PELVIS

Heba Al-Hussaini MB ChB, PhD

Assistant professor
Anatomy department
Faculty of medicine
2014
 OBJECTIVES

Anatomy of the male & female pelvis.

Anatomy of the external genitalia and
perineum.
Blood supply, innervation and lymphatic
drainage of the perineum.
Anatomical relations of different viscera of
the pelvis.
 PELVIC BONES

Pelvic brim

The false (or greater) pelvis , formed by the iliac fossa and largely in contact with
intraperitoneal content.
The true (or lesser) pelvis contain the urogenital organs.
 THE SACRUM

The sacrum is formed by the fusion of the five, originally separated, sacral vertebrae.
The hip bones articulate posteriorly with the sacrum at the sacro-iliac joints to form the pelvic girdle.
PELVIC INLET
PELVIC OUTLET
 PELVIC POSITION

In the anatomical position, the right and left anterior superior iliac spines and the
anterior aspect of the pubic symphysis lie in the same vertical plane.
The lumber lordosis that accompanies erect posture tilts the axis of the pelvic
inlets so that it faces anteriorly and the inferior ischiopubic rami lie horizontal.
 PELVIC BONES

1. L4
2. L5
3. Promontory
4. Ala of the sacrum
5. Iliac fossa
6. Iliac crest
7. Anterior superior iliac spine
8. Anterior inferior iliac spine
9. Superior ramus of the pubis
10. Inferior ramus of the pubis
11. Pubic crest
12. Pubic tubercle
13. Ischium
14. Ramus of ischium
 SACROILIAC JOINT

The sacroiliac joints are strong weight-bearing compound joints, consisting of an anterior synovial joint
(between the auricular surface of the sacrum and the ilium, covered with articular cartilage) and
posterior syndesmosis (between the tuberosities of theses bones).
Differ from most synovial joints in that limited mobility is allowed, a consequence of their role in
transmitting the weight of most of the body to the hip bones.
the joint is held together by the posterior and interosseous sacro-iliac ligaments.
POSTERIOR LIGAMENTS OF THE PELVIS
 POSTERIOR LIGAMENT OF THE PELVIS

Relaxation at the sacroiliac joint permits rotation of the pelvic and increase in
pelvic diameter during child birth.
 ANTERIOR LIGAMENTS OF THE PELVIS

During pregnancy, the pelvic joints & ligaments relax and pelvic movement increase.
Loosening of the interpubic disc during childbirth increases pelvic diameter.
The coccyx moves posteriorly and increases pelvic outlet during childbirth.
 PUBIC JOINT

The pubic symphysis consists of fibrocartilaginous interpubic disc and surrounding ligaments uniting the
bodies of the pubic bones in the median plane.
The inter-pubic disc is generally wider in woman.
The ligaments joining the bones are thickened at the superior and inferior margins of the symphysis,
forming superior and inferior pubic ligaments.
 PELVIC GIRDLES OF MALE & FEMALE

Android (common Gynecoid (common Anthropoid Platypelloid

in male) in female) (common in male (uncommon
&black females) in both sexes)
COMPARISON OF MALE & FEMALE BONY
PELVESC

Bony Pelvic Male Female

General Thick& Thin & light
structure heavy
Greater Deep Shallow
pelvic
Lesser Narrow& Wide& shallow
pelvic deep
Pelvic inlet Heart Oval or round
shaped

Pelvic Small large

outlet
Pubic arch 70 80
Obturator Round Oval
foramen
 PELVIC INLET &OUTLET

The size of lesser pelvis is particularly important because it is the bony canal through which the fetus
passes during normal child birth.
In all pelvic girdles, the ischial spines extend toward each other, and the interspinous distance between
them is normally the narrowest part of the pelvic canal.
The minimum anteroposterior (AP) diameter of the lesser pelvis is from the middle of the sacral
promontory to the posterosuperior margin of the pubic symphysis (true conjugate).
 PELVIC DIAPHRAGM
(SUPERIOR VIEW)

The pelvic floor is formed by the bowl-or funnel-shaped pelvic diaphragm, which consist of the
coccygeus and levator ani muscle and fascia covering the superior and inferior aspects of these muscles.
Thr urogenital hiatus is the anterior gap between the medial borders of the levator ani muscles of each
side which gives passage to the urethra and in female the vagina.
 PELVIC DIAPHRAGM
(INFERIOR VIEW)

The levator ani muscles are innervated directly by branches from the anterior ramus of S4
and by branches of the pudendal nerve (S2-S4)
 PELVIC FASCIA

The pelvic fascia is connective tissue that occupies the space between the membranous peritoneum and
the muscular pelvic walls and floor not occupied by the pelvic viscera.
The parietal pelvic fascia is the membranous layer that lines the inner aspect of the muscles forming the
walls and floor of the pelvis.
The visceral pelvic fascia includes the membranous fascia that directly ensheathes the pelvic organs,
forming the adventitial layer of each.
 TENDINOUS ARCH OF PELVIC FASCIA

The tendinous arch of pelvic fascia is a continuous bilateral band running from the pubis to the sacrum
along the pelvic floor adjacent to the viscera, formed by thickening of the parietal fascia.
 HYPOGASTRIC SHEATH

Lateral ligament of the bladder (anterior most lamina) conveying the superior vesical arteries &veins.
Lateral rectal ligament (posteriormost lamina) conveying the middle rectal artery and vein.
In male the middle lamina forms the rectovesical septum. In female it forms the cardinal ligament.
INJURY TO THE FASCIA OF THE PELVIC
FLOOR
INJURY TO THE MUSCLES OF THE
PELVIC FLOOR

TEAR OF PUBOCOCCYGEUS
NERVES & NERVE PLEXUS OF THE PELVIS
APERTURES IN THE PELVIC WALL
 PERINEUM
Heba Al-Hussaini MB ChB, PhD
Assistant professor
Anatomy department
Faculty of medicine
 BOUNDARIES OF THE PERINEUM
Pubic symphysis
Ischiopubic
rami

Ischial
tuberosities

Sacrotuberous
ligament

Coccyx
MIDLINE SAGITTAL SECTION THROUGH
THE PELVIS AND PERINEUM
 UROGENITAL DIAPHRAGM

The urogenital diaphragm is formed by the sphincter urethrae and the deep transverse perineal muscle, which
are sandwished between the superier and inferior fascia layer.
 UROGENITAL DIAPHRAGM

The urogenital diaphragm is formed by the sphincter urethrae and the deep transverse
perineal muscle, which are sandwished between the superier and inferior fascia layer.
 ERECTILE BODIES

The penis consists of a root, body,

and glans. It is composed of three
cylindrical cavernous bodies of
erectile tissue: the pairedcorpora
cavernosa dorsally and the single
corpus spongiosum ventrally.
The root of the penis (attached
part) consists of the crura, bulb,
and ischiocavernosus and
bulbospongiosus muscles. It is
located in the superficial perneal
pouch.
The body of the penis is the free
pendulous part that is suspended
from the pubic symphysis.
The glans is the conical-shaped
expansion of the distal end of the
corpus spongiosum
 MUSCLES OF SUPERFICIAL PERINEAL
POUCH

Bulbospongiosus muscle
compresses the bulb of the penis
and corpus spongiosum aiding in
emptying the urethra of residual
urine or semen.
Ischiovavernosus muscle force
blood from the crura into distal
parts of the corpora cavernosa,
which increase the firm
distention of the penis during
erection.
Vaginismus is thought to be due
to involuntary spasms of the
bulbospongiosus, transverse
perineal and levator ani muscle.
DEEP & SUPERFICIAL PERINEAL POUCH
Deep & superficial perineal pouch
FASCIA OF THE
PERINEUM
 PERINEAL BODY

The perineal body is a fibromuscular node lying in the midline of the perineum. It is pyramidal in shape
and provides an anchor point for several of the muscles within the perineum (e.g . Bulbospongiosus,
external anal sphincter, transverse perineal muscle, urethral sphincter & levator ani)
 PUDENDAL NERVE

Origin : ventral rami S2, S3, and S4.

Divides into :
1- Dorsal nerve supplies:
Deep transverse perineal M.
Uretheral sphincter M
Corpus cavernosum.
Glans of penis or clitoris and skin.
2- Perineal nerve:
Scrotum or labia
Muscles eg. Bulbospongiosus,
ischiocavernosus, S.tranverse
perineal M.
NERVOUS SUPPLY OF THE PERINIUM
(female)
 EPISIOTOMY

Episiotomy is a surgical procedure that involves cutting the perineum and inferoposterior vaginal wall
during labor to enlarge the vaginal opening. The procedure is intended to prevent vaginal tears during
delivery.
Pudendal nerve block is used for the relief of pain in the lower genital tract during the second stage of
labor. The ischial spine can be used as a landmark of administration of pudandal nerve block.
NERVOUS SUPPLY OF THE PERINIUM
(male)

Superficial & deep Superficial & deep

Branches of perineal Branches of perineal nerve
nerve
ARTERIAL SUPPLY OF THE PERINIUM
ARTERIAL SUPPLY OF THE PERINIUM
(female)
 ARTERIAL SUPPLY OF THE PERINIUM
(male)

1. Inferior rectal artery

2. Internal pudendal
vessels
3. Internal pudendal artery
passes superior to
perineal membrane.
4. Perineal artery and vein.
5. Posterior scrotal
arteries.
 CROSS SECTION OF THE PENIS

Each cavernous body has an outer fibrous covering, the tunica albuginea.
The deep fascia of the penis is the continuation of the deep perineal fascia.
The corpus spongiosum contains the spongy urethra.
The corpora cavernosa are fused with each other in the median plane, except posteriorly where they separate
to form the crura of the perin.
 FEMALE EXTERNAL GENITALIA

The mons pubis is the rounded fatty eminence anterior to the pubic symphysis, formed by a mass of
fatty subcutaneous tissue.
The labia majora are prominent folds of skin filled with loose subcutaneous tissue containing smooth
muscle, and the termination of the round ligament of the uterus.
Labia minora are rounded folds of fat free, hairless skin. The medial lamina forms the frenulum of the
clitoris and the lateral lamina forms the prepuce.
Female circumcision is an operation in which the prepuce of the clitoris is removed and commonly also
part of the clitoris and the labia minora.
THE HYMEN
 MALE EXTERNAL GENITALIA

The prepuce or foreskin is a hoodlike fold of skin that covers the glans and connected to it by a fold called
frenulum.
Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis.
Female circumcision is an operation in which the prepuce of the clitoris is removed and commonly also part of
the clitoris and the labia minora.
 ISCHIAL FOSSA

Laterally: ischium, obturator internus,

obturator fascia.
Medially: anal canal , external anal
sphincter.
Posteriorly: sacrotuberus ligament,
gluteus maximus.
Anteriorly: external urethral sphincter,
deep perineal muscle &fascia.
Floor is skin and subcutaneous fat.
 Female reproductive system

References

Essential Clinical Anatomy, Moore & Agur, 3rd edition

or

Clinically Oriented Anatomy, Moore & Dalley, 7th edition

or

Clinically Anatomy by system, Richard S. Snell,