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Pelvis and Perineum
The bony pelvis and joints
 Ileum
 Ischium

 Pubis

 Sacrum

 Coccyx

Joints:
*Sacroiliac joint
*Sacrococcygeal jt.
*Symphysis pubis
Bony parts
 The pelvic inlet or pelvic brim: a
bony rim made up of the sacral
promontory, the iliopectineal line
and the superior border of the
svmphysis pubis.
 The pubic tubercle(s).
 The obturator foramina.
 The pubic arch (made up of a right
and a left ramus).
 The ischial tuberosities: verify on
yourself that this is the part you sit
on.
 The ischial spines.
 The acetabulum. A Unshaped
socket which articulates with the
head of the femur
 The Sacrum and coccyx
 Promontory of the
sacrum
 Anterior sacral
Foramina
 Posterior sacral
foramina
 Sacral hiatus
 Coccygeal bone
The pelvic outlet: A diamond-shaped area, best appreciated when viewed from
below. The boundaries of the pelvic outlet are: the pubic symphysis,
right and left rami of the pubic arch, the ischial tuberosities, the
sacrotuberous ligaments and the tip of the coccyx.
 In the living person (or the intact cadaver) there are 2
important ligaments which help to stabilize the bony pelvis:

The sacrospinous ligament and the sacrotuberous ligament.

 Differences
Characteristics Male pelvis Female pelvis
Size Smaller Larger
Greater sciatic Narrower Wider
notch
Inferior pubic Narrower Wider
angle
False pelvis Tall Flared
Pelvic inlet Android Gynecoid
Pelvic outlet Smaller Larger
. Two muscles and their fasciae form part of
the walls of the pelvic cavity:
 The piriformis muscle: Takes origin from the front
of the sacrum near the 3rd and 4th sacral foramina.
The muscle leaves the pelvis by passing laterally
through the greater sciatic foremen and inserts on the
upper border of the greater trochanter of the femur.
 The obturator internus muscle: Takes origin from
the inner surface of the obturator membrane, which
closes over most of the obturator foremen, and from
the interior surfaces of the pubis and ischium, below
the Iliopectineal line, and from the pubic ramus. This
is a fan-shaped muscle which becomes tendinous as it
passes through the lesser sciatic foremen. The tendon
inserts on the greater trochanter of the femur.
The Piriformis and Obturator internus
muscles
Two muscles and their fasciae form the floor
of the pelvic cavity, the pelvic diaphragm:
The levator ani muscle: This is a thin sheet of muscle which takes
origin from the pubic bone and the adjacent fascia of the obturator
internus muscle on the coccyx; onto a fibrous band running from the
rectum and coccyx called the anococcygeal rapine; and onto a fibrous
body lying between the prostate or vagina and rectum, known as the
perineal body. The levator ani muscle can be subdivided, depending on
the exact origin and insertion of the fibers:
 levator prostatae or sphincter vaginae - include the fibers taking origin
from the posterior surface of the pubis, and inserting in the perineal body.
These form a "sling" around the prostate or vagina.
 puborectalis - origin from the posterior surface of the pubis, and form a sling
around the rectum. The puborectalis is thought to be important in maintaining
fecal continence, rectal sling
 pubococcvgeus - origin from the posterior surface of the pubis and insert
into the anococcygeal rapine.
 iliococcvgeus - origin from the obturator internus fascia and ischium and
insert into the anococcygeal rapine.

The coccvgeus muscle: takes origin from the ischial spine and inserts onto the
lower part of the sacrum and coccyx.
Muscles forming the pelvic diaphragm
Levator ani and Coccygeus muscle
Orientation of the Abdominal and Pelvic
cavities
Arterial blood supply to the pelvis
Venous and Lymphatic drainage
Nerve supply of the pelvis
 Lumbosacral plexus – provides the somatic
innervation to the pelvis and lower extremities

1. Lumbosacral trunk
-lies in the posterior abdominal wall and iliac
fossa.
2. Sacral plexus – lies in the minor pelvis, supplies
the gluteal,posterior thigh, leg,& foot
3. Pelvic splanchnic nerve from S2 to S4
consists of parasympathetic, preganglionic
fibers and visceral afferent fibers.
Major branches of the Sacral Plexus
 Superior gluteal nerve(L4-S1) to the gluteus medius and minimus. Injury
“abductor lurch” a rolling gait due to loss of abductive power of the hips.
 Inferior gluteal(L5-S1) to the gluteus maximus. Injury results to difficulty in
climbing stairs or rising from chair.
 Common peroneal nerve(L4-S2) to the anterior leg and dorsum of foot.
Injury results to inability to dorsiflex ( foot drop) and evert the foot.
 Tibial nerve (L4-S3anterior) to the posterior of thigh, leg & plantar of foot.
Injury results to inability to stand on toes and loss of Achilles tendon reflex
 Pudendal nerve (S2-S4 anterior) lies in the Alcocks canal.
 Inferior rectal nerve – motor to external anal sphincter and sensory toinferior
part of anal canal and anal triangle
 Perineal nerve – motor to urogenital diaphragm and external genitalia, sensory to
urogenital triangle of perineum and external genitalia
 There are 4 major "gateways" to the
lower limb
 Structures passing under the inguinal ligament
 Iliopsoas muscle, Femoral nerve, Femoral artery and

veins
 Lymphatic drainage to inguinal nodes

 Via Obturator foramen = Obturator nerve & vessels

 Via the Sciatic foramen = piriformis m., inferior gluteal
nerves & vessels, superior gluteal nerves & vessels ,
sciatic nerve
 Via Lesser sciatic foramen = obturator internus tendon
Major organs in the pelvic cavity, The
Urinary system
Organs in the pelvic cavity, The Rectum
Organs in the pelvic cavity, The
Reproductive organs
 Development of the External
genitalia
 Indifferent stage week 3 – 6
 Cloacal fold separates the lumen of the hindgut from the
perineal region
 Genital tubercle form from the fusion of the cloacal folds
 Urorectal septum divides the cloaca into urogenital sinus and
anal canal
 The fusion of the urosinus with cloacal membrane forms the
central tendon of the perineum ( perineal body) and divides into
urethral fold and anal fold.
 Genital swellings (labial and scrotal fold)
 Urogenital and anal membrane degenerate to form an opening
of the alimentary canal and urogenital canal to the perineum.
Definitive external genitalia of male

 Phallus = produced by the elongation of

the genital tubercle on the 12th week
 13th week, scrotal fold migrate posteriorly
and fuse to form the scrotum. Testes lies
in the inguinal region
 16th week the glans penis differentiates.
 7th month testes starts to descend thru the
inguinal canal to the scrotum
 Congenital anomalies of the penis

 Hypospadias – incomplete dusion of penile

urethra opening in the ventral surface.
 Epispadias – opening of the urethra in the
dorsal surface
 Micropenis – congenital absence
 Doubling of the glans penis
 Definitive external genitalia for
females
 Clitoris – formed by the slight elongation of the genital
tubercle
 Labia majora develop from the genital swellings.
 Ovaries develop and migrate in the 9th week, formation
of the ovarian ligament and round ligament of the ovary
 13th week the Ovaries lie in the minor pelvis, forms the
suspensory ligament of the ovary.
 An evagination of the coelom (processus vaginalis, canal
of Nuck) penetrates the abdominal wall of the inguinal
region and enters the labial fold
The Male and Female Reproductive organs and its
functions
 Important information about male
pelvic reproductive system.
 The vas deferens pass behind the prostate gland.
 The seminal vesicles also lie posterior to the bladder, lateral to the vas
deferens.
 The ducts of the seminal vesicles join up with the ductus deferens to
form the ejaculatory ducts in the substance of the prostate gland.
 The ejaculatory ducts empty into the prostatic urethra, and from that
point on spermatozoa travel through the urethra to get to the outside (or
inside) world.
 Secretions of 3 pairs of glands, the, prostate and bulbourethral glands
are added to the substance that is ejaculated (semen). Secretions of the
seminal vesicles and prostate seem to play an important role in sperm
motility. Secretions of the bulbourethral glands appear to be more
important for lubrication during sexual arousal.
 
 Important features of the Female
reproductive organ
 Although the ovaries are completely surrounded by peritoneum
(they are intraperitoneal and have a short mesentery, the
mesovarium)
 When the ovarian follicle ruptures, the ovum ruptures through the
peritoneal covering into the peritoneal cavity.
 The ovum is then picked up by the fimbriae at the expanded end of
the uterine tube, called the infundibulum, which are highly motile.
 An ovum produced by the left ovary may be picked up by, and
migrate through either the right or left uterine tube.
 The uterine tubes open into the peritoneal cavity. Therefore in the
female, the potential exists for infection to spread from the uterine
tubes to the peritoneal cavity.
 Muscle of the Perineum
 Superficial transverse perineal, to central perineal body,
stabilizes perineum S2.S4
 Deep transverse perineal, to midraphe & CPB, reinforce
pelvic floor stabilizes vagina, S2-S4,Pud.n.
 External urethral sphincter, to circumurethral, urinary
continence, S2,S4, Pud.n.
 Ischiocavernosus, to body of penis or clitoris
 Bulbocavernosus, to body of penis or clitoris
 External anal sphincter, to circumanal, fecal continence,
S2S4, Pud. N.
 Male Urogenital traingle
 Penis
 Vascular Erectile tissues:
a.corpus spongiosum
(urethra)
b.Corpora cavernosa
- Prepuce or foreskin attach

to the ventral raphe by the

frenulum
- Deep fascia of Buck, invest

the muscle from the root to

the glans
- Blood from the internal

pudendal artery,
- pudendal nerve supply
 Scrotum
 Labial scrotal fold suspended
from the perineum
 Dartos layer formed by the
fusion of the superficial and
deep layers of the superficial
fascia. Muscles that are
temperature sensitive for
regulate.
 Nerve by the Ilioinguinalk,
genitofemoral and dorsal
nerves of penis
 External female genitalia
 Vulva, consist of the genital labia
and the urogenital sinus
 Labia majora from the labio-
scrotal fold
 Uroginetal sinus or vestibule,
Fossa navicularis,
 Greater vestibular
gland( Bartholins glands-glands of
Cowper in males)
 Paraurethral glands (Skene glands
–prostate in males)
 Clitoris, corpora cavernosa,
prepuce, bulbocaverrnos muscle
 Blood by the internal poudendal
artery
 Fascia of the female urogenital
triangle
 Cruveilhers fascia – a fatty layer
continuous with Camper’s fascia
 Colle’s fascia – deeper layer of superficial
fascia continuous with Scarpa’s fascia
 Deep investing fascia of Gallaudet- covers
the muiscles of the superficial pouch
Internal female genitalia
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