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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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 Via Obturator foramen = Obturator nerve & vessels

attach to the ventral

invest the muscle from

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