The Pelvis
The pelvic cavity consists of the pelvic inlet, walls, and floor and contains elements of the urinary,
gastrointestinal, and reproductive systems.
-
Inlet: S1, alae of sacrum, arcuate line, linea terminalis (pubic crest, pecten pubis, arcuate line),
and pubic symphysis
Walls: obturator internus, piriformis, sacrospinous and sacrotuberous ligaments, greater and
lesser sciatic foramina, sacrum, coccyx, ischium, pubis
Floor: levator ani (3 parts: iliococcygeus, pubococcygeus, and puborectalis), coccygeus, perineal
membrane, muscles of deep perineal pouch
Apertures of the Pelvis
Aperture
Greater Sciatic
Foramen
Lesser Sciatic
Foramen
Obturator
Canal
Boundaries
Greater sciatic notch,
sacrotuberous and
sacrospinous
ligaments, and the
Ischial spine, it is
divided into 2 parts by
the piriformis
Lesser sciatic notch,
Ischial spine,
sacrospinous and
sacrotuberous
ligaments
Obturator membrane,
obturator muscles,
superior pubic ramus
Gap between
pubic
symphysis and
perineal
membrane
Pelvic Inlet
Contents
Above piriformis: superior gluteal
nerves and vessels
Below piriformis: inferior gluteal
vessels and nerves, sciatic nerve,
pudendal nerve, internal pudendal
vessels, posterior femoral cutaneous
nerves and the nerves to the obturator
internus and quadrates femoris
muscles
Pudendal nerve and internal pudendal
vessels, tendon of obturator internus
Obturator nerve and vessels
Dorsal vein of penis and clitoris
S1, alae of sacrum,
arcuate line, linea
terminalis, and pubic
symphysis
Significance
Communication
between pelvic
cavity and lower
limb
Above the pelvic
floor
Communication
between gluteal
region and
perineum
Below pelvic floor
Communication
between pelvic
cavity and
adductor region of
thigh
Communication
between pelvic
cavity and
perineum
Separates the true
from the false
pelvis,
communication
between the
abdomen and the
pelvic cavity
Pelvic Outlet
Pubic symphysis,
bodies and inferior
rami of pubis, rami of
ischium, and the Ischial
tuberosity,
sacrotuberous ligament
and coccyx
Terminal parts of the urinary and GI
tracts, and the vagina
Area enclosed is
the perineum
Male vs. Female Pelvis:
Characteristic
Pelvic Inlet
Male
Heart-shaped, more distinct
promontory of sacrum
50-60⁰
Prominent
Female
Circular, broader alae of sacrum
Sacrospinous
Connection
Ischial spine and margins of
sacrum and coccyx
Sacrotuberous
Ischial tuberosity to the PSIS and
dorsolateral sacrum and coccyx
Significance
Create Sciatic Foramina and
stabilize the sacrum by resisting
upward tilting
Create Sciatic Foramina and
stabilize the sacrum by resisting
upward tilting
Stabilize lumbosacral joints
Pubic Arch
Ischial Spines
80-85⁰
Less prominent
Ligaments of the Skeletal Pelvis:
Ligament
Iliolumbar
Lumbosacral
Anterior Sacro-iliac
Interosseous Sacro-iliac
Posterior Sacro-iliac
Superior Pubic
Inferior Pubic
Transverse process of L5 to the
ilium
Transverse process of L5 to the
sacrum
Runs anteriorly and inferiorly to
the sacro-iliac joint
Immediately posterosuperior to
the sacro-iliac joint and fills the
gap between the ilium and
sacrum
Covers the interosseous sacroiliac ligament
Above the pubic symphysis
Below the pubic symphysis
Stabilize lumbosacral joints
Transmit forces from the lower
limbs to the vertebral column
Largest, strongest sacro-iliac
ligament
Transmit forces from the lower
limbs to the vertebral column
Transmit forces from the lower
limbs to the vertebral column
Muscles of the Pelvis:
Muscle
Obturator Internus
Piriformis
Levator Ani
Coccygeus
External Urethral
Sphincter
Deep Transverse
Perineal
Compressor Urethrae
Sphincter
Urethrovaginalis
External Anal
Sphincter
Ischiocavernosus
Bulbospongiosus
Superficial Transverse
Perineal
Attachments
Obturator membrane to
greater trochanter
Anterior sacrum to greater
trochanter
Posterior pubic bone,
obturator internus, Ischial
spine to perineal
membrane, perineal body,
around the anal canal, and
anococcygeal ligament
Ischial spine and
sacrospinous ligament to
coccyx and sacrum
Inferior ramus of pubis
and walls of deep perineal
pouch to membranous
part of urethra
Ischial ramus to perineal
body
Ischiopubic ramus to its
partner anterior to
urethra
Perineal body to its
partner, surrounding the
urethral and vaginal
openings
Anal canal and aperture to
perineal body and
anococcygeal body
Ischial tuberosity and
ramus to crus of penis or
clitoris
Perineal body to perineal
membrane, corpus
cavernosum, bulb of
vestibule, body of clitoris,
bulbospongiosus
Ischial tuberosity and
ramus to perineal body
Innervation
L5, S1: Nerve to
obturator internus
L5, S1, S2
Inferior rectal
branch of pudendal
nerve (S2-S4), and
S4 ventral rami
S3 and S4 anterior
rami
Perineal Branches
of Pudendal Nerve
(S2-S4)
Perineal Branches
of Pudendal Nerve
(S2-S4)
Perineal Branches
of Pudendal Nerve
(S2-S4)
Perineal Branches
of Pudendal Nerve
(S2-S4)
Pudendal Nerve
(S2-S4) and
branches directly
from S4
Pudendal Nerve
(S2-S4)
Pudendal Nerve
(S2-S4)
Pudendal Nerve
(S2-S4)
Action
Lateral rotation of extended
hip, abduction of flexed hip
Lateral rotation of extended
hip, abduction of flexed hip
Forms pelvic floor, supports
pelvic viscera, maintains
angle between rectum and
anal canal, reinforces
external anal sphincter, acts
as vaginal sphincter
Forms pelvic floor, supports
pelvic viscera, pulls coccyx
forward after defecation
Compresses membranous
urethra, relaxes during
micturition
Stabilizes perineal body
Accessory sphincter of the
urethra
Accessory sphincter of
urethra, may close the
vagina
Closes anal canal
Retain blood in penis or
clitoris
Move blood into glans of
penis or clitoris,
in men: remove residual
urine from urethra, pulsatile
emission of semen
Stabilize the perineal body
Viscera of the Pelvis:
-
Rectum and Anal Canal: the rectum is continuous with the sigmoid colon at S3 and below at the
anal canal as it penetrates the pelvic floor
-
Ureters: enter the pelvic cavity anterior to the bifurcation of the common iliac artery. They are
crossed in the pelvis by the ductus deferens or uterine artery
Bladder: most anterior pelvic viscera, expands into abdominal cavity when full. Consists of a
apex (toward top of pubic symphysis, connected to median umbilical ligament [urachus]), base
(faces posteroinferiorly, smooth mucosa, contains trigone), and the inferolateral surfaces
(cradled between levator ani and obturator internus muscles). The neck of the bladder is the
most inferior and fixed area anchored to the pubic bones by pubovesical or puboprostatic
ligaments
Urethra: begins at base of bladder and ends with external opening in perineum
o Women: 4cm long and passes inferiorly through pelvic floor and into perineum, passing
through deep perineal pouch and perineal membrane before opening into vestibule
between labia minora. Skene’s glands are associated with the lower end of urethra.
o Men: 20cm long and passes through prostate, deep perineal pouch, perineal membrane,
and enters the root of the penis. The male urethra is divided into 4 parts:
- Preprostatic: 1cm, internal urethral sphincter (prevents semen from flowing
backward into bladder).
-Prostatic: 3-4cm, contains urethral crest, prostatic sinus, seminal colliculus,
and prostatic utricle. Connection between urinary and reproductive tracts
occurs here.
-Membranous: narrow, passes through the deep perineal pouch where it is
surrounded by the external urethral sphincter (skeletal muscle).
-Spongy: surrounded by erectile corpus spongiosum, forms a bulb at the end of
the penis called the navicular fossa. The bulbourethral glands enter into the
spongy urethra. Vulnerable to damage during catheterization.
-
-
The Perineum: inferior to the floor of the pelvic cavity
-
-
Contains: Terminal openings of the GI and urinary systems, External openings of reproductive
tract, and Roots of the external genitalia
Bounded by: the pubic symphysis, coccyx, ischiopubic rami (Anterolateral), and sacrotuberous
ligaments (posteriorly), levator ani (roof)
Pudendal nerve (S2-S4) and Pudendal artery are main nerve and artery of the region
2 Triangles: divided by imaginary line between the two Ischial tuberosities
o Urogenital: anterior triangle, in the horizontal plane, contains openings of the urinary
systems and reproductive systems (in the Urogenital hiatus), the perineal membrane
anchored to the perineal body, the superficial perineal pouch (contains erectile fibers),
and this triangle functions to anchor the external genitalia (via the perineal membrane
and deep perineal pouch)
o Anal : posterior triangle, faces posteriorly, contains the anus and the external anal
sphincter (3 skeletal muscle parts: deep, superficial, and subcutaneous)
Ischio-anal Fossae: Inverted wedge shaped gutters between the levator ani muscles, deep
perineal pouch, and the adjacent pelvic walls (ischium, obturator internus, and sacrotuberous
ligament).
o The anterior recesses project into the Urogenital triangle superior to the deep perineal
pouch
o Allow movement of the pelvic diaphragm and expansion of the anal canal during
defecation
o Normally filled with fat
Layers of Pelvic Floor: Deep to Superficial
1
2
3
Structure
Levator ani and
coccygeus muscles
Superior fascia
Deep Perineal Pouch
4
5
Perineal Membrane
Superficial Perineal
Pouch
6
Inferior (superficial)
fascia
Contents
Skeletal muscle
Ischio-anal fossae and recesses (fat)
External urethral sphincter, sphincter urethrovaginalis, compressor
urethrae, deep transverse perineal muscles, bulbourethral glands
Fibrous membrane
Erectile structures that form the penis or clitoris, bulbs of vestibule, glans
clitoris, corpus spongiosum (proximal part is bulb of penis)
skeletal muscles: ischiocavernosus, bulbospongiosus, superficial
transverse perineal
A membranous deep layer, Colles’ fascia , which is attached to the
perineal membrane and ischiopubic rami (it does not extend into the anal
triangle or into the thigh). It defines the external limits of superficial
perineal pouch and enters the scrotum/labia and extends around the
body if the penis/clitoris
*Because this layer is continuous with the abdomen, infectious materials
that accumulate in the superficial perineal pouch can track out of the
perineum and enter the lower abdominal wall*
Male Reproductive System:
Structure
Testis
Epididymis
Ductus
Deferens
Ejaculatory
Duct
Urethra
Penis
Prostate
Gland
Seminal
Vesicles
Bulbourethral
Glands
Location
Inside scrotum, attached to
abdominal wall by spermatic cords
Function
Produce sperm cells in
seminiferous tubules
Posterolateral side of testes
Stores sperm as they
mature before
ejaculation
Scrotum, inguinal canal, bends
medially around inferior epigastric
a., crosses external iliac v. and a. ,
pelvic cavity, crosses ureter,
inferomedially along bladder,
anterior to rectum, and enters
duct of seminal vesicle
Through prostate gland
From neck of bladder to the
external urethral opening in tip of
penis
Outside of body in pubic region,
attached to the pubic arch and
anchored to the perineal
membrane
Inferior to bladder, posterior to
pubic symphysis, and anterior to
rectum
Between bladder and rectum
Within deep perineal pouch,
lateral to membranous urethra
Transports sperm from
the tail of the
epididymis to the
ejaculatory duct
Carries secretions of
ductus deferens and
seminal vesicles into
urethra
Conducts urine from
bladder to outside of
body
Conducts urine and
semen
Contributes secretions
to semen
Contributes significant
secretions to semen
Contribute to
lubrication of the
urethra and preejaculatory emissions
Key Features
Tunica vaginalis, tunica
albuginea, rete testis,
mediastinum testis
Head (efferent
ductules), (true
epididymis) body and
tail
Very long
Penetrates prostate to
enter urethra
4 parts: preprostatic,
prostatic, membranous,
and spongy
Copulatory organ
Erectile tissue,
composed of 2 corpora
cavernosa and a corpus
spongiosus. As a bulb,
roots (crura), body , and
glans
Surrounds urethra
Accessory gland
Ducts open into spongy
urethra at the root of
the penis
Female Reproductive System:
Structure
Ovaries
Uterine Tubes
Uterus
Vagina
Clitoris
Greater
Vestibular
Glands
Para-urethral
Glands
Location
Adjacent to lateral pelvic wall
just inferior to pelvic inlet
Produce egg cells
Project laterally from body of
uterus, passing superiorly over
ovaries
Conduct egg cells
into body of uterus
Midline, between bladder and
rectum
Holds developing
fetus during
pregnancy
Extends from cervix, through
pelvic floor, and perineum to
the outside of the body
(introitus). Between bladder and
rectum.
Beneath pubic symphysis and
the underside of the ischiopubic
rami and anchored to the
perineal membrane
Located posterior to the bulbs of
the vestibule on either side of
the vaginal opening
Located on either side of the
urethra, its ducts open into the
vestibule at the lateral margins
of the urethral opening
Function
Accepts semen
deposited during
intercourse, serves as
birth canal during
childbirth
Great sensitivity
Produce lubricating
secretions during
arousal
Produce lubricating
secretions
Key Features
Suspended by
mesovarium, connected
to body wall by
suspensory ligament and
to uterus by ligament of
ovary
Enclosed by mesosalpinx,
Have fimbriae,
infundibulum, and
ampulla (usual site of
fertilization)
Consists of a fundus, body,
and cervix (canal forms
external and internal os,
and it forms fornix at
junction with vaginal wall)
Copulatory organ in
women
Composed of the glans
and the corpora
cavernosa: has a root and
a body
Also called Bartholin’s
Glands, found in
superficial perineal pouch
Also called Skene’s Glands
Erectile Tissues:
-
-
Erection is a vascular event mediated by the parasympathetic fibers of the pelvic splanchnic
nerves (anterior rami of S2-S4)
The pelvic splanchnics branch from the hypogastric plexus and pass through the deep perineal
pouch and perineal membrane to innervate the erectile structures in the superficial perineal
pouch
Stimulation of these nerves causes branches of the internal pudendal arteries to relax, allowing
blood to fill the penis or clitoris, causing erection
Branches of the Pudendal nerve (S2-S4) carry sensory nerves from the penis/clitoris
Fascia, Peritoneum and Ligaments: continuation of extraperitoneal connective tissue of the abdomen
Fascia
Rectovaginal
Pubocervical Ligament
Transverse Cervical Ligament
Uterosacral Ligament
Vesico-uterine Pouch
Pouch of Douglas (recto-uterine)
Recto-uterine Folds
Broad Ligament
Prostatic
Rectovesical Pouch
Rectovesical Septum
Suspensory Ligament of Penis
Fundiform Ligament of Penis
Location/Function
Separates the posterior surface of the vagina from the rectum
Stabilize the uterus in the pelvic cavity
(Cardinal Ligament) Stabilize the uterus in the pelvic cavity
Stabilize the uterus in the pelvic cavity
Between the bladder and the uterus
Between uterus and rectum
Raised ridge of peritoneum on each side near the base of the rectouterine pouch. Covers the Uterosacral ligaments.
Runs from lateral pelvic walls to the uterus and covers the ovaries,
uterine tubes, round ligaments and ligaments of ovaries (remnants
of gubernaculum)
Contains and surrounds the prostatic plexus of veins
Occurs between the bladder and the rectum
Separates the posterior surface of the prostate and the base of the
bladder from the rectum
Supports base of body of penis, attached superiorly to pubic
symphysis
Supports body of penis, attached to the linea alba of the anterior
abdominal wall and splits into 2 bands that unite under the penis
Important Nerves in the Pelvis:
Sacral Plexus:
-
Formed by the anterior rami of the lumbosacral trunk (L4-L5) and S1-S4. S4 only has a ventral
division.
It is located anteriorly to the piriformis muscle.
The pelvic visceral nerves (S2-S4) provide parasympathetic fibers to the inferior hypogastric
plexus
Major Branches include: sciatic, superior and inferior gluteal, pudendal nerve, nerve to
obturator internus, nerve to quadrates femoris and inferior gemellus, piriformis, and levator ani,
posterior cutaneous and perforating cutaneous nerves
Coccygeal Plexus:
-
Formed by the anterior rami of S4-Co
Form the anococcygeal nerves
Penetrate the coccygeus muscle, overlying sacrospinous and sacrotuberous ligaments, passing
superficially to innervate the skin in the anal triangle
Superior Hypogastric Plexus: situated anterior to vertebrae L5 between the promontory of the sacrum
and the bifurcation of the aorta.
Hypogastric Nerves: the entrance of the prevertebral plexus into the pelvis, crossing the pelvic inlet
medially to the internal iliac vessels. Formed b y the separation of the superior hypogastric plexus into
right and left bundles.
Inferior Hypogastric Plexus: form when hypogastric nerves are joined by the pelvic splanchnic nerves
carrying parasympathetic fibers. Gives rise to:
-
-
Rectal plexus
Uterovaginal Plexus
Prostatic Plexus
Vesical Plexus
Cavernous Nerves: terminal branches supplying the erectile tissues of the penis and clitoris
Sympathetics: T10-L2, innervate blood vessels, contract internal anal and urethral sphincters,
smooth muscle contraction of reproductive glands and tract, and move secretions from the
epididymis and accessory glands into the urethra to form semen.
Parasympathetics: S2-S4, vasodilatory, contract bladder, stimulate erection, modulate enteric
nervous system of the colon distal to left colic flexure.
Visceral Afferents: follow sympathetic (these VAs carry pain) and parasympathetic (these VAs
carry receptor information) fibers to the spinal cord
Pudendal Nerve: leaves greater sciatic foramen inferior to piriformis, passes around sacrospinous
ligament, then enters the anal triangle by passing through the lesser sciatic foramen to supply the
perineum. 3 terminal branches:
-
Inferior Rectal Nerve: external anal sphincter, levator ani, skin of anal triangle
Perineal Nerve: motor to muscles of deep and superficial perineal pouches and sensory to skin
of scrotum/labia
Dorsal Nerve of Penis/Clitoris: sensory to penis/clitoris
Nerve
Sciatic
Pudendal
(accompanied by
internal pudendal
vessels)
Superior Gluteal
Inferior Gluteal
Nerve to Obturator
internus
Cord Levels
L4-S3
Inferior to piriformis
Motor
Posterior thigh, and the
leg and foot
S2-S4
Inferior to piriformis,
through lesser sciatic
foramen
Skeletal muscles of
perineum (external
urethral and anal
sphincters, levator ani)
L4-S1
Superior to piriformis
Gluteus medius, gluteus
minimus, and tensor
fascia latae
Gluteus maximus
L5-S2
Inferior to piriformis
L5-S2
Obturator internus and
Superior gemellus
Sensory
Skin of foot (tibial part)
and lateral leg
(common fibular part)
Skin of perineum, penis,
and clitoris
Nerve to quadrates
femoris and inferior
gemellus
Posterior Femoral
Cutaneous
Perforating Cutaneous
Nerve to Piriformis
Nerves to levator ani,
coccygeus, and external
anal sphincter
L4-S1
Inferior to piriformis
S1, S3
Inferior to piriformis
S2, S3
Through sacrotuberous
ligament
L5, S1, S2
S4
Pelvic Splanchnic
Nerves
S2-S4
Anococcygeal Nerves
S4-Co
Quadrates femoris and
inferior gemellus
Skin of posterior thigh
Skin over gluteal fold
Piriformis
Levator ani, coccygeus,
and external sphincter
Visceral: stimulate
erection, modulate
mobility of GI system
distal to left colic
flexure, inhibits internal
urethral sphincter
Skin between anus and
coccyx
Visceral: visceral
afferents from pelvic
viscera and parts of
distal colon. Pain from
cervix and possibly from
bladder and proximal
urethra
Perianal skin
Dermatomes of the Perineum and Pelvic Floor
Arteries of the Pelvis:
The Internal Iliac Artery on each side is the major artery for the pelvis and perineum; it originates
from the Common Iliac Artery anteriorly to the disc between L5 and S1, courses inferiorly over the
pelvic inlet, dividing into anterior and posterior trunks at the level of the superior border of the
greater sciatic foramen.
o
o
Posterior trunk: lower posterior abdominal wall, posterior pelvic wall, and gluteal
region
 Iliolumbar Artery: divides into lumbar, spinal, and iliac branches
 Lateral Sacral Arteries
 Superior Gluteal Artery
Anterior Trunk: pelvic viscera, perineum, gluteal region, and the adductor region of the
thigh.
 Umbilical Artery
 Superior Vesical Artery
 Inferior Vesical Artery or Vaginal Artery
 Middle Rectal Artery
 Obturator Artery
 Internal Pudendal Artery: many branches to perineum
 Inferior Rectal Artery
 Perineal Artery: Transverse Perineal Branch and Posterior Scrotal/Labial
Artery
 Artery of Bulb of Penis/Vestibule
 Urethral Artery
 Deep Artery of Penis/Clitoris
 Dorsal Artery of Penis/Clitoris
 Inferior Gluteal Artery
 Uterine Artery
External Pudendal Arteries: a superficial and a deep vessel that originate from the femoral
artery: enter the perineum and supply the skin of the penis/clitoris and scrotum/labia majora
Testicular/Ovarian Arteries: originate from the abdominal Aorta
Cremasteric Arteries: originate from the inferior epigastric branch of the external iliac artery,
accompanying the spermatic cord into the scrotum
Veins:
The veins of the pelvis drain into the internal iliac veins which join the common iliac veins. Veins
associated with the rectum and anal canal drain into the portal system. The Pelvic Plexus is an
important portacaval shunt when the hepatic system is blocked.
-
Internal Pudendal Vein
Internal Iliac Vein
Obturator Vein
Pelvic Plexus
o Vesicular
o
-
Rectum: internal (between internal anal sphincter and epithelium lining the anal canal)
and external (encircles the external anal sphincter and is subcutaneous)parts drain via
the superior, middle, and inferior rectal veins into the portal and caval systems
o Prostate
o Uterus
o Vagina
Deep Dorsal Vein: drains erectile tissues of penis or clitoris. Joins the prostatic plexus in men or
the vesicle plexus in women
Median Sacral Veins: join to empty into the left common iliac or the junction of the common
iliac veins
Ovarian Veins: the left one joins the left renal vein and the right one joins the IVC
External Pudendal Veins: come from great saphenous vein in thigh and drain the superficial skin
of the penis or clitoris and scrotum or labia majora
Important Anastomoses:
-
Uterine artery with Ovarian and vaginal arteries (uterine and vaginal from anterior internal iliac
and ovarian from abdominal aorta)
Middle rectal artery (from anterior internal iliac) with superior rectal artery (inferior
mesenteric)and the inferior rectal artery (internal pudendal)
Median Sacral artery (from posterior abdominal aorta) with the iliolumbar and lateral sacral
arteries (from posterior internal iliac)
Pelvic Plexus: rectum, bladder, prostate, uterus, vagina
Dorsal Artery of Penis with Deep Artery of Penis and the Urethral Artery
Lymph Drainage: Remember that lymph follows the major arterial supplies!
Region
Testes, Ovaries and related parts of Uterus and
Uterine Tubes
Pelvic Viscera, Gluteal region, deep areas of
Perineum
Superficial tissues of Penis/Clitoris and
Scrotum/Labia Majora
Glans Penis/Clitoris, Labia Minora, and lower
Vagina
Nodes Providing Drainage
Lumbar nodes and pre-aortic nodes
Internal Iliac Nodes
Superficial Inguinal Nodes
Deep Inguinal Nodes and External Iliac Nodes
Clinical Correlations:
-
Femoral Artery: palpated midway between ASIS and pubic tubercle, inferior to inguinal ligament
Bone Marrow Biopsy: iliac crest often used because it lies close to the surface and is easily
palpated
Obstetric Pelvic Measurements: transverse and Sagittal measurements of pelvic inlet and outlet
can help predict likelihood of safe vaginal delivery. Obtained by using radiographs and MRIs
-
-
-
-
-
Defecation: quadrates lumborum, rectus abdominis, external and internal obliques, and
transversus abdominis contract to raise intra-abdominal pressure. The puborectalic (levator ani)
relaxes to allow straightening of the anorectal angle (increase angle from 90⁰ to about 135⁰) as
the external and internal anal sphincters relax to shorten the anal canal and allow passage of
feces
Episiotomy: an incision in the skin and perineal body to allow room for the fetus to pass through
the vagina to prevent stretching and tearing of the perineal body. A clean incision is easier to
suture than a complex jagged tear. A posterolateral episiotomy bypasses the perineal body and
a median episiotomy cuts through the perineal body.
Digital Rectal Examination: can palpate anal mucosa, posterior wall of vagina and cervix or the
prostate gland.
Suprapubic Catheterization: catheterize the bladder through the anterior abdominal wall above
the pubic symphysis.
Urethral Catheterization: women are easier because the urethra is very short and nearly
straight. The male anatomy can make it more challenging, the spongy urethra is vulnerable to
injury because of its angles.
Vasectomy: surgical dissection and division of the ductus deferens, can be performed through
skin above inguinal canal instead of entering the abdomen or pelvis
Tubal Ligation: clip the uterine tubes to prevent eggs from entering the uterus to be fertilized
Recto-uterine Pouch (Pouch of Douglas): site of collection for infected fluids and materials in
the pelvic cavity because it is the lowest portion of the abdominopelvic cavity
Pudendal Block: given where the pudendal nerve crosses the lateral aspect of the sacrospinous
ligament near its attachment to the Ischial spine. Ischial spines are palpated transvaginally, and
the needle is passed through the skin above the medial aspect of the Ischial spine
Prostatectomy and Impotence: when the prostate is removed, the seminal vesicles are removed
with it and the pelvic splanchnic nerves in the inferior hypogastric plexus may be disturbed
causing erectile dysfunction/impotence
Clinical Finding
Pelvic Fracture
Sacro-iliac joints
Urinary Stones
Bladder Cancer
Anatomy Involved
Bony rings of pelvis:
pelvic inlet and
obturator foramina
Fibrous and synovial
components of joint
Kidneys, Ureters,
bladder, urethra
Bladder, sometimes
rectum, uterus,
prostate gland, and
lateral pelvic walls
Patient Presents With
Large hematoma,
disruption/compression of
urethra, bowel, nerves/vessels
Pain and discomfort in sacroiliac region
Problems emptying bladder,
pain referred to pubic, flank,
inguinal areas, and
lateral/medial thighs.
Other complications of urinary,
GI, and/or reproductive tracts
as the cancer spreads
Miscellaneous
Cause significant
bleeding
Can be caused by
rheumatoid arthritis,
IBD, and psoriasis
Residual urine left in
bladder may become
infected and alter pH
Can spread via internal
iliac lymph nodes
Bladder Infection
Bladder, urethra
Cystitis (inflammation of
bladder)
Testicular Cancer
testes
Prostate
Problems
Prostate gland, urethra
Hysterectomy
Uterus, uterine tubes,
ovaries
Internal and External
rectal venous plexuses
at or inside the anal
sphincter
Abnormal lumps felt in
scrotum
Hard, enlarged prostate,
problems urinating due to
compressed urethra
Reproductive malignancy,
endometriosis, excessive
bleeding
External hemorrhoids cause
pain, swelling (pudendal nerve
innervation), internal
hemorrhoids usually bleed, but
do not cause pain
Anal canal, ischio-anal
fossae
Tear in anal canal leading to
infection
Hemorrhoids
Abscess in ischioanal fossae
Urethral Rupture
Urethra, surrounding
tissues/fascias
Hydrocele,
Varicocele
Testes, scrotum,
pampiniform venous
plexus
Straddling injury, urine collects
in scrotum and deep to
superficial abdominal fascia. In
pelvic fractures the
prostatic/membranous urethra
may be torn and urine will
collect inside the true pelvis
Hydrocele- enlarged scrotum
Varicocele- “bag of worms”
Women more
susceptible because of
short urethras
Occur in younger
patients
Prostate cancer is one
of the most common
cancers in men
Pfannenstiel’s incision
used (transverse
Suprapubic)
Pectinate line
distinguishes between
external and internal
hemorrhoids
Caused by straining,
obesity, sedentary life
Infection may tract into
pelvic cavity or laterally
into the i-a fossae
Proximal spongy
urethra is most
commonly ruptured
Most serious is related
to disruption of
puboprostatic ligaments