Anatomy clinical correlates: Female pelvis and perineum

The pelvis lies between the abdomen and the lower limbs, forming the lower part of the trunk. It supports and contains organs of the gastrointestinal system, the urinary system, and the reproductive system.

Furthermore, the structure and contents of the pelvis differs between biological male and biological female individuals.

These anatomic differences are important to understand as they have large clinical implications in biological females for things such as fertility and childbirth.

So, why don’t we make like a baby and dive into the clinical correlates of the female pelvis and perineum head first!

Speaking of babies, as cute and adorable as they are, pregnancy and childbirth can lead to a number of complications such as the risk of perineal or pelvic floor injury.

The pelvic floor holds the pelvic organs in a stable position, and during childbirth the pelvic floor makes every effort to support the fetal head.

During delivery the fetal head stretches the pelvic floor, frequently resulting in injury to the perineum, levator ani, and ligaments of the pelvic viscera.

Specifically, injury to the pubococcygeus and the puborectalis muscles of the levator ani often occur. These muscles surround and support the urethra, vagina, and anal canal.

So injury to these muscles can lead to decreased support for the vagina, bladder, uterus, or rectum.

Another important structure that can be damaged is the perineal body, which is the fibromuscular center point of the perineum, that serves as an attachment point for structures such as the muscles of the levator ani, fibers from the external urethral sphincter and urethrovaginal sphincter, and the external anal sphincter.

Damage to the pelvic floor or perineal body can lead to urethral hypermobility and stress urinary incontinence, which is when drops of urine come out when intra abdominal pressure increases.