Anatomy clinical correlates: Female pelvis and perineum

00:00 / 00:00



Anatomy clinical correlates: Female pelvis and perineum

Prerequisite basic sciences

Prerequisite basic sciences

Prerequisite basic sciences

Prerequisite basic sciences


Anatomy clinical correlates: Female pelvis and perineum

USMLE® Step 1 questions

0 / 9 complete

USMLE® Step 2 questions

0 / 12 complete


USMLE® Step 1 style questions USMLE

of complete

USMLE® Step 2 style questions USMLE

of complete

A 56-year-old woman comes to the clinic for follow-up after a radical abdominal hysterectomy for endometrial cancer a month ago. Over the last two weeks, the patient has noticed continuous urine leakage that soaks two to three pads a day. She has not experienced difficulty passing urine, urinary retention, or incomplete emptying. Past medical history includes depression treated with venlafaxine and escitalopram, and multiple sclerosis. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 20/min, and blood pressure is 105/75 mmHg. Abdominal examination is unremarkable. The vagina has a scant clear discharge. Pelvic examination reveals a granular mass on the anterior vaginal wall. Post void residual urine is 50 ml. Which of the following is the most likely underlying cause of this patient’s condition?  


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.


  1. "Terminologia Anatomica" Thieme (1997)
  2. "Miller's Anesthesia" Elsevier Health Sciences (2009)
  3. "Περίς, πηρίς and περίναιος" Emerita (2016)
  4. "Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial" BJOG: An International Journal of Obstetrics and Gynaecology (1997)
  5. "The prevention and treatment of postpartum haemorrhage: what do we know, and where do we go to next?" BJOG: An International Journal of Obstetrics & Gynaecology (2014)
  6. "Levonorgestrel-releasing intrauterine system: uses and controversies" Expert Review of Medical Devices (2008)
  7. "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location" Human Reproduction Update (2013)
  8. "The erogenous zones: their nerve supply and its significance" Proc Staff Meet Mayo Clinic (1959)
  9. "American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 165: prevention and management of obstetric lacerations at vaginal delivery" Obstet Gynecol (2016)

Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.