Learning Objectives for Intro to Pelvis and Perineum, Gluteal region
1.
Based on your knowledge of urethral anatomy, why are women more susceptible to urinary tract infections than men? a.
Women get UTIs more often than men primarily because of anatomy. In women, the opening of the urethra is closer to the external genital area and anus so bacteria are more likely to be near it, and the urethra is shorter so bacteria are more likely to move up it.
2.
Be able to label a diagram of the broad ligament and understand how the ovary is attached to it and the subdivisions of the ligament formed by this attachment. a.
b.
Laterally, the ligament is prolonged superiorly over the ovarian vessels as the suspensory ligament of the ovary. Between the layers of the broad ligament on each side of the uterus, the ligament of the ovary lies posterosuperiorly and the round ligament of the uterus lies anteroinferiorly. The part of the broad ligament by which the ovary is suspended is the mesovarium. The part of the broad ligament forming the mesentery of the uterine tube is the mesosalpinx. The major part of the broad ligament serves as a mesentery for the uterus and is the
mesometrium, which lies inferior to the mesosalpinx and mesovarium.

Learning Objectives for Intro to Pelvis and Perineum, Gluteal region
3.
Be able to label the various portions on a sagittal section through the pelvis. a.
b.
4.
Be able to trace the pathway of the spermatozoa from the seminiferous tubule out into the ductus deferens. a.
The sperms are formed in the seminiferous tubules that are joined by b.
straight tubules to the rete testis.
5.
Define the anatomy of the uterine tubes from the peritoneal cavity to the uterus.
What is the function of the uterine tubes?
6.
Define the attachments of the sacrotuberous and sacrospinous ligaments. What two foramina are formed by these structures?
7.
Define: mesovarium, mesosalpinx. a.
Mesovarium: The part of the broad ligament by which the ovary is suspended. b.
Mesosalpinx: The part of the broad ligament forming the mesentery of the uterine tube.
8.
Describe the blood supply to the rectum.

Learning Objectives for Intro to Pelvis and Perineum, Gluteal region a.
9.
Describe the difference between the true and false pelvis. a.
The true pelvis is also known as the lesser or minor pelvis and lies
inferior to the pelvic inlet and extends inferiorly to the inferior pelvic
aperture (pelvic outlet). It contains the pelvic viscera (ie. Urinary bladder, uterus, prostate). b.
The false pelvis is also known as the greater or major pelvis, and lies
superior to the superior pelvic aperture (pelvic inlet) between the iliac fossae and crests. It contains abdominal viscera (ie. Ileum and sigmoid colon) and is bound by the alae of the ilium and S1 vertebrae.
10.
Describe the venous drainage of the rectum. a.
The rectal venous plexus (or hemorrhoidal plexus) surrounds the rectum, and communicates in front with the vesical venous plexus in the male, and the uterovaginal plexus in the female. b.
The veins of the hemorrhoidal plexus are contained in very loose connective tissue, so that they get less support from surrounding structures than most other veins, and are less capable of resisting increased blood pressure.
11.
Does the rectum have a mesentery? a.
At the level of the middle of the sacrum, the sigmoid colon loses its mesentery and gradually becomes the rectum, which, at the upper limit of the pelvic diaphragm, ends in the anal canal b.
The rectum is considered a retroperitoneal structure and therefore doesn’t have a mesentery.
12.
How is parasympathetic innervation distributed within the pelvis? a.
Pelvic splanchnic nerves are splanchnic nerves that arise from sacral spinal nerves S2, S3, and S4 to provide parasympathetic innervation to the hindgut. b.
The pelvic splanchnic nerves arise from the ventral rami of the S2-S4 and enter the sacral plexus. They travel to their side's corresponding inferior hypogastric plexus, located bilaterally on the walls of the rectum. c.
From there, they contribute to the innervation of the pelvic and genital organs. The nerves regulate the emptying of the urinary bladder and the rectum as well as sexual functions like erection. d.
They contain both preganglionic parasympathetic fibers as well as visceral afferent fibers. e.
The parasympathetic nervous system is referred to as the craniosacral
outflow; the pelvic splanchnic nerves are the sacral component. They are in the same region as the sacral splanchnic nerves, which arise from the sympathetic trunk and provide sympathetic efferent fibers. f.
The proximal 2/3 of the transverse colon, and the rest of the proximal gastrointestinal tract is supplied its parasympathetic fibers by

Learning Objectives for Intro to Pelvis and Perineum, Gluteal region the vagus nerve. In the distal 1/3 of the transverse colon, and through the sigmoid and rectum, the pelvic splanchnic nerves take over.
13.
How is the ovary suspended medially? Laterally? a.
The ovary is suspended by the mesosalpinx of the broad ligament superiorly and by two ligaments medially and laterally. b.
Medially, the ovary is suspended by the ovarian ligament that runs between the ovary and the uterus. c.
Laterally, the ovary is suspended by the suspensory ligament of the
ovary that houses the ovarian vessels and runs between the ovary and body wall.
14.
How many peritoneal-lined recesses are there in the male? Name them. a.
In the male, the peritoneum encircles the sigmoid colon, from which it is reflected to the posterior wall of the pelvis as a fold, the sigmoid mesocolon. It then leaves the sides and, finally, the front of the rectum, and is continued on to the upper ends of the seminal vesicles and the bladder; on either side of the rectum it forms a fossa, the pararectal
fossa, which varies in size with the distension of the rectum. b.
The peritoneum of the anterior pelvic wall covers the superior surface of the bladder, and on either side of this viscus forms a depression, termed the paravesical fossa, which is limited laterally by the fold of peritoneum covering the ductus deferens. c.
Supravesical pouch d.
Between the rectum and the bladder the peritoneal cavity forms, in the male, a pouch, the rectovesical excavation (or rectovesical pouch), the bottom of which is slightly below the level of the upper ends of the vesiculae seminales—i.e., about 7.5 cm. from the orifice of the anus.
15.
Is the urinary trigone located on the anterior or posterior wall of the bladder? a.
Posterior wall. b.
The trigone is a smooth triangular region of the internal urinary bladder formed by the two ureteral orifices and the internal urethral orifice. c.
The area is very sensitive to expansion and once stretched to a certain degree, the urinary bladder signals the brain of its need to empty. The signals become stronger as the bladder continues to fill.
16.
Know the anatomy of the uterus.

Learning Objectives for Intro to Pelvis and Perineum, Gluteal region a.
17.
List the ligaments of the uterus. a.
The uterosacral ligaments travel from the posterior cervix to the anterior face of the sacrum. b.
The cardinal ligaments travel from the ischial spines to the lateral portions of the cervix. c.
The pubocervical ligaments travel from the side of the uterus to the pubic symphysis. d.
The round ligaments of the uterus travel from the uterine horns to through the inguinal canal and to the labia majora.
18.
Name the muscles that form the walls of the pelvis? What is the innervation of these muscles? a.
The walls of the pelvis are made up of many mm both individually and as a group. They are levator ani (the combination of puborectalis, pubococcygeus, and ileococcygeus), coccygeus (forms the pelvic diaphragm with levator ani), Obturator internus, and piriformis. b.
All of the above mm. are innervated by branches of the ventral primary rami of spinal nerves S3-S4 except obturator internus (sacral plexus) and piriformis (1 st and 2 nd sacral n).
19.
Name the pelvic portions of the tubular G.I.T.

Learning Objectives for Intro to Pelvis and Perineum, Gluteal region a.
Distal sigmoid colon and rectum.
20.
Name two peritoneal-lined recesses within the pelvis in the female. a.
21.
Outline the pathway a spermatozoa would take on its way to fertilize an ovum within the uterine tubes. a.
22.
What are the 3 portions of the male urethra? Which portion is the longest? a.
Prostatic urethra, intermediate/membranous urethra, and spongy/cavernous urethra are the three parts of the urethra b.
The spongy portion of the urethra is the longest.
23.
What can happen if these ligaments lose their function? a.
The uterus (womb) is normally held in place by a hammock of muscles and ligaments. Prolapse happens when the ligaments supporting the uterus become so weak that the uterus cannot stay in place and slips down from its normal position. These ligaments are the round ligament, uterosacral ligaments, broad ligament and the ovarian ligament. The uterosacral ligaments are by far the most important ligaments in preventing uterine prolapse.
24.
What defines the fundus of the uterus? a.
25.
What do hemorrhoids indicate?
26.
What does the ductus deferens traverse (pass through) to access the abdominal cavity?
27.
What is a fornix? What are the divisions of the fornix?
28.
What is delivered via the ejaculatory ducts?
29.
What is delivered via the prostatic ducts?
30.
What is meant by anteverted, anteflexed? Over what structure is the uterus anteverted? What is the implication of this anatomical association during pregnancy?
31.
What is the function of the 2 divisions of the autonomic nervous system in the bladder?
32.
What is the function of the bulbourethral glands? Into what segment of the male urethra do they open? How are the bulbourethral glands located in relation to the prostate?
33.
What is the function of the epididymis?
34.
What is the perineal body? Where is the perineal body located? Why is the perineal body clinically important?
35.
What is the triangular smooth area on the wall of the bladder called? What structures delineate this triangle?
36.
What major vessel acts as the trunk for origin of all the various vessels that supply the organs of the pelvis?
37.
What muscles form the floor of the pelvis? Where do the muscles of the pelvic floor arise? What is the innervation of these muscles? What do these muscles form a sling around?

Learning Objectives for Intro to Pelvis and Perineum, Gluteal region
38.
What organ with an anatomical relationship to the prostate allows palpation for hypertrophy?
39.
What structure crosses the pelvic ureter in the male? In the female? Why is this association clinically important in the female?
40.
What structures penetrate (traverse) the prostate?
41.
What two plexuses are concerned with pelvic autonomic distribution?
42.
Where are the seminal vesicles located? What is the function of the seminal vesicles?
43.
Where do the ureters become pelvic?
44.
Where does fertilization of the ova normally occur? What type of ectopic pregnancy might occur here?
45.
Where does the ductus deferens begin? Terminate?
46.
Where does the rectum begin?
47.
Where does the sympathetic innervation come from? Via what structure(s) does this sympathetic innervation arrive here?
48.
Which bones fuse to form the hip (innominate) bone?
49.
Which nerves are concerned with innervating the muscular floor of the pelvis?
50.
Which of the fornices is the deepest? Why?