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Pelvis and perineum

Author: Jana Vasković • Reviewer: Nicola McLaren MSc • Last reviewed: April 01, 2020 

The pelvis is inferior most part of the trunk. Consisting of the pelvic girdle and perineum, it supports the urinary and
reproductive organs. 

Humans use pelvic organs for both pleasure and reproduction, and we bet that after reading about them for the first
time from a textbook you’ve probably lost the will for both. We know that understanding the anatomy of the pelvis,
especially perineum anatomy, can be very challenging. The pelvis and perineum anatomy will be presented in this
page.

Key facts about the pelvis and perineum

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Pelvis Definition: Trunk region between the abdomen and

the lower limb.
Parts: greater pelvis, lesser pelvis, perineum

Perineum Definition: Part of the lesser pelvis that contains

the external genitalia
Parts: urogenital triangle, anal triangle

Viscera Distal parts of the urinary system: ureter, urinary

bladder, urethra
Parts of the alimentary tract: terminal ileum,
sigmoid colon, rectum, anus
Reproductive organs: internal genitalia, external
genitalia

Blood vessels Internal iliac artery, gonadal arteries, median sacral

artery, superior rectal artery

Nerves Lumbar plexus, sacral plexus, coccygeal plexus,

splanchnic nerves

Pelvis

The bony framework of the pelvis is called the pelvic girdle. It is

composed of the two hip bones and the sacrum. Pelvic bones are 
held together by the two main joints of the pelvis; the pubic
symphysis and the sacroiliac joint, and reinforced by pelvic
muscles. The pelvic cavity opens superiorly to, and is continuous
with, the abdominal cavity through the pelvic inlet. Whilst the pelvic
outlet is enclosed by the pelvic floor, made of the pelvic diaphragm.
There are two parts of the pelvis; greater (false) pelvis and lesser
(true) pelvis. The greater pelvis is found superior to the pelvic inlet
and contains the inferior parts of the abdominal organs. The lesser
pelvis is located between the pelvic inlet and pelvic outlet, and it
includes the distal urinary organs, internal reproductive organs and
the perineum.
 

Pelvis
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Pelvis
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Pelvic floor

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The pelvic floor is formed by the funnel-shaped pelvic diaphragm. The pelvic diaphragm comprises of the two paired
muscles and their fasciae; levator ani muscle and the coccygeus muscle. The function of the pelvic diaphragm is to
support the pelvic organs and prevent them from prolapse. 

Pelvic floor: Diagram

Levator ani muscle is the main guy here. It consists of three parts; puborectalis, pubococcygeus, and the iliococcygeus.
The puborectalis part makes a U-turn around the anorectal junction (puborectal sling), forming the urogenital hiatus.
Besides the rectum and urethra in both sexes, in females, this hiatus also transmits the vagina.

Key facts about the levator ani and coccygeus muscles

Levator ani Origin: posterior surface of bodies of pubic bones

(puborectalis and pubococcygeus); tendinous arch
of internal obturator fascia, ischial spine
(iliococcygeus)
Insertion: puborectal sling (puborectalis);
anococcygeal ligament, coccyx (pubococcygeus,
iliococcygeus)
Innervation: nerve to levator ani (S2-S4)
Function: supports pelvic viscera, increases
intraabdominal pressure, assists with fecal and
urinary continence

Coccygeus Origin: ischial spine

Insertion: inferior end of sacrum, coccyx
Innervation: anterior rami of spinal nerves S4-S5
Function: supports pelvic viscera, flexes coccyx

Feeling like studying muscle facts will last forever? Shorten your study and revision time with Kenhub’s Muscle
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Muscles of the pelvic floor

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Perineum

The perineum is the part of the pelvis which contains the external genitalia and anus. It is inferior to the pelvic
diaphragm. Regarding the surface anatomy, the perineal area is the region between the thighs, extending from the
pubic symphysis anteriorly to the gluteal folds posteriorly.  

The perineum is diamond shaped, and the corners of that diamond are the:

Pubic symphysis anteriorly

Sacrum and coccyx posteriorly
Ischial tuberosities on each lateral side
The pelvic diaphragm is the roof, while the perineal skin forms the floor.

An imaginary line connecting the ischial tuberosities divides the perineum into the urogenital triangle (UGT) anteriorly,
and the anal triangle posteriorly.  The anal triangle includes the rectum and the two ischioanal fossae. These fossae
are filled with fat tissue which supports the movements of the pelvic diaphragm. They communicate with the UGT
through their anterior recesses.

The urogenital triangle contains the perineal membrane and superficial fascia of Colles. They bound two anatomical
spaces within the UGT; superficial perineal pouch and deep perineal pouch. Among sexes, there are anatomical
differences only within the contents of the urogenital triangle as it contains the external genitals. A mass of
connective, skeletal and smooth muscle tissues called the perineal body is found between the triangles. It is the
central mass of the perineum which anchors most of the perineal muscles.

Female pelvis

The female pelvis is broader and larger than the male pelvis to provide a comfortable environment for fetus
development. The greater pelvis is a part of the abdomen study section, we won’t spend too long on that here. Just
note that the terminal ileum, cecum and sigmoid colon are found within the greater pelvis in both sexes. 

The lesser pelvis in females contains: 

Distal parts of the urinary and digestive systems: ureter, urinary bladder, urethra and rectum.
Internal genitalia: ovaries, uterine tubes, uterus and vagina 
External genitalia, contained by the perineum 

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Female anatomy: Diagram

Let’s look at the anatomical relationships for the female pelvic viscera.

In the medial view, from anterior to posterior we see the rectum just anterior to the coccyx, urinary bladder posterior
to the pubic symphysis, and the uterus sandwiched between the two of them. Peritoneum overlays the superior
surfaces of these organs, creating two peritoneal pouches: the rectouterine pouch of Douglas between the rectum
and the uterus, and the vesicouterine pouch between the uterus and the bladder. These three organs communicate
with the outside of the body by extending through the perineum: 

The urethra extends from the inferior surface of the bladder and opens at the external urethral orifice 
The vagina extends from the cervix of the uterus and opens at the ostium of the vagina 
The rectum continues as the anal canal which opens at the anus 

Now, where are the uterine tubes and the ovaries? In the peritoneal cavity suspended within their respective
peritoneal folds, mesovarium and mesosalpinx. The uterine tubes extend from each lateral side of the body of the
uterus and open near the ovaries. Learn more about the female pelvis with Kenhub’s study materials.

Female pelvic viscera and

perineum
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Female perineum
The urogenital triangle in females includes the internal genitalia and perineal muscles. Compared to males, it has two
more muscles in the deep perineal pouch. 

Contents of the female perineum

Deep perineal pouch Proximal urethra

Deep transverse perineal muscle
Inferior part of external urethral sphincter
Urethrovaginal sphincter and compressor urethrae
muscle
Dorsal nerves and vessels of the clitoris

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Superficial perineal pouch Roots of the erectile tissues (corpora cavernosa,

bulbs of the vestibule)
Bulbospongiosus, Ischiocavernosus, Superficial
transverse perineal muscles
Muscles mnemonic:  Bulb Is Super

Surface anatomy Mons pubis

Labia majora
Labia minora
Glans of clitoris
Vaginal orifice

Female perineum
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Male pelvis

In comparison to the female pelvis, the male pelvis is narrower. The lesser pelvis in males contains: 

Distal parts of the urinary and digestive systems: ureter, urinary bladder, urethra and rectum.
Internal genitalia: testes, epididymides, ductus deferens, seminal glands, ejaculatory ducts, prostate, and
bulbourethral glands
External genitalia within the perineum

Male anatomy: Diagram

The rectum is found anterior to the coccyx. Anteriorly is the urinary bladder. Between the rectum and bladder are the
seminal glands superiorly and the prostate inferiorly. The rectum continues as the anal canal and then opens through
the anus. 

The male urethra extends from the inferior wall of the bladder, penetrates the prostate and then enters the
perineum. It passes through the penis and opens at the external urethral orifice. Each seminal gland also has its own
canal called the ejaculatory duct. These ducts also penetrate the prostate where they open into the ureter. So this is
where the male reproductive and urinary systems meet.

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Testes and epididymides are found in the scrotum. They are considered to be internal genitalia because of their
development in the abdominopelvic cavity. Ductus deferens is the continuation of the epididymis which joins the
ducts of the seminal gland in forming the ejaculatory duct. Finally, bulbourethral glands are small glands just inferiorly
to the prostate, which opens into the penile urethra.

Male perineum
The urogenital triangle in males contains the perineal muscles and external genitalia. We’ll keep things simplistic here
and list everything you have to remember in one table. 

Contents of the male perineum

Deep perineal pouch Perineal part of the urethra

Deep transverse perineal muscle
Inferior part of external urethral sphincter
Bulbourethral glands
Dorsal nerves and vessels of the penis

Superficial perineal pouch Root of the penis (corpora cavernosa, corpus

spongiosum)
Bulbospongiosus, Ischiocavernosus, Superficial
transverse perineal muscles
Muscles mnemonic:  Bulb Is Super

Surface anatomy Penis (body and glans) and scrotum

Learn more about the male pelvic and perineal viscera here.

Male pelvic viscera and perineum

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Blood vessels

There are four main arteries of the pelvis:

Paired internal iliac arteries, which supply the pelvic viscera

Paired gonadal arteries (testicular and ovarian), which supply the internal genitalia outside of the pelvic cavity
(testis, epididymis; ovaries, uterine tubes)
A single median sacral artery that supplies sacrum and coccyx
A single superior rectal artery that supplies the rectum  

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Blood vessels of the pelvis and perineum: Diagram

Most significant is the internal iliac artery. Its branches are grouped into the anterior and posterior divisions. The true
pelvic viscera are supplied by the many branches of the anterior division. The internal pudendal branch is the main
artery of the perineum. The remainder include the umbilical, obturator, inferior vesical (males), uterine (females),
middle rectal and inferior gluteal arteries. The posterior division of the internal iliac artery supplies the pelvic and
gluteal muscles.

Venous blood from the pelvis is drained by the venous plexuses that surround the pelvic organs. They include the
rectal, vesical, prostatic, uterine and vaginal venous plexuses. Most of them empty into the internal iliac vein, which is
a tributary to the inferior vena cava. Other than the vena cava, some portion of the venous blood flows into the
inferior mesenteric vein and then into the hepatic portal system. If you came here confused about the pelvic
vasculature, we have a study set to help you learn this topic efficiently.

Blood supply of the male pelvis Blood supply of the female pelvis
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Innervation

There are four major nervous structures found in the pelvis:

Lumbosacral trunk
Sacral plexus 
Coccygeal plexus 
Autonomic pelvic nerves

These nerves supply the pelvic viscera, muscles of the pelvic floor and perineum, gluteal region and the lower limb.

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Nerves of the pelvis and perineum: Diagram

The lumbosacral trunk is a nerve bundle formed by the anterior rami of L4-L5 lumbar nerves. It is a root which
contributes to the sacral plexus. The lumbosacral trunk and anterior rami of S1-S4 interconnect to form the sacral
plexus. Whilst the anterior rami of S4, S5 and Co (coccygeal nerve) unite to form the coccygeal plexus.Concerning the
autonomic pelvic nerves, there are sympathetic and parasympathetic inputs. They are given by the lumbar, sacral and
pelvic splanchnic nerves. Lumbar and sacral splanchnic nerves provide the pelvis with sympathetic innervation,
whereas the parasympathetic supply is given by the pelvic splanchnic nerves. Splanchnic nerves contribute to forming
additional pelvic plexuses, such as the inferior hypogastric plexus. This plexus is the source for all subsequent
plexuses that innervate the pelvic viscera: prostatic plexus (males), uterovaginal plexus (females) and middle rectal
plexus. 

Nerves of the male pelvis Nerves of the female pelvis

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Lumbar and sacral plexus

The lumbar plexus (L1-L4) is formed by the anterior rami L1-L4 and a contribution from the anterior ramus of T12. The
plexus spreads over the anterior surface of the psoas major muscle. Forming 6 main branches, it provides innervation
for the muscles of the posterior abdominal wall and thigh, as well as for the skin of the scrotum, labiae, inguinum, and
thigh.

Sacral plexus is formed by the lumbosacral trunk (L4, L5), anterior rami of S1-S4 and a part of the anterior ramus of S5.
The plexus is found inferiorly to the lumbar plexus, lying on the anterior surface of the piriformis muscle. Most of its
branches supply the gluteal and lower limb muscles. The perineum is supplied by the pudendal nerve.

Branches of the lumbosacral plexus

Lumbar plexus iliohypogastric, ilioinguinal, genitofemoral, lateral

femoral cutaneous, femoral, obturator, short
muscular branches and accessory obturator nerves

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Sacral plexus Nerve to quadratus femoris and gemellus inferior,

nerve to obturator internus and gemellus superior,
nerve to piriformis, superior gluteal, inferior gluteal,
posterior femoral cutaneous, sciatic, perforating
cutaneous, pudendal, nerves to levator ani and
external anal sphincter

Lumbar plexus Sacral plexus

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Pelvis and perineum: want to learn more about it?

Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top
results faster.

What do you prefer to learn with?

VIDEOS QUIZZES BOTH

“I would honestly say that Kenhub cut my

study time in half.” – Read more.

Kim Bengochea, Regis University, Denver

References:

Drake, R. L., Vogl, A. W., & Mitchell, A. W. M. (2015). Gray’s Anatomy for Students (3rd ed.). Philadelphia, PA:
Churchill Livingstone.
Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Clinically Oriented Anatomy (7th ed.). Philadelphia, PA:
Lippincott Williams & Wilkins.
Standring, S. (2016). Gray's Anatomy (41tst ed.). Edinburgh: Elsevier Churchill Livingstone.

Illustrations:

Pelvic floor (diagram) - Liene Znotina

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Female anatomy (diagram) - Irina Münstermann

Male anatomy (diagram) - Irina Münstermann
Blood vessels of the pelvis and perineum (diagram) - Irina Münstermann
Nerves of the pelvis and perineum (diagram) - Irina Münstermann

© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by

German and international copyright laws. All rights reserved.

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Muscles of the pelvic floor

Male pelvic viscera and perineum

Neurovasculature of the female perineum

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