CLINICAL ANATOMY OF PELVIS

Clinical Anatomy
of the Pelvis
Kharkiv, 2015

Plan of lecturePlan of lecture
1.1. Pelvis: bones, ligaments, musclesPelvis: bones, ligaments, muscles
2.2. Pelvic floorPelvic floor
3.3. Internal genitaliaInternal genitalia
4.4. PerineumPerineum
5.5. External genitaliaExternal genitalia
6.6. Operations on organs of PelvisOperations on organs of Pelvis

promontory
sacrum, lateral
part
Iliac bone
pubic bone
pubic symphysis
ischial bone
coccyx
linia terminalis

Abdominal
cavity
Vertebral
column
False pelvic
Anal aperture
Penis
Perineum
Coccyx
Pelvic
cavity
Sacrum
Anterior
superior
iliac spine

 Iliac Crest
 Anterior Superior Iliac Spine –
upper lateral end of the fold of
the groin
 Posterior Superior Iliac Spine –
posterior end of the iliac crest,
lies at the bottom of a small
skin dimple and on a level with
the second sacral spine.
 Greater Trochanter

 Pubic Tubercle – upper
border of the pubis
 Symphysis Pubis –
cartilaginous joint that lies in
the midline between the
bodies of the pubic bones.
 Pubic Crest – ridge of bone
on the superior surface of
the pubic bone, medial to
the pubic tubercle

 Spinous Process of the
Sacrum – fused in the
midline to form the
median sacral crest
 Sacral Hiatus – posterior
aspect of the lower end of
the sacrum
 Coccyx – inferior surface
and tip can be palpated in
the natal cleft behind the
anus

 Location of some
abdominal viscera (ileum
and sigmoid colon)
 Bounded by abdominal
wall anteriorly, the iliac
fossa posteriolaterally
and L5 S1 vertebrae
posteriorly

 Location of pelvic viscera,
the urinary bladder and
reproductive organs such
as the uterus and ovaries
 Bounded by the pelvic
surfaces of the hip bones,
sacrum, and coccyx
 Limited inferiorly by the
musculofascial pelvic
diaphragm

promontory
sacrum, lateral
part
sacral canal
superior articular process
wing of sacrum
basis of sacrum

lateral part
promontory
basis of sacrum
sacral wing
superior articular
process
apex
anterior sacral
foramen
sacral canal
superior articular
process
median sacral crest
intermediate sacral crest
lateral sacral crest

ala of ilium
sacroiliac joint
L4
L5
sacrum
Hip joint
head of femur
neck of femur
symphysis
pubis
obturator
foramen
superior ramus of pubis
Inferior ramus
of pubis
ramus of ischium
Iliac crest
ant. sup. iliac spine
ant. inf. iliac spine
sacrum lateral
part
ischiadic spine

 Superior aperature or Inlet-
upper border of symphysis to
sacral promontary
 Inferior aperature or Outlet-
inferior border of symphysis to
tip of coccyx

 Heavier
 More conical-deeper
 Obturator foramen
rounder
 Laterally narrower
 Pubic arch more acute
angle
 Inlet round, outlet narrow

 Lighter in structure
 Roomier cavity-
childbearing
 Wider, shallower
 Inlet larger and more oval
 Sacrum wider and curves
more sharply posteriorly
 Sacral promontory flatter
 Outlet wider

Male vs. Female Pelvis
MaleFemale
Pelvic Inlet
Pelvic Outlet
Pelvic Cavity
Pelvic Arch

Gynecoid pelvis
 Occurs 52%-58.9%
 round, slightly ovoid or elliptical inlet.
 anterior segment well-rounded , posterior segment
spacious .
 wide interspinous diameters(≥10cm).
 the side walls are straight
 the sacrum is well curved, and the sacrosciatic
notch is adequate

Platypelloid pelvis
 occurs in approximately 23.2%-29% women
 There is a distinct oval inlet.
 very wide subpubic arch.
 posterior segmet flat.
 the sacrum is normal
 the side walls are straight
 the sacrosciatic notch is narrower

Android pelvis
 occurs in only 2% to 5% of women
 wedge-shaped inlet
 the side walls converge
 the sacrum is inclined forward
 the sacrosciatic notch is narrow
 narrow anterior segmet, flat posterior segment,

Anthropoid pelvis
 occurs in approximately 20% ;approximately 40% of
black women
 the inlet is oval, long, and narrow
 the side walls are straight(do not converge)
 the sacrum is long and narrow
 the sacrosciatic notch is wide.
 Both the interspinous and intertuberous diameter are
somewhat smaller

Floors of the Pelvis
1. Peritoneal floor
2. Subperitoneal floor
3. Subcutaneous floor
(fossa ischiorectalis)
1
2
3

obturator internus m.
coccygeus m.
Obturator Internus:
Origin:
obturator
membrane and
adjoining part
of hip bone
Insertion:
greater
trochanter of
femur
Action: lateral
rotator of femur
at hip joint

coccygeus m.
levator ani m.
int / ext. anal sphincter m.

obturator externus m.
pectineus m.
Outer hip muscles
and extensors
gluteus maximus m.
levator ani m.

 Formed by the funnel shaped
pelvic diaphragm
 Consists of the levator ani
and coccygeus muscles and
their fascia
 Stretches between the pubis
anteriorly and the coccyx
posteriorly and from one
lateral pelvic wall to the other.

Perineal muscles
obturator
fascia
levator ani m.
ext. anal sphincter m.
transversepe
rineal mm.
gluteus maximus m.
ischiocavernosus
m.
bulbospongiosus m.
bulbocavernosus m.

superior rectal a.
median rectal a.
obturator
internus m.
levator ani m.
Inferior rectal a.
Levator ani:
Origin: body of pubis,
fascia of obturator
internus, spine of
ischium
Insertion: perinela
body, anococcygeal
body, walls of
prostate, vagina,
rectum and anal canal
Action: supports
pelvic organs

The Coccygeus Muscles
Pubococcygeus m.
Iliococcygeus m.
Coccygeus m.
Rectococcygeus m.
Sacrococcygeus m.
Coccygeus:
Origin: spine of ischium
Insertion: lower end of sacrum; coccyx
Action: assists levator ani to support pelvic organs

Fasciae of the pelvis and perineum. Median sagittal section in the male. The deep fascia of the
abdominal wall, the layers of the urogenital fascia and the mesorectal fascia are in green, the
peritoneum in blue, the superficial fascia of the abdominal wall and perineum in red. Muscles
are shown in brown.

Arteries – common iliac artery
and its branches
• Bifurcation of abdominal aorta: L4
• Bifurcation of common iliac artery: in the
level of sacroiliacal joint
• External iliac a.
– On the medial part of psoas major m.
– Under the inguinal lig. – femoral a.
– Branches:
• inferior epigastric a.
• deep circumflex iliac a.

Internal iliac a. and its branches
• Parietal branches
– iliolumbal a. (segmental lumbal arteries)
– lateral sacral a. (sacral canal)
– superior / inferior gluteal a.
– obturator a. – acetabul ramus – femur head!!

Internal iliac a. and its branches
• Visceral branches
– umbilical a. (umbilical lig)
– superior vesical a.
– inferior vesical a.
– uterine a.
– median rectal a.
– internal pudendal a.
– deep/superficial arteries of the penis

iliolumbal a.
lat. sacral a.
sup. gluteal a.
inf. gluteal a.
internal
pudendal a.
obturator a.
umbilical a.
superior vesical a.
uterine a. median rectal a.

The lymphatic drainage of structures of the pelvis and perienum.
Rules:
• Lymphatics drain
toward lymph nodes
along internal iliac
veins, except for the
ovary (para-aortic
nodes), and superior
portion of the rectum
(inferior mesenteric
nodes)
• Perineum drains to
superficial inguinal
nodes
Para-aortic
External iliac
Internal iliac
Superficial Inguinal

Sagittal section of the male pelvis.

Sagittal section of the female pelvis.

Sigmoid colon and rectum
levator ani m.
int. anal sphincter m.
• levator ani m.
• int / ext. anal sphincter m.
• Blood supply:
– Sigmoid: inf. mesenteric a. –> sigmiod aa.
– Rectum: inf. mesenteric a. –> sup. rectal a.
internal iliac a. –> median/inf. rectal a.

Superior rectal
artery
Middle rectal
artery
Main descending
branch
Right branch
Terminal descending
branch
Pudendal artery
M. levator
ani
Ascending branches
Anus ----------------------------------

Inferior rectal vein
Superior rectal vein

Urogenital tract of the male
• Kidney – renal pelvis – ureter – urinary bladder
• Prostate
• Seminal vesicule – ejaculatory duct
• Testis
• Epididymis – ductus deferens – ejaculatory
duct
• Urethra
• Penis

Urinary bladder
• Fundus, body, apex
• Ureter (medial-anterior part of the psoas major
m.)
• Male: ductus deferens, seminal vesicle
– prostate gland

There are 3 crossed layers in the tunica muscularis:
stratum externum, includes longitudinal fibers;
stratum medium – includes circular or transversal fibers;
stratum internum - includes longitudinal and transversal fibers.

Prostate – seminal vesicule
ductus deferens
seminal
vesicule
prostate, medial lobe
prostate, right/left lobe
urethra

We are 50%
done!!!
Relaxing
TIME…..
It’s coming!

Female Reproductive SystemFemale Reproductive System

Female Internal Genitalia
The internal genitalia
consists of the:
• Vagina
• Cervix
• Uterus
• Fallopian Tubes
• Ovaries

VAGINA
• It is a distensible fibromuscular
tube that extends from the
perineum through the pelvic floor
and into the pelvic cavity
• It measures approximately 8–12
cm in length.
• It extends from the vestibule to
the uterus, and is situated behind
the bladder and in front of the
rectum.
• It is directed upward and
backward.
• Its axis forming with that of the
uterus an angle of over 90°,
opening forward.
• vaginal opening may be partially
covered by the hymen
77

Hymen: As the labia minora are spread,
the vaginal introitus, guarded by the
hymenal ring, is seen. The hymen may
take many forms, however, such as
perforated centrally,a cribriform plate
with many small openings or a
completely imperforate diaphragm, and
varying in size from a pin-hole to one
that admits two fingers. The hymen is
partially ruptured at the first coitus and
further disrupted during childbirth.

VAGINA
• The anterior wall of the
vagina is related to the
base of the bladder and
to the urethra; in fact,
the urethra is embedded
in, or fused to, the
anterior vaginal wall.
• Posteriorly, the vagina is
related principally to the
rectum.

• Fornices of vagina:
– These are 4 pouches formed by the upper part of
vagina around the vaginal part of cervix
– (2 lateral, 1 anterior & 1 posterior)
– The posterior fornix is the deepest one & the only
one covered by peritoneum
– Lateral one related to uterine artery & ureter.

VAGINA
Blood Supply
• The blood supply to the
vagina is from the vaginal
artery (branch of the
internal iliac artery) and the
vaginal branch of the
uterine artery.
Lymphatic drainage
• Lymph from the upper
vagina drains into the
internal and external iliac
nodes.
• Lymph from the lower
vagina drains to the
superficial inguinal nodes
81

Uterus
• The uterus is a thick-walled
muscular organ in the
midline between the bladder
and rectum.
• It consists of a body and a
cervix.
• Inferiorly it joins the vagina.
• Superiorly, uterine tubes
project laterally from the
uterus and open into the
peritoneal cavity
immediately adjacent to the
ovaries.
82

Parts Of The Uterus
1) Fundus:
It is dome-shaped part that lies
above level of the opening of the
Fallopian tubes.
It is completely covered by
peritoneum. It is related to coils of
small intestine & sigmoid colon.
2) Body:
 is the part extending from level
of opening of the Fallopian tubes
to the constriction called isthmus.
It contains uterine cavity. It is the
site of implantation of the zygote &
also the site of menstruation.

3) Isthmus:
Slight constriction between the body and the cervix.
4) Cervix: it has supra-vaginal & vaginal parts
Supra-vaginal part:
Anteriorly: it is not covered by peritoneum and related to
the U.B.
Posteriorly: it is covered by peritoneum of Douglas pouch
which separates it from the rectum.
Laterally: it gives attachment to the broad ligament and is
related to the ureter and uterine vessels just below the root
of the broad ligament.
Vaginal part: is surrounded by the vaginal fornices.

Uterus
• The cervix forms the
inferior part of the uterus
and is shaped like a short,
broad cylinder with a
narrow central channel.
• The cervix is angled
forward (anteverted) on
the vagina so that the
inferior end of the cervix
projects into the upper
anterior aspect of the
vagina.

THE CERVIXTHE CERVIX
• The uterus consists of two unequal
parts: an upper corpus, and a lower
cervix.
• The cervix is cylindrical in shape
and continuous above with the body
of the uterus. The cervix canal is
spindle shaped, being constricted
below at the internal os and above
at the external os, where it opens
into the vagina.
• In women who have not borne
children the external os is circular,
but after labour it has the form of a
transverse slit.
• In adult, the cervix is approximately
2.5-3 cm in length
• The wall of the cervix consists of
fibromuscular tissue.

The cervix consists of a vaginal portion, which is easily seen during speculum
examination of the vagina, and a supravaginal portion, which is very important in
the endopelvic fascial support system of the cervix and upper vagina. The vaginal
portion protrudes into the vagina and is surrounded by the fornices is covered with a
nonkeratinizing squamous epithelium. The cervical epithelium is of tall columnar
type. At about the external cervical os, the squamous epithelium covering the
exocervix changes to simple columnar epithelium, the site of transition being referred
to as the squamo-columnar junction, and it is at this site that carcinoma is particularly
liable to arise.
Surrounding the supravaginal portion of
the cervix is a dense ring of endo-pelvic
fascia into which is anchored the
pubocervical fascia, as well as the
uterosacral and cardinal ligaments. This
endopelvic fascial ring has also been
called the “paracervical fascia.

The “paracervical ring” is the key link in the
important mechanical continuity of the
endopelvic fascia to the vagina and cervix from
both the upper vertical and horizontal support
axes. Here, both cardinal ligaments –
uterosacral ligament complexes of the vertical
support axis merge with the pubocervical fascia
of the horizontal support axis.
““PARACERVICAL RING”PARACERVICAL RING”
relationship to the vaginarelationship to the vagina
The cervix enters the vagina by coursing
perpendicularly to the anterior vaginal wall,
thus explaining the shorter length of the
anterior vaginal wall [8cm] when compared to
the posterior vaginal wall [10-11cm].

Uterus
• The body of the uterus is
flattened anteroposteriorly
and above the level of
origin of the uterine tubes
it has a rounded superior
end (fundus of uterus).
• The cavity of the body of
the uterus is a narrow slit,
when viewed laterally.
• It is shaped like an
inverted triangle, when
viewed anteriorly.

Uterus
• Each of the superior
corners of the cavity is
continuous with the lumen
of a uterine tube; the
inferior corner is
continuous with the
central canal of the cervix
• The body of the uterus
normally arches forward
(anteflexed on the cervix)
over the superior surface
of the emptied bladder

Relations of Uterus
Anteriorly
• The uterus and cervix are
related to the uterovesical
pouch and superior surface
of the bladder.
Posteriorly
• The uterus is related to the
recto-uterine pouch (of
douglas), which extends
down as far as the posterior
fornix of the vagina.
Laterally: the broad ligament

The peritoneum
reflected from the
rectum to the upper part
of the vagina, forming
recto-uterine pouch,
then cover the posterior
surface of the uterus,
fundus, anterior surface
of the body of the
uterus, which is
reflected at the isthmus
on the upper surface of
U.B. forming the utero-
vesical pouch. So
anterior surface of the
cervix and vagina have
no peritoneal covering

Four paired sets of ligaments are attached to the uterus:
round ligament : inserts on the anterior surface of the uterus just in
front of the fallopian tube, passes to the pelvic side wall in a fold
of the broad ligament, traverses the inguinal canal, and ends in the
labium majus.
The round ligaments are of little supportive value in preventing
uterine prolapse but help to keep the uterus anteverted.

The uterosacral ligaments are
condensations of the endopelvic
fascia that arise from the sacral
fascia and insert into the
posteroinferior portion of the
uterus at about the level of the
isthmus. They provide important
support for the uterus and are also
significant in precluding the
development of an enterocele.
THE UTERUSTHE UTERUS

The cardinal ligaments are the other important supporting structures of the uterus that
prevent prolapse. They extend from the pelvic fascia on the lateral pelvic walls and
insert into the lateral portion of the cervix and vagina, reaching superiorly to the level
of the isthmus. The pubocervical ligaments pass anteriorly around the bladder to the
posterior surface of the pubic symphysis.

Broad ligament: the body of the uterus covered with
peritoneum except for a narrow area on each side where
the peritoneum sweeps away laterally to form the broad
ligament. Between the two leaves of each broad ligament
are contained the fallopian tube, the round ligament, and
the ovarian ligament, in addition to nerves, blood vessels,
and lymphatics.

The fold of broad ligament containing the fallopian tube is called the
mesosalpinx. Between the end of the tube and ovary and the pelvic
side wall, where the ureter passes over the common iliac vessels, is
the infundibulopelvic ligament, which contains the vessels and
nerves for the ovary. The ureter may be injured when this ligament
is ligated during a salpingo-oophorectomy procedure.

Uterus
Blood supply
• The uterine artery (a branch of the internal
iliac artery)
• Veins form the uterovaginal venous plexus
that accompanies the uterine artery.
Lymph drainage
• Lymphatics
from the fundus
accompany the
ovarian artery
and drain into
the para-aortic
nodes.
• Lymphatics
from the body
and cervix drain
to the internal
and external
iliac lymph
nodes.

Lymphatic drainage of the uterusLymphatic drainage of the uterus

Positions Of The Uterus
• Normal position anteverted
anteflexed:
the long axis of the uterus is bent
forward on the long axis
of the vagina.This position is
referred to as anteversion (90
degree) of the uterus .
• the long axis of the body of the
uterus is bent forward at the level of
the internal os with the long axis
of the cervix. This position is
termed anteflexion (170 degree) of
the uterus.

Abnormal position: retroverted, retroflexed
• the fundus and body of the uterus are bent backward on
the vagina so that they lie in the rectouterine pouch
(pouch of Douglas). In this situation, the uterus is said to
be retroverted. If the body of the uterus is, in addition,
bent backward on the cervix, it is said to be retroflexed.
Leads to back pain.

The uterus is supported mainly
by: A) muscles
1) the tone of the Pelvic
diaphragm (pelvic floor)
muscles: levator ani muscles
and coccygeus muscle.
resisting downward push of
uterus during increased intra-
abdominal pressure.
2) Urogenital diaphragm: the
muscles of the deep perineal
pouch.
3) Perineal body: is a
fibromuscular body between
the vagina & anal canal;
receiving the insertions of all
perineal muscles. Thus,
maintains the integrity of the
pelvic floor.
Supporting Factors Of UterusSupporting Factors Of Uterus

THE FALLOPIAN TUBETHE FALLOPIAN TUBE
It is described in four parts:
Intramural (interstitial) part:
It is the shortest (1 cm) and narrowest part.
It passes through the wall of the
superoateral angle of the uterus to open into
the uterine cavity.
Isthmus:
It is narrow and 2 cm in length.
Ampulla:
It is the longest (5 cm), thin-walled, tortuous
and widest part. It is the site of fertilization.
Infundibulum (fimbriated end):
It is 2cm in length and funnel-shaped.
It pierces the broad ligament to open into
the peritoneal cavity near the ovary. Its
margins carry fimbria which spread over
the medial surface of the ovary.

• Tubal ligation:
A simple and
effective method of
birth control is to
surgically ligate the
uterine tubes,
preventing
spermatozoa from
reaching ova.
• Conduct of the
ovum in the uterine
tube to the uterine
cavity is helped by:
ciliary movement of
mucosal lining &
peristaltic
movement of the
tube

Blood Supply Of The Uterine Tube
 Arterial supply:
Medial 2/3: by the uterine
artery.
Lateral 1/3 : by the ovarian
artery.
 Venous drainage:
By veins accompanying the
arteries into the uterine
and ovarian veins.
 Lymph drainage:
Most of the tubal lymphatics
pass to the para-aortic
L.Ns.
Lymphatics of the isthmus
pass to the superficial
inguinal L.Ns.

The ovary
• The ovaries are the sites of
egg production (oogenesis).
• Like the testes in men.
• The ovaries lie adjacent to
the lateral pelvic wall just
inferior to the pelvic inlet.
• Each of the two almond-
shaped ovaries is about 3 cm
long and is suspended by a
mesentery (the
mesovarium) from the
posterior aspect of the broad
ligament.

THE OVARIESTHE OVARIES
The ovaries are situated on the
superior surface of the broad ligament
and are suspended between the
ovarian ligament medially and the
suspensory ligament of the ovary or
infundibulopelvic ligament laterally
and superiorly. They are oval, white
in color, flattened organs,
approximately 3 cm in length, 2 cm in
depth and 1 cm in thickness. The
ovaries are an important endocrine
organ for the female, as well as
producing her ova.

The ovary
Blood supply
The ovarian artery (a branch of
the abdominal aorta)
Venous drainage
To the inferior vena cava on the right and to the left renal vein on
the left.
Lymphatic drainage
• To the para-aortic nodes

PERINEUM
• The muscle and tissue located between the vaginal
opening and anal canal.
• It supports and surrounds the lower parts of the
urinary and digestive tracts.
• The perinium contains an abundance of nerve
endings that make it sensitive to touch.
110

Skeleton and Boundaries of the Perineum

The superficial perineal space contains
the muscular tissue and erectile
tissue needed for female sexual
response, as well as for support and
stabilization of the perineal body.
• Posterior part (anal triangle)
The anal triangle contains the anal
canal, external and internal anal
sphincters and ischioanal fossae
The line joining the ischial tuberosities forms the anal triangle
posteriorly and the urogenital triangle anteriorly. The
midpoint of this line is the perineal body.
•Anterior part (urogenital triangle)
The urogenital triangle contains the distal parts of the
urethra and the external genitalia including the superficial
perineal space.

The pelvic floor is formed by three layers of muscles and
fasciae:
The superficial compartment of the perineum consists of the
ischiocavernosus muscles which cover the crura leading to the clitoris;
and the bulbocavernosus muscles, which extend from the central tendon
of the perineum around each side of the vaginal opening to insert upon
the base of the clitoris and which cover the erectile bulbs of the
superficial space.
Also in the superficial space are the
superficial transverse perineal
muscles which from the ischial
tuberosities to the perineal body, the
external sphincter ani, Bartholin’s
glands and the perineal vessels and
nerves.

Arteries and nerves of the perineum.

Female External Genitalia
Vulva is the term
given to the female
external genitalia.
The vulva includes:
– Mons pubis
– Labia majora
– Labia minora
– Clitoris
– Urethral opening
– Vaginal opening
– Perineum

mons pubis
The mons pubis is
composed of fibro-fatty
tissue which covers the
bodies of the pubis bones.
It is covered with pubic
hair, and divides to
become continuous with
labium majus of each side
.
THE VULVATHE VULVA

Labia majora
The most prominent
features of the vulva, the
labia majora, are large,
hair-covered two folds of
skin which merge
posteriorly into the
perineum where they are
jioned together by the
fourchette, they contain
sebaceous glands and lie
on either side of the
introitus.

Labia minora
prepuce
The labia minora are two
thin folds of skin which lie
between the labia majora ,
their inner surfaces are the
lateral boundaries of the
vestibule. Anteriorly they
divide into two thin folds, the
upper of which unite over
the clitoris to form the
prepuce , and the lower of
which unite to form the
frenulum. They contain no
hair but have a rich supply of
venous sinuses, sebaceous
glands, and nerves. They
are very sensitive and
contain some erectile tissue.
Frenulum
labium pudendal
Frenulum

The vestibule is the
triangular area bounded
anterolaterally by the labia
minora and posteriorly by the
fourchette. At the apex of the
triangle is the clitoris. It
contains the urethral meatus
located approximately 2 to 3
cm posterior to the clitoris,
immediately in front of the
vaginal opening. Into the
vestibule open the ducts of
Bartholin’s glands.

Bartholin‘s glands are two small
rounded structures situated just
posterior to the vestibular bulbs.
During sexual excitation, they
secrete a glairy fluid which
serves as lubricant. Their ducts
open in the groove between the
labia minora and the hymen.
Each duct is about 0.5cm long,
and unless it is inflamed the
orifice cannot usually be seen.
They are often the site of
gonococcal infections and
painful abscesses.

Vestibular bulb are two
oblong masses of erectile
tissue which lie on either
side of the vaginal entrance
from the vestibule. Each
bulb is covered by the
bulbocavernosus muscle.
These muscles aid in
constricting the venous
supply to the erectile
vestibular bulbs and also
act as the sphincter
vaginae.

CLITORIS
• The small penis-like structure.
• Highly sensitive organ composed of nerves, blood
vessels, and erectile tissue
• Located under the prepuce
• It is made up of a shaft and a glans.
• Becomes engorged with blood during sexual
stimulation.
• Key to sexual pleasure for most women.
• Urethral opening is located directly below clitoris
131

The clitoris lies just in front of the
urethra and consists of the glans, the
body, and two crura. Only the glans of
the clitoris is visible externally. The
glans is covered with modified skin
containing many nerve endings. The
body extends superiorly for a distance
of several centimeters and divides
into two crura, which are attached to
the undersurface of either pubic
ramus. The body and the crura are
composed of erectile tissue. Each
crus is covered by the corresponding
ischiocavernosus muscle and by their
contraction produce erection of the
clitoris.

The female external
genitalia are supplied on
each side by the internal
pudendal artery and by the
deep and superficial
external pudendal arteries.
Most of the vulva is
innervated by the branches
of the pudendal nerve.
Anterior to the urethra, the
vulva is innervated by the
ilioinguinal and
genitofemoral nerves.

Emergency suprapubic cystostomy

Open suprapubic cystostomy
(sectio alta)

Surgical treatment of Hydrocele

CLINICAL ANATOMY OF PELVIS

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