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The femoral nerve from the lumbar plexus is primarily involved in supplying the muscles of the thigh. In the interval between these two plexuses lies the lumbosacral trunk, which is composed of fibers from the fourth and fifth Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum nerves. It curves in an exposed location over the Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum of the pelvis at the sacroiliac articulation to join in the formation of the sacral plexus.

In this position it lies directly on the bone of the pelvic inlet. Its fibers are destined to join in the formation of the sciatic nerve and eventually to form the common peroneal nerve and the tibial nerve. In some cases these signs may be secondary to herniation cobas roche e411 an intervertebral disk.

There is Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum prominent midline ridge formed by the lumbar spine. The psoas muscles produce ridges that extend downward from the spine on either side of the pelvic inlet. The prominence of the lumbar spine forces the pregnant uterus to choose either the left or right gutter in which to lie. The psoas ridges become important during external cephalic version.

As the fetal head is moved downward toward the pelvis, some resistance is often encountered learned helplessness a theory for the age of personal control attempts are made to push the head over the inlet and past the psoas ridge. Gentle upward pressure on the head through the flank can be used at this point to i keep waking up the head over this ridge and position it over the pelvic inlet.

The structures of the perineum lie below the pelvic diaphragm and are most easily viewed from below. The more superficial features of this region will be described first. Frontal section showing uterus and pelvic floor. Anteriorly, the mons overlies the pubic bones and is composed of hair-bearing skin over a cushion of adipose tissue. Extending posteriorly from the mons, the labia majora are composed of similar hair-bearing skin and adipose tissue, which contain the termination of the Hydromorphone Hydrochloride (Dilaudid)- FDA ligaments of the uterus and the obliterated processus vaginalis.

The labia minora are hairless skin folds. Anteriorly, each labium minus splits to run over, and under the glans of the clitoris. The more anterior folds unite to form the hood shaped prepuce of the clitoris, while the posterior folds insert into the under side of the glans as the frenulum. The area between the labia minora and surrounding the vagina is called Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum vestibule. Its moist squamous epithelium overlies the vestibular bulbs.

In the posterior lateral aspect of the vestibule, the duct of the major vestibular gland can Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum seen 3 mm to 4 mm outside the hymenal ring. The minor vestibular glands can be found in a line parallel and just exterior to the hymen. The urethra protrudes slightly through the vestibular skin anterior to the vagina and posterior to the clitoris.

The subcutaneous tissue underneath the skin, and superficial to the external genital muscles, consists of lobules of fat interlaced with connective tissue (see Fig. The superficial layer of this tissue, where fat predominates, has been called Camper's fascia. In the deeper layers, there is less fat and the fibrous connective tissue strata between the lobules of fat are more evident.

This fibrous layer is called Colle's fascia. These fibrous connections, which limit the spread of hematomas or infection in this deep compartment, gave rise to considering Colle's fascia as a separate entity from the superficial Camper's fascia, which lacks these connections.

There is no attachment of Colle's fascia to the pubic bones anteriorly and fluid collections in this space may extend into the abdominal wall. The erectile bodies and their associated muscles lie deep to the subcutaneous tissues of the vulva and are applied to the surface of the urogenital diaphragm (Fig. The clitoris is composed of a midline shaft (body) Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum with the glans.

This shaft is suspended from the pubic bones by a subcutaneous suspensory ligament. The paired crura of the clitoris bend downward from the shaft Gemcitabine in Sodium Chloride injection (Infugem)- Multum are firmly attached to the inferior aspects of the pubic rami.

The ischiocavernosus muscles originate at the ischial tuberosities and the free surfaces of the crura, to insert on the upper crura and body of the clitoris. Contraction of these muscles pulls the shaft downward.

There are a few muscle fibers that originate in common with the ischiocavernosus muscle and that run medially to the perineal body. These are called the superficial transverse perineus muscles. Deep perineal structures, pudendal artery, and genital tract blood vessels. They are covered by the bulbocavernosus muscles that originate in the perineal body and lie over their lateral surfaces.

These muscles insert into the body of the clitoris and act to pull it downward. The greater vestibular gland is found at the tail end of the bulb of the vestibule, lying beneath the bulbocavernosus muscle. There Levonorgestrel and Ethinyl Estradiol (Ayuna Tablets)- Multum a triangular sheet of dense musculofascial tissue that spans the anterior half of the pelvic outlet. Rather than forming an uninterrupted sheet in the female, as it does in the male, the urogenital diaphragm attaches the vagina and perineal body to the anterior bony outlet (see Fig.

This layer arises from the inner aspect of the inferior ischiopubic rami above the ischiocavernosus muscles and the crura of the clitoris. The medial attachments of the urogenital diaphragm are to the walls of the vagina and to the perineal body. Within the substance of the urogenital diaphragm, there is skeletal muscle, called the deep transversus perineus. It is never as well developed as many illustrations would imply.

By attaching these structures to the pelvic bones, their descent is limited during the great downward pressure that is exerted on the vagina and perineum during the second stage of labor. If these attachments remain intact after parturition, they will contribute to the normal support of the vaginal outlet. If torn or detached from the vagina and perineal body, then the pelvic floor sags and the introitus gapes. There is an ischiorectal fossa that lies on either side of the rectum and vagina (see Fig.



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