1. ANATOMY OF THE FEMALE PELVIC FLOOR AND PERINEUM
Dr. A. O. FAWOLE
DEPT. OF OB-GYN
UCH

2. Pelvic Floor and Perineum
Anterior perineum
Posterior perineum
Pelvic Floor

3. Borders of pelvic outlet
Perineum
Borders of pelvic outlet
Anteriorly – ischiopubic rami
Posteriorly – coccyx and sacro-tuberous ligament
Division (ischial tuberosities)
Anterior perineum (urogenital triangle)
Posterior perineum (anal triangle)
Structures overly perineal membrane

4. Anterior Perineum

5. Structures of the Vulva
Mons
Labia
Clitoris
Vestibule
Erectile structures

6. Vulva Mons Labia majora Labia minora Hair-bearing skin
Cushion of adipose tissue
Labia majora
Termination of round ligaments of uterus
Labia minora
Hairless skin fold
Lacks bed of adipose tissue
Forms prepuce/frenulum of clitoris

7. Glands of the vulva
Labia majora – sebaceous gland
Sweat glands
Bartholin’s glands

8. Superficial compartment
Space between subcutaneous tissues and perineal membrane
Clitoris
Crura
Vestibular bulb/Bartholin’s gland
Ischicavernosus (from ischial tuberosity)
Bulbospongiosus (from perineal body)
Superficial transverse perineal muscle
Muscles contained in superficial perineal pouch

10. Triagular sheet in anterior half of pelvic outlet
The Perineal Membrane
Triagular sheet in anterior half of pelvic outlet
Dense fibromuscular tissue
Previously called urogenital diaphragm
Functions
Supports pelvic floor
Counteracts effects of raised intra-abdominal pressure
Counteracts effects of gravity

11. Complete sheet in males Arises from ischiopubic rami Attachments
The Perineal Membrane
Complete sheet in males
Arises from ischiopubic rami
Attachments
Urethra
Vagina
Perineal body
Limits downward descent

12. Perineal Body Mass of connective tissue
Synonym: central tendon of the perineum
Located between vagina and anus
Attachments
Perineal membrane
Superficial transverse perineal muscle
Bulbospongiosus
Levator ani
Coccyx (via external anal sphincter)

13. Posterior Perineum

14. Posterior triangle
Anus
Anal sphincter
Levator ani
Ischio-rectal fossa

15. Ischio-rectal fossa Lateral - Pudendal vessels/nerve (Pudendal canal)
Medial – Fascial covering of levator ani/external anal sphincter
Posterior – sacrotuberous ligament
Anterior – urogenital perineum
Floor – skin/ subcutaneous fat

16. Pudendal Nerve/Vessels
Similar channels
Nerve arises from sacral plexus (S2- S4)
Sensory
Motor
Artery: anterior division of internal iliac artery
Branches
Clitoral
Perineal (largest branch: muscles/skin)
Inferior rectal

17. External anal sphincter
Superficial portion
Deep portion
Internal anal sphincter
Thickening of circular smooth muscle of anal wall
Important during repair of third (fourth) degree perineal laceration

18. Demands of upright posture Support for pelvic structures
The Pelvic Floor
Demands of upright posture
Support for pelvic structures
Passage of fetus
Openings for waste elimination
Fibromuscular floor
Visceral ligaments/fascia

19. Levator ani/Pelvic Wall
Levator ani most important muscle
Pubo-rectal
Pubo-coccygeal
Coccygeal
Origin: Posterior aspect of pubic bone, fascia of pelvic side wall, ischial spine
Insertion: Perineal body, anal sphincter, coccyx
Constitute pelvic diaphragm
Surfaces covered by fascia

20. Pubo-rectal and pubo-coccygeal most medial
Pelvic Floor
Pubo-rectal and pubo-coccygeal most medial
Pelvic diaphragm forms U-shaped layer of muscle
Opening end of U directed anteriorly (urogenital sinus)
Urethra
Vagina
rectum

22. Pelvic supports
Condensations of connective tissue or endopelvic fascia
Cardinal ligament
Uterosacral ligament
Pubocervical fascia

23. Clinical significance
Prolapse of pelvic structures
Damage
Weakness

24. Cardinal ligament Transverse cervical/Mackenrodt’s ligament
Attaches lateral cervix/upper vagina to pelvic side wall
Connective tissue/involuntary muscle
Ureter in upper part

25. Uterosacral ligament
Postero-lateral attachment of lateral vaginal fornix/cervix/isthmus to sacro-iliac joint/third piece of sacrum

26. Pubo-cervical fascia Extends between cardinal ligament and pubis
Lateral to the bladder
Significant in repair operation for cystocoele (anterior colporrhaphy)