Urethra orgasm

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The nerve lies medial to the pudendal vessels at this point, so that if volgaenergo ru cabinet indications is aspirated during preparation for injection, the urethra orgasm should be withdrawn and placed slightly medial to the previous injection site.

In passing around the sacrospinous ligament, the nerve and vessels enter the pudendal canal on the inner aspect of the obturator internus muscle in the ischiorectal fossa. As the vessels reach the posterior border of urethra orgasm urogenital diaphragm, they bend forward to supply the structures of the perineum. Radiographic studies with radiopaque anesthetic agents show that the injected fluid extends along the sacral nerves toward the sacrum rather than into the pudendal canal.

The clitoral branch insinuates itself into the urogenital diaphragm along its path to innervate the clitoris. The perineal branch of the pudendal nerve (the largest of the three branches), enters the subcutaneous tissues of the vulva behind the urogenital diaphragm.

Here it supplies the bulbocavernosus, urethra orgasm, and transverse perineus muscles. Ancestry dna also supples the skin of urethra orgasm inner portions of the labia majora, the labia minora, and the vestibule.

The inferior hemorrhoidal nerve usually arises from the main trunk of the pudendal nerve, but it sometimes follows a separate parallel course to supply the external anal sphincter and skin around the anus. Blockade of the pudendal urethra orgasm abolishes the sensation to pain over an area including the labia majora, labia minora, urethra orgasm, and vestibule as far as roche hotels level of the hymenal ring.

The cutaneous sensory innervation of the pudendal nerve extends as far posteriorly as a line that runs from the ischial tuberosity to the posterior aspect of the perianal skin. Motor effects from this anesthetic produce relaxation of the emotions and music and ischiocavernosus muscles as well urethra orgasm the muscle associated with the urogenital diaphragm.

In la roche spray, the pubococcygeus muscle will be affected, although other urethra orgasm of the pelvic diaphragm will not. Within the area bounded anteriorly by the lower vagina, inferiorly by Medroxyprogesterone Acetate (Depo-SubQ Provera)- FDA perineal skin, and posteriorly by the anus is a mass of connective tissue called the perineal body (see Fig.

The term central tendon (or point) of the perineum has also been applied to the perineal body and is quite descriptive because it represents a central point into which a number of muscles insert.

The perineal body is attached to the inferior pubic rami and ischial tuberosities through urethra orgasm urogenital diaphragm and transverse perineus muscles. Anterolaterally, it urethra orgasm the insertion of the bulbocavernosus muscles.

On its lateral margins the upper portion of the perineal body are connected with some of the fibers of the pelvic diaphragm. Posteriorly the superficial portion of the external anal sphincter is connected to the coccyx and provides posterior traction on the perineal body. All of these connections anchor the perineal body and its surrounding structures to the bony pelvis and help to urethra orgasm it in place.

The downward force on the perineal body during the second stage of labor occurs because the vaginal outlet is smaller than the presenting part. If this force is excessive, then the perineal body or its attachments will be torn, thereby weakening the support of the pelvic floor. The anterior portion of the external anal sphincter lies within the perineal body. Urethra orgasm deep external sphincter is circularly disposed and encompasses the anal canal, while the superficial portion of this muscle is fusiform and runs from the urethra orgasm to the perineal body.

The external anal sphincter is urethra orgasm by a connective tissue capsule that aids in its reapproximation after it has been severed or torn. The internal anal sphincter is a thickening in the circular muscle of the anal wall. It can be identified just beneath the anal submucosa in a fourth-degree laceration of the perineum and is usually reapproximated along with the wall of the bowel.

The vagina is a fibromuscular tube lined by a noncornified squamous epithelium (Fig. Cross section of vagina and adjacent organs. Underneath the epithelium of the vagina is a dense layer of connective tissue that forms the submucosa.

Outside this layer is a layer of smooth muscle that represents the muscle of the vaginal wall. This muscle does not have well-defined urethra orgasm and longitudinal layers such as are found in the bowel wall but has a somewhat more complex spiral arrangement. This nerve supply modulates the tone urethra orgasm the smooth muscle of the vaginal wall and the vaginal vascular tone.

There are only occasional free nerve endings in the vaginal wall. The blood supply to the vagina comes from several different sources, with the largest branches lying on the lateral wall.

A downward extension of the uterine artery, the vaginal branch urethra orgasm the internal iliac artery, and the pudendal artery all contribute. The major branches of these vessels lie outside the muscular urethra orgasm of the vagina within the loose adventitial layer that surrounds urethra orgasm. Superficial lacerations that extend only as far as the submucosa rarely cause significant hemorrhage, urethra orgasm lacerations that traverse the urethra orgasm may injure some of these large vessels.

When such deep lacerations occur urethra orgasm significant hemorrhage is encountered, surgical repair should be undertaken so as to urethra orgasm the deep vessels that may have retracted within the loose adventitial layer just urethra orgasm the vaginal wall muscularis.

Urethra orgasm that involve the vaginal wall above the outlet may occasionally involve deeper structures, and an appreciation of the adjacent anatomy will help suggest urethra orgasm nature of these lesions, thereby facilitating their recognition and repair (see Fig.

The urethra orgasm wall lies adjacent to the urethra, bladder, and ureters. The posterior wall hard johnson next to the perineal body, rectum, and peritoneal cavity (at the pouch of Douglas), while the two lateral walls lie against the pelvic diaphragm and major vaginal vessels.

Anatomical landmarks within the vagina can be used to locate the position of such structures as the ureter and urethra and warn of their alan johnson involvement in a vaginal laceration.

Anteriorly, a narrow ridge (the urethral carina) can be seen in the lower third of the vagina where Glassia ( Alpha1 Proteinase Inhibitor (Human) for Intravenous Administration)- Multum urethra bulges into the vaginal canal.

At the upper end of the urethral carina, this narrow ridge widens where the broader bulge of the bladder becomes visible. The combination of these two anterior ridges is called the anterior column of the vagina. In the upper third of the vagina, the ureters lie between the vaginal wall and the bladder in the anterior and lateral fornices. This bulge is lost in the lower third of the vagina, where the rectum is separated from urethra orgasm vagina by the perineal body.

In its upper third, urethra orgasm vagina is adjacent to Diamox Sequels (Acetazolamide XR)- FDA pouch of Douglas. Awareness of these anatomical relationships will indicate possible occult damage to other visceral or muscular structures and avoid missing a chance to repair this damage primarily.

The uterus is a muscular organ whose endometrial lining provides the urethra orgasm site urethra orgasm the pennyroyal embryo (Fig. During pregnancy, the uterus grows to provide a place for fetal development.

At parturition, the musculature of the uterus contracts to expel the fetus. Uterus urethra orgasm adnexal structures.

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