Genital Anatomy and Sandwiches

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I am up late studying for our third written section for gross anatomy, which is the thorax, abdomen, and pelvis. I’m decent with thorax, moreso the heart and I’m pretty confident about abdomen except for the esoteric vasculature and innervation. I don’t know whether it’s a mental block of mine not to be able to learn the autonomic nervous system or whether the teaching was so bad in this area, there’s no wonder I don’t know it.

The pelvic cavity, however, is impossible for me to get. It’s not the significant variations of anatomy for men and women, it’s the imaginary spaces, planes, floors, dividing structures. You have these everywhere in anatomy, such as the 6-some-odd neck triangles which are a PITA to memorize but straightforward in concept, but the pelvic ones are impossible for me to visualize 3D. I won’t bore the non-medical readers with examples of funky pelvic anatomy (or embarrass myself by exposing my inability to grasp what are probably simple concepts for others), so instead I’ll share some humor regarding this “special” area I have found in my studies this weekend.

I bought Clinical Anatomy Made Ridiculously Simple during the 1st part of anatomy. I was armpit deep in the brachial plexus (bad joke for those that get it) and a friend mentioned how the Neuroanatomy version of the same series helped him, so I got this. Mistake. I don’t think there was but 5 things I said, “Hey, that’s a good way to remember such and such” from this book, but I paid $24 for it (twice what Amazon sells it for — retail for specialty books from America are often list price + import fees if it’s not a “friendly” publisher or high-volume) so I keep trying to get some mileage out of it. The drawings, mnemonics, and “scenarios” are preposterous.

This example takes the cake. The urogenital triangle (imaginary triangle which contains the genitals but is in front of the anus) is described as “half of a deli sandwich” as a way to remember:

The bread of the sandwich represents the two fascial layers of the urogenital diaphragm. An olive (bulbospongious m.) rests on the sandwich and a toothpick (urethra) extends all the way through the olive and sandwich…. Inside the sandwich, is a round slice of salami (sphincter urethrae m.) which surrounds the urethra and has been pierced by the toothpick. For the female, stick an extra toothpick in the olive to represent the vagina. Also inside the sandwich is a piece of bacon (deep transverse perineal m.)…in the male, two capers (Cowper’s or bulbourethral glands) are also inside the sandwich.

I swear I couldn’t have made this up if I tried. There is a picture but it’s of little help; it’s just a pencil drawing of a dissected pelvis with a sandwich (with olive and toothpick) sitting on top. This is more work remembering the crazy-ass analogy than to learn the anatomy. I can see myself on the USMLE, “Crap! Is the olive deep to the bacon or vice versa?” After this gem, the author then likens the two anal sphincters to doughnuts of different proportions. Please, please: save the food analogies for some aspect of the limbs or whatever. Don’t make food analogies with the anus, genitals, urinary tract, etc. That’s just bad form (unless it’s a 9-1/2 Weeks kind of thing…)

The last bit of genital nonsense has to do with the penis. The penis, like many structures has fascia or membranous “packaging” that keeps things together and/or separate. It has a superficial fascia, which contains the outer vessels/nerves for the skin, and it has a deep fascia for the erectile tissue called Buck’s fascia (I guess after the guy that discovered it). Buck’s fascia. You’re hard pressed to get more “manly” than Buck. Maybe there’s a Bubba’s sphincter, or a Mack’s canal. It wouldn’t be right to say, “Melvin’s fascia,” ya know?

If I wasn’t so tired, I’d come up with some witty ones, but I’ll leave that to the commenters, if there’s even anybody that read this far. I’m blogging about penile anatomy and genital sandwiches, so if that’s not a “Danger Will Robinson!” indication for me to go to bed, I don’t know what is. Buenas noches.

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  By Chris Rangel MD, November 26, 2005 @ 6:45 pm

  huh?
  What if you don’t know what a deli sandwich is?!?!?!? What’s a caper? Come on! I eat at Taco Bell! So they expect to teach you human anatomy by comparing it to sandwich anatomy?
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  By jen, December 12, 2008 @ 6:25 pm

  hi enrico, what anatomy book do you recommend as a good review?

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