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  ANATOMY                 FEMALE   PERINEUM    LIGAMENTS 

 

 

In most common handbooks male perineum ligaments  are still described  through    "theories".   The female perineum is rather more badly depicted.  For many surgeons  the female urethra remains as a no subject.  Operating on the female urethra  is merely unthinkable since any touch to a diseased tube is likely to turn into fistula.

 

MY  PERSONAL  CONTRIBUTION  

After a 40 years experience of discrepancy between theory and practice here are my observations :

 

a)  Halban fascia does not disappear into  neighbouring  tissues. Its anatomical entity  continues into sub-urethral fascia

In fact, base of bladder and urethra down to its first third  are closely surrounded by a fibrous layer.

Female terminal urethra, as its male homologue,   is "membranous"  i.e. devoid of continence muscles but with a rich blood supply thanks to its spongious tissue.

       

                           

 

b)   This intermediate fibrous envelope can be dissected.  When repairing a urinary fistula  the three layers must be sutured separately

      

c)  Similar to male, female urethra has three layers.  Although very thin and not depicted in treatises, the  albuginea  is a quite visible layer.   It could often  be sutured  with fine material.

                             

Yet noticeable to any perineal surgeon  the sub-urethral fold  remains, to my knowledge, undescribed

 

Next Page : the sub-urethral fold     Pictures