenital distance Anogenital distance (AGD) is the distance from the midpoint of the anus to the genitalia, the underside of the vagina, the clitoris or the scrotum. It is considered medically significant for a number of reasons, in both humans and other animals, i ...
in men, in comparison to the corresponding lack of distance in women. As a result of
folk etymologies Folk etymology (also known as popular etymology, analogical reformation, reanalysis, morphological reanalysis or etymological reinterpretation) is a change in a word or phrase resulting from the replacement of an unfamiliar form by a more famili ...
(such as ἰνάω ináō, "to carry off by evacuations"), it is contemporaneously extended to both sexes.


Structure

The perineum is generally defined as the surface region between the
pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...
and the
coccyx The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and other ...
. The perineum is below the pelvic diaphragm and between the legs. It is a diamond-shaped area that includes the
anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, de ...
and, in females, the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
. Its definition varies: it can refer to only the superficial structures in this region, or it can be used to include both superficial and deep structures. The perineum corresponds to the
outlet of the pelvis The lower circumference of the lesser pelvis is very irregular; the space enclosed by it is named the inferior aperture or pelvic outlet. It is an important component of pelvimetry. Boundaries It has the following boundaries: * anteriorly: the ...
. A
line Line most often refers to: * Line (geometry), object with zero thickness and curvature that stretches to infinity * Telephone line, a single-user circuit on a telephone communication system Line, lines, The Line, or LINE may also refer to: Art ...
drawn across the surface connecting the ischial tuberosities divides the space into two triangles: * The anterior
urogenital triangle The urogenital triangle is the anterior part of the perineum. In female mammals, it contains the vagina and associated parts of the internal genitalia. Structure The urogenital triangle is the area bound by a triangle with one vertex at the pub ...
, contains the
penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do no ...
(males) or
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
(females) * The posterior anal triangle containing the
anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, de ...
The formal anatomical boundaries of the perineum may be said to be: * in front: the
pubic arch The pubic arch, also referred to as the ''ischiopubic arch'', is part of the pelvis. It is formed by the convergence of the inferior rami of the ischium and pubis on either side, below the pubic symphysis. The angle at which they converge is kno ...
and the arcuate ligament of the pubis * behind: the tip of the
coccyx The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and other ...
* on either side: the inferior rami of the pubis and
ischial tuberosity The ischial tuberosity (or tuberosity of the ischium, tuber ischiadicum), also known colloquially as the sit bones or sitz bones, or as a pair the sitting bones, is a large swelling posteriorly on the superior ramus of the ischium. It marks t ...
, and the
sacrotuberous ligament The sacrotuberous ligament (great or posterior sacrosciatic ligament) is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends. Structure It runs from the sacrum (the lower ...
* superiorly:
pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the leva ...
* inferiorly: skin and fascia


Perineal body

The perineal body (or central tendon of perineum) is a pyramidal fibromuscular mass in the middle line of the perineum at the junction between the
urogenital triangle The urogenital triangle is the anterior part of the perineum. In female mammals, it contains the vagina and associated parts of the internal genitalia. Structure The urogenital triangle is the area bound by a triangle with one vertex at the pub ...
and the anal triangle. In males, it is found between the
bulb of the penis In botany, a bulb is structurally a short stem with fleshy leaves or leaf basesBell, A.D. 1997. ''Plant form: an illustrated guide to flowering plant morphology''. Oxford University Press, Oxford, U.K. that function as food storage organs durin ...
and the
anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, de ...
; in females, it is found between the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
and anus, and about 1.25 cm in front of the latter. The perineal body is essential for the integrity of the
pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the leva ...
, particularly in females. Its rupture during vaginal birth leads to widening of the gap between the anterior free borders of
levator ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...
muscle of both sides, thus predisposing the woman to prolapse of the
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...
,
rectum The rectum is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the sigmoid colon) at the le ...
, or even the
urinary bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
.
Perineal tear A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most com ...
s and
episiotomy Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening ...
often occur in childbirth with first-time deliveries, but the risk of these injuries can be reduced by preparing the perineum, often through massage. At this point, the following muscles converge and are attached: #
External anal sphincter The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus. Anatomy The external anal sphincter measures about 8 t ...
#
Bulbospongiosus muscle The bulbospongiosus muscle (bulbocavernosus in older texts) is one of the superficial muscles of the perineum. It has a slightly different origin, insertion and function in males and females. In males, it covers the bulb of the penis. In femal ...
#
Superficial transverse perineal muscle The transverse perineal muscles (transversus perinei) are the superficial and the deep transverse perineal muscles. Superficial transverse perineal ...
# Anterior fibers of the
levator ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...
# Fibers from
male Male (Mars symbol, symbol: ♂) is the sex of an organism that produces the gamete (sex cell) known as sperm, which fuses with the larger female gamete, or ovum, in the process of fertilization. A male organism cannot sexual reproduction, repro ...
or female external urinary sphincter # Deep transverse perineal muscle


Fascia

The terminology of the perineal
fascia A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs ...
can be confusing, and there is some controversy over the nomenclature. This stems from the fact that there are two parts to the fascia, the superficial and deep parts, and each of these can be subdivided into superficial and deep parts. The layers and contents are as follows, from superficial to deep: #
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different de ...
# superficial perineal fascia:
Subcutaneous tissue The subcutaneous tissue (), also called the hypodermis, hypoderm (), subcutis, superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the layer are fibroblasts, adipose cells, and macro ...
divided into two layers: (a) A superficial fatty layer, and (b) Colles' fascia, a deeper, membranous layer # deep perineal fascia and muscles: :4. fascia and muscles of
pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the leva ...
(
levator ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...
,
coccygeus The coccygeus muscle or ischiococcygeus is a muscle of the pelvic floor, located posterior to levator ani and anterior to the sacrospinous ligament. Structure The coccygeus muscle is posterior to levator ani and anterior to the sacrospinous lig ...
)


Areas

The region of the perineum can be considered a distinct area from pelvic cavity, with the two regions separated by the
pelvic diaphragm The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the le ...
. The perianal area ('' peri-'' and ''
anal Anal may refer to: Related to the anus *Related to the anus of animals: ** Anal fin, in fish anatomy ** Anal vein, in insect anatomy ** Anal scale, in reptile anatomy *Related to the human anus: ** Anal sex, a type of sexual activity involving ...
'') is a subset of the perineum. The following areas are thus classified as parts of the perineal region: * perineal pouches: superficial and deep (see above for details) *
ischioanal fossa The ischioanal fossa (formerly called ischiorectal fossa) is the fat-filled wedge-shaped space located lateral to the anal canal and inferior to the pelvic diaphragm. It is somewhat prismatic in shape, with its base directed to the surface of the p ...
 – a fat-filled space at the lateral sides of
anal canal The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional segme ...
, bounded laterally by the obturator internus muscle, and medially by the pelvic diaphragm and anal canal; its base is the skin **
anal canal The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional segme ...
** pudendal canal – contains
internal pudendal artery The internal pudendal artery is one of the three pudendal arteries. It branches off the internal iliac artery, and provides blood to the external genitalia. Structure The internal pudendal artery is the terminal branch of the anterior trunk of ...
and the
pudendal nerve The pudendal nerve is the main nerve of the perineum. It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well as the motor supply to various pelvic muscles, including the male or fema ...


Clinical significance

Extensive deformation of the pelvic floor occur during a vaginal delivery. Approximately 85% of women have some
perineal tear A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most com ...
during a vaginal delivery and in about 69% suturing is required. Obstetric perineal trauma contributes to postpartum morbidity and frustration of women after delivery. In many women the childbirth trauma is manifested in advanced age when the compensatory mechanisms of the pelvic floor become weakened making the problem more serious among the aged population. The
anogenital distance Anogenital distance (AGD) is the distance from the midpoint of the anus to the genitalia, the underside of the vagina, the clitoris or the scrotum. It is considered medically significant for a number of reasons, in both humans and other animals, i ...
is a measure of the distance between the midpoint of the
anus The anus (Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, de ...
and the underside of the
scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum con ...
or the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
. Studies show that the human perineum is twice as long in males as in females. Measuring the anogenital distance in neonatal humans has been suggested as a noninvasive method to determine male feminisation and thereby predict neonatal and adult reproductive disorders. There are claims that sometimes the perineum is excessively repaired after childbirth, using a so-called " husband stitch" and that this can increase vaginal tightness or result in pain during intercourse.


Society and culture

Perineum sunning is a wellness practice that involves exposing the perineum (area between the genitals and anus) to sunlight. Adherents claim various unproven health benefits such as improved libido, circulation, sleep, and longevity. There is no scientific evidence that this behavior promotes any of the alleged benefits. The practice of exposing a sensitive area of skin to sunlight also increases the risk of skin cancers such as
melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye (u ...
,
squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on th ...
, and
basal-cell carcinoma Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raise ...
. Doctors recommend safer alternative options such as relaxation, meditation, and mindfulness, which can also achieve the same desired benefits.


Gallery

File:Male_perineum.jpg, Annotated male perineum: 1. Perineum. 2. Raphe perinealis. 3. Anus. 4. Testicles, Scrotum. 5. Raphe scrotalis. Image:Gray1119.png, Stages in the development of the external sexual organs in the male and female


See also

*
Deep perineal pouch The deep perineal pouch (also deep perineal space) is the anatomic space enclosed in part by the perineum, and located superior to the perineal membrane. Structure The deep perineal pouch is bordered inferiorly by the perineal membrane, also kno ...
*
Erogenous zone An erogenous zone (from Greek , ''érōs'' "love"; and English ''-genous'' "producing", from Greek , ''-genḗs'' "born") is an area of the human body that has heightened sensitivity, the stimulation of which may generate a sexual response, suc ...
*
Intimate part An intimate part, personal part or private part is a place on the human body which is customarily kept covered by clothing in public venues and conventional settings, as a matter of fashion and cultural norms. In several cultures, revealing these p ...
*
Mula Bandha A bandha ( sa, बंध) is a kriyā in Hatha Yoga, being a kind of internal mudra described as a "body lock," to lock the vital energy into the body. ''Bandha'' literally means bond, fetter, or "catching hold of".Iyengar, 1976: pp.435–437 M ...
*
Pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the leva ...
*
Perineal raphe The perineal raphe is a visible line or ridge of tissue on the body that extends from the anus through the perineum to scrotum (male) or labia majora (female). It is found in both males and females, arises from the fusion of the urogenital fold ...
*
Perineal tear classification A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most com ...
* '' 101 Vagina'' * ''
Femalia ''Femalia'' is a book of 32 full-color photographs of human vulvas, edited by Joani Blank and first published by Down There Press in 1993. A reprint edition was published by Last Gasp in 2011. The photographs were taken by Tee Corinne, Michael ...
''


References


External links


Perineum at The Anatomy Lesson
by Wesley Norman (Georgetown University) {{Authority control Pelvis Human surface anatomy