Pelvis and Perineum

Dental Gross Anatomy

Paul W. L. Kwan, Ph.D.

Pelvis: Part of the trunk inferoposterior to the abdomen and is the

area of transition between the trunk and the lower limbs. The space
enclosed by the pelvic girdle.

Pink:Abdominal
cavity

Blue: Pelvis

Orange: Perineum
Moore & Dalley 3.1A

Lippincott, Williams & Wilkins 1999

False and true

Pelvis
False Pelvis
Actually the inferior part
of abdominal cavity.
Holds some abdominal
viscera.

True Pelvis
Between pelvic inlet and
outlet
Holds pelvic viscera

The Bony Pelvis

Two coxal (hip) bones, sacrum, and coccyx form the
bony pelvis.
Each coxal bone has 3 parts: Ilium, Pubis, Ischium
The 3 parts join at the acetabulum of the hip joint.

Moore & Dalley 2006 Lippincort, Williams & Wilkins

Pelvic Joints and

Ligaments

Iliolumbar ligament
Ant. sacroiliac ligament
Sacral promontory
Ant. sup. iliac spine
Greater sciatic foramen
Sacrospinous ligament
Lesser sciatic foramen
Sacrotuberous ligament
Pubic symphysis
Stretch during pregnancy

N341 ICON Learning Systems 2003

Pelvic Inlet and Outlet

Pelvic Inlet
Pelvic brim
Sacral promontory to
superior margin of pubic
symphysis
True pelvis below
Pelvic Outlet
Inferior margin of pubic
symphysis to tip of coccyx
Closed by pelvic
diaphragm and urogenital
diaphragm.
Pelvic axis
Moore & Dalley 3.5A

Lippincott, Williams & Wilkins 1999

Gender Differences in
the Pelvis
Female measurements
longer
Bones thinner
Inlet shorter a/p
Outlet larger
Pubic arch and angle
wider
Iliac wing more flared
Ischial tuberosity more
apart
Netter 342 ICON Learning Systems 2003

Pelvic Floor
Floor made up of
muscles.
pelvic diaphragm
urogenital diaphragm
Bears weight and
pressure of
abdominopelvic viscera.

Sauerland 1999 Lippincott, Williams & Wilkins

Walls of the Pelvic

Cavity
Anterior:
Pubis bone and
pubic symphysis
Lateral:
Obturator internus
muscles
Inferior:
Pelvic floor
Posterior:
Piriformis muscles

Ilium

Sacrum
Netter 345
ICON Learning Systems 2003

Pelvic Diaphragm

3.20 Inferior View

Male
Levator ani (3 parts):
Puborectalis
Pubococcygeus
Iliococcygeus
+
Coccygeus (aka
ischiococcygeus)
Anterior gap: urogenital hiatus
(with urogenital diaphragm)
Sauerland 1999 Lippincott, Williams & Wilkins

Puborectalis Sling

Sling around the anorectal junction,maintains the anorectal flexure.

Pelvic Diaphragm
Female

Inferior view

Levator ani (3 parts):

Puborectalis
Pubococcygeus
Iliococcygeus
+
Coccygeus (aka
ischiococcygeus)
Anterior gap: urogenital hiatus
with urogenital diaphragm
3.42
Sauerland 1999 Lippincott, Williams & Wilkins

Views of the Pelvic Diaphragm

3.42

Sauerland 1999 Lippincott, Williams & Wilkins

Pelvic Floor
During
Childbirth
Bulbospongiosus,
Levator ani may be torn.
Episiotomy: surgical
incision to widen external
orifice of birth canal.
3. 35
Sauerland 1999 Lippincort, Williams & Wilkins

Female Pelvic
Organs
1. Ureter
2. Urinary bladder
3.

(Sigmoid colon)

4.
5.
6.
7.
8.

Rectum
Ovaries
Oviducts
Uterus
Vagina
Netter 347B

ICON Learning Systems 2003

Pelvic Viscera and Perineum: Female

Median (sagittal) Section

N360B Saunders Elsevier 2006

Urinary Bladder
Female

FRONTAL

N366A353B
Saunders
Elsevier
N343A,
Novartis
19972006

Ureteric opening
Urethra
Sphincter urethrae muscle
Urethra venous plexus
Levator ani
Urethral glands
Paraurethral
(Skenes duct)

Functions of the Female Reproductive Organs

Uterus
Ovary
Production of gametes
Site of implantation
(eggs)
& fetal development
Production of female
Menstrual bleeding
hormones
Vagina
Uterine Tube
Copulatory organ
Transport of gametes
Birth canal
Site of fertilization
Transport of zygote to
uterus

Uterus and Adnexa

Uterus , Oviduct, Ovary

hyster-, salphingo, ophoro-

Sauerland 1999 Lippincort, Williams & Wilkins

Pelvic Viscera and Perineum, Female

Median (sagittal)

N360B Saunders Elsevier 2006

Cervix, Gross, Inferior view

Ventral
A

Dorsal

Broad Ligament of the Uterus

Broad Ligament:
2 layers of peritoneum, ant,
& post. aspects of uterus
draped over each other.
Mesosalpinx over uterine
tube
Mesovarium over ovary
Mesometrium over uterus

* Note relation of ureter and

uterine artery with each other

3. 39
Sauerland 1999 Lippincort, Williams & Wilkins

Pelvic Ligaments

Some Supportive
Ligaments of the Uterus
Transverse cervical
ligament (Cardinal,
Mackenrodts)
Uterosacral
Pubovesical
Not shown here:
Round ligament
Broad ligament

Sauerland 1999 Lippincott, Williams & Wilkins

Round Ligament of the Uterus

2. 15
Moore and Dalley 1999 Lippincort, Williams & Wilkins

Laparoscopy 1

Peritoneum in the
Female Pelvis
1.
2.
3.
4.
5.
6.

Ant. Abdominal wall

Pubic bone level
Sup. Surface of bladder
Vesicouterine pouch
Posterior fornix of vagina
Rectouterine pouch of
Douglas
7. Sides of rectum
8. Sigmoid mesocolon

Sauerland 1999 Lippincott, Williams & Wilkins

The Lowest Points of the Body When In

Recumbent Position

2. 38
Sauerland 1999 Lippincort, Willaims & Wilkins

Pelvic Viscera and Perineum, Female

Median (sagittal)

Pouch of
Douglas

N360B Saunders Elsevier 2006

Rectouterine Pouch of Douglas, Cul-de-sac

Male Pelvic Organs

3

1. Ureter
2. Urinary bladder

1
7

3. Sigmoid colon

4.
5.
6.
7.

Rectum
Prostate
Seminal vesicles
Ductus deferens

4
2

Netter 348A

ICON Learning Systems 2003

Frontal

Urinary Bladder
Male

Ductus deferens

N343B

Novartis 1997

Ureteric orifice
Vesical venous plexus
Prostate / prostatic urethra
Colliculus seminalis
Levator ani
Sphincter urethrae muscle
Bulbourethral gland
Spongy urethra
Corpus spongiosum

Male
Urogenital
System

Sauerland 1999 Lippincort, Willaims & Wilkins

Functions of the Male Reproductive Organs

Testis
Production of male
gametes (sperms)
Production of male
hormones

Epididymis
Maturation of sperms
Ductus Deferens
Transportation of sperms

Prostate, Seminal
Vesicles, Bulbourethral
Glands
Accessory sex glands,
secretions contribute to
the semen

Penis
Copulatory organ
Passage for sperms
Passage for urine

Peritoneum in the
Male Pelvis
1.
2.
3.
4.
5.
6.
7.
8.

Ant. Abdominal wall

Pubic bone level
Sup. surface of bladder
Post. surface of
bladder
Seminal vesicle
Rectovesical fossa
Sides of rectum
Sigmoid mesocolon
Sauerland 1999 Lippincott, Williams & Wilkins

Digital Rectal Exam

One Uncomfortable Man

Selected Branches of the

Internal Iliac in the Female
Pelvis
Aorta Common iliac
Internal iliac:
Post. & Ant. Divisions
Anterior Division:
Internal pudendal
Middle rectal
Vaginal, with branch to
bladder
Uterine
Umbilical*
Superior vesical

Sauerland 1999 Lippincott, Williams & Wilkins

Blood Supply of Ovary, Oviduct, Uterus, & Vagina

Aorta Gonadal
1. Ovarian
Internal Iliac:
2.Uterine
3.Vaginal
4.Internal pudendal
* Note relationship of
ureter to uterine artery

Netter 384B Posterior view

ICON Learning Systems 2003

Selected Branches of the

Internal Iliac in the Male
Pelvis
Aorta Common iliac
Internal iliac:
Post. & Ant. Divisions

Anterior Division:

Internal pudendal
Inferior vesical
Umbilical*
Superior vesical
Middle rectal

3.25
Sauerland 1999 Lippincott, Williams & Wilkins

Pelvic Innervation
Sacral plexus:
Pudendal n. (S2 ,3 , 4)
Nerve to pelvic
diaphragm (S3, S4)

Pelvic Plexus:
Pelvic splanchnic (S2-4)
with parasympathetic f.
Hypogastric plexuses,
mixed

Sauerland 1999 Lippincort, Williams & Wilkins

Female Pelvic
Plexus
(Inferior Hypogastric
Plexus)

Sauerland 1999 Lippincott, Williams & Wilkins

Pelvis: Part of the trunk inferoposterior to the abdomen and is the

area of transition between the trunk and the lower limbs. The space
enclosed by the pelvic girdle.

Pink:Abdominal
cavity

Blue: Pelvis

Orange: Perineum
Moore & Dalley 3.1A

Lippincott, Williams & Wilkins 1999

Perineum: area of the surface of the trunk between the thighs and the
buttocks, and the shallow compartment lying deep to this area and inferior
to the pelvic diaphragm. Includes the anus and external genitalia.

Moore and Dalley 1999 Lippincort, Williams & Wilkins

The Perineum
Definition: A diamond-shaped
region between the thighs and
inferior to the pelvic
diaphragm.
2 Triangles:
Anal Triangle with the anal
canal.
Urogenital Triangle with the
outlets of the urinary and
genital systems.
* Perineal body:
Central point of perineum;
attachment of the perineal
muscles.

*
3.2

Sauerland 1999 Lippincott, Williams & Wilkins

Male and Female Perineum

Ischioanal Fossa and Related

Structures

3.8 & 3.9

Sauerland 1999 Lippincort, Willaims & Wilkins

Ischioanal Fossae

Ischioanal Fossa
Peritoneum / pararectal
fossa
Ureter
Extraperitoneal space, fat
Obturator internus m. /
fascia
Levator ani m.
Pudendal canal (Alcock),
internal pudendal vessels,
pudendal n., perineal n.
Fat body of ischioanal fossa
Ischial tuberosity
N392 Saunders Elsevier 2006

External Genitalia
(Vulva)
In Lithotomy Position

Mons pubis
Labia majora and minora
Vestibule of the vagina
Clitoris and prepuce of
clitoris
Vaginal orifice
External urethral orifice
Openings of paraurethral
glands of Skene
Sauerland 1999 Lippincott, Williams & Wilkins

Female
Perineum
After Removal of the
Superficial Perineal
Fascia (Colles), and the
Deep Perineal Fascia of
Gallaudet

Sauerland 1999 Lippincort, Williams & Wilkins

Female Perineum
Superficial perineal space.
Erectile tissue and glands

/Perineal membrane/
Clitoris (erectile tissue)
Bulb of vestibule (erectile tissue)
Greater vestibular glands
3 Superficial perineal muscles*
invested by the deep perineal fascia of
Gallaudet (removed):
*Superficial transverse perineal
*Ischiocavernosus (over crura)
*Bulbospongiosus (over bulb)
[Superficial perineal fascia (Colles)
removed]

Perineal
membrane

Superficial transverse
perineal

*
Perineal body

Sauerland 1999 Lippincort, Williams & Wilkins

Female Perineum
Deep Perineal Space
D

(Pelvic cavity if you keep going)

/Superior fascia of the deep
perineal muscles/
*Deep transverse perineal m.
*Compressor urethrae m.
*Sphincter urethrovaginalis
*Sphincter urethrae
*These muscles & their fasciae
form the urogenital diaphragm
(Perineal membrane)
Sauerland 1999 Lippincott, Williams & Wilkins

Urogenital Diaphragm
D

Superior Fascia of deep

perineal muscles
------------------------ Deep transverse perineal
muscles
Compressor urethrae
Sphincter urethrae /
urethrovaginal muscle
-------------------------- Perineal membrane=
inferior fascia of deep
perineal muscles =
fascia diaphragmatis
urogenitalis inferior
(inferior view)

Sauerland 1999 Lippincott, Williams & Wilkins

Male Perineum and External

Genitalia

Netter 363 ICON Learning Systems 2003

Male Perineum
Superficial Perineal
Space

/Perineal membrane/
Root (bulb and crura) of penis
*Ischiocavernosus muscle
*Bulbospongiosus muscle
*Superficial transverse
perineal muscle
* invested by deep perineal
fascia of Gallaudet (removed)
[Superficial perineal fascia
(Colles)--- removed]
S
Sauerland 1999 Lippincott, Williams & Wilkins

Male Perineum
(Pelvic cavity if you keep
going)
D
Superior fascia of deep
perineal muscles
-------------------------------- Deep transverse perineal
muscle
Sphincter urethrae muscle
Compressor urethrae m.
Bulbourethral glands
These muscles & fasciae
form the urogenital
diaphragm
--------------------------------S (Perineal membrane)
Inferior fascia of dpm

Deep Perineal Space

Sauerland 1999 Lippincott, Williams & Wilkins

Male Pelvis, coronal section through pelvis anterior to rectum.

In deep pouch
In superficial pouch

Note the superficial perineal space/ pouch/ compartment and the deep perineal space/
pouch/ compartment separated by the perineal membrane.

Male Perineum and External

Genitalia

Netter 363 ICON Learning Systems 2003

Scrotum and
Contents
Netter 387A
Saunders Elsevier 2006

Normal Anatomy and Pathologic

Conditions
Process Vaginalis and Tunica Vaginalis

2. 21
Sauerland 1999 Lippincort, Willaims & Wilkins

Layers of the Anterior Abdominal Wall Prolonged

Into the Scrotum

Extravasation
of
Urine

3. 11

Sauerland 1999 Lippincort, Williams & Wilkins

The Testis

2. 20

Sauerland 1999 Lippincort, Willaims & Wilkins

Perineum & External Genitalia

N381 Saunders Elsevier 2006

Penis
Netter 365B
ILS 2003

Buck

Arteries and Veins of the Female Perineum

N404 Saunders Elsevier 2006

Superficial

Deep

Arterial
Supply of the
Male
Perineum

Moore and Dalley 1999 Lippincort, Williams & Wilkins

Pudendal
Nerve &
Artery

3. 7

Pudendal Nerve
in Male
Passing through 5
regions.
It divides into 3
major branches.
3.28

Sauerland 1999 Lippincort, Willaims & Wilkins

Nerves of Female Perineum and External Genitalia

N413 Saunders Elsevier 2006

Pudendal and Ilioinguinal Nerve Blocks

Sauerland 1999 Lippincort, Willaims & Wilkins

Pelvic Nerves

3. 8

Pudendal, Inf. hypogastric plexus,

Pelvic splanchnic
Moore and Dalley 1999 Lippincort, Williams & Wilkins