The pelvic floor (Pelvic Diaphragm)

4/1/2022 ANC Module 1

 Outline
 Function

 Superficial pelvic floor muscles

 Deep pelvic floor muscles

 Perineal body

 Pelvic fascia

4/1/2022 ANC Module 2

 Objective
• At the end of this topic, students
will be able to:

List parts of superficial pelvic floor

muscles

List parts of deep pelvic floor

muscles

Explain advantages of pelvic fascia

4/1/2022 ANC Module 3
 The pelvic floor (pelvic diaphragm)
• The pelvic floor is formed by the soft tissue which fill
the outlet of the pelvis.
• The urethra, the vagina and the anal canal pass through
it.
Function
 Supports the weight of the abdominal and pelvic
organs.
 Its muscles are responsible for the voluntary control of
micturition, defecation and play a role in sexual
intercourse.
 Maintenance of intra- abdominal pressure.
 It influences the passive movement of the fetus through
the birth canal.

4/1/2022 ANC Module 4

 The muscles of the pelvic floor
I. Superficial pelvic floor muscles
Includes:
♥ Transverses perineal muscles – arises from
the inner surface of ischial tuberosity and
passes transversely a cross the outlet to
meet its follow (go behind).

• Helps to fix the position of the perineal

body and support the lower part of the

4/1/2022
vagina. ANC Module 5
 Muscles …
♥ Bulbo-cavernous muscles – arise from the central
point of the perineum and pass forwards around the
vagina lying superficial to bartholin’s glands and the
vestibular bulbs, and deep to the labia.

 They are inserted into the corpora cavernous of the

clitoris in the upper part of the pubic arch.
 Its action is to diminish the size of the vaginal orifice
and to cause engorgement of clitoris during sexual
activity.

4/1/2022 ANC Module 6

 Muscles …
♥ Ischio cavernous muscles – pass from
the ischial tuberosity a long the pubic arch to
the corpora cavernous of the clitoris.
 Their function is to cause engorgement of the
clitoris.
♥ External anal sphincter – surrounds the
anal canal, lying below the internal sphincter
and the levator ani.
• Anteriorly it enters in to the formation of the
perineal body and posteriorly some of its fibers
are attached to the tip of the coccyx.
• Its function is to close the lumen of the anal
4/1/2022
canal. ANC Module 7
 Muscles…
♥ The membranous sphincter of the
urethra – is composed of muscle fibers
passing above and below the urethra and
attached to the pubic bones.
II. Deep pelvic floor muscles
• Is composed of three pairs of muscles which
together are known as the levator ani
muscles. Each lavetor ani muscles consists
of the following muscles.
♣Ilio coccygeus muscles – arise from
the white line of fascia on the inner aspect
of each iliac bone and from ischial spine
and runs posteriorly to the coccyx.
4/1/2022 ANC Module 8
 Muscles…
♣Ischio coccygeus muscles arise from
–

the ischial spine and pass to the upper part of the

coccyx and lower border of the sacrum, in front of
the sacro-spinous ligament.
 It helps to stabilize the sacroiliac and sacro-
coccygeal joints.
♣Pubococcygeus muscles- arises from
the back of the body of pubic bones.
 Its fibers sweep posteriorly below the bladder on
either side of the urethra and the lowest third of the
vagina, to enter the perineal body.
 The longest fibers gain insertions into ano-cocygeal
body and the coccyx.
 They surround and support the urethra, vagina and
rectum.
 It helps in controlling micturition and defection, as
4/1/2022 well as normal sexualANCfunction.
Module 9
 Fig. Pelvic floor muscles and ligaments
4/1/2022 ANC Module 10
 The perineal body
♦ It is a fibro- muscular pyramid situated
between the lowest third of the vagina in front,
the anal canal behind, and the ischial
tuberosities laterally.
♦ It is triangular in shape and each side of the
triangle is approximately 3.5cm in length.
♦ Structurally it is composed of three layers of
tissue;
 Outer covering of skin
 Superficial pelvic floor muscles
 Bulbo cavernous
 Transverse perinea
 Deep pelvic floor muscle-puboccygeus
4/1/2022 ANC Module 11
 Pelvic fascia
 Is a combination of connective tissue, blood
vessels and voluntary and involuntary muscle
fibers.

 It lines the walls and floor of the pelvic cavity

and fills the area between the organs, thus
giving additional support. The fascia thickens
to form pelvic ligaments. These are
Two lateral ligaments – extend from the
white line of the fascia to the lateral walls
of the bladder .
Two pubovesical ligaments – extend from
the neck of bladder to the inner surface of
each pubic body.
• They form part of the pubo-cervical
ligaments.
4/1/2022 ANC Module 12
 Pelvic fascia…
 Two cervical ligaments – are attached to the
inner surface of each pubic body; they run
posteriorly and become attached to the neck
of bladder, the vault of the vagina and the
supra vaginal cervix.

 Transverse cervical ligaments (cardinal or

mackenrodt’s) - are attached to the vaginal
vault and supra vaginal cervix.
• Run transversely across the pelvic floor and
run out until they reach the white line of the
fascia.
• They are the strongest of the pelvic
ligaments.
4/1/2022 ANC Module 13
 Pelvic fascia…
 Uterosacral ligaments – are attached to the
vaginal vault and supravaginal cervix.
 They pass posteriorly and attach to the
lateral border of the 1st sacral body.
 Round ligaments – arise anteriorly from
just below the cornu of the uterus and
fallopian tubes then take a V shaped canal
before inserting in to each labia major.
The cardinal, uterosacral and round
ligaments all contribute to the support of
the uterus and maintenance of its position

4/1/2022 ANC Module 14

4/1/2022 ANC Module 15
The Anatomy of the Female Genital Organs

4/1/2022 ANC Module 16

 Outline
 External female genital
Function of female external genitalia

Internal female genitalia

Structures of female internal genitalia

Function of female internal genitalia

4/1/2022 ANC Module 17

 Objectives
At the end of this lesson you will be able to:

 List female external genital organs

 Mention function of female external

organs

 List female genital internal organs

 Identify Function of female internal organs

4/1/2022 ANC Module 18

 The Anatomy of the Female Genital Organs
♣ External Genitalia
Vulva – is formed from the following structures;
 Mons pubis – is a pad of fatty tissue situated in front
of the symphysis pubis.

 It is covered by skin and pubic hair which develop at

the time of puberty and appears triangular in
distribution.
 Purpose – protect the junction of the pubic bone from
trauma.

4/1/2022 ANC Module 19

 External Genitalia…
 Labia majora- are two large rounded
folds of fatty tissue covered by skin
which meet anteriorly at the mons pubis.

 Posteriorly each labia majora fuses

medially to form the posterior other
tissue connecting two similar structure.
 Contains sebaceous glands, sweet glands
and hair follicle.
4/1/2022 ANC Module 20
 External Genitalia…
 Labia minora – are two thin smaller folds
of skin lying longitudinally with the labia
majora.

 The area they in close is known as the

vestibule
- Anteriorly they divided in to two folds.

 The upper folds surround the clitoris and

unite to form the prepuce.
 The two lower folds are attached to
undersurface of the clitoris and are known as
the frenulum.
 Posteriorly, the labia minora unite to form a
thin fold of skin, the fourchette.
4/1/2022 ANC Module 21
4/1/2022 ANC Module 22
 External Genitalia…
 Clitoris:- is small extremely sensitive
erectile structure situated with in the folds of
the prepuce and frenulum.

 It is about 2.5 cm long and is composed of two

corpora cavernosea (blood sinus that form
erectile tissue).
 It consists of the glands, body and two crura.
 It is analogue to the penis in the male and highly
vascularized

4/1/2022 ANC Module 23

4/1/2022 ANC Module 24
 External Genitalia…
 Vestibules:- is a triangular space bounded
anteriorly by the clitoris, posterior by the fourchette
and on either said by labia minus.

• There are four openings in to the vestibule.

1.The urethral meatus – lies 2.5 cm below the clitoris.
2.The vaginal orifice (introitus) – occupies the lower
two thirds of the vestibule lying between the labia
minora.

4/1/2022 ANC Module 25

 Hymen- is a thin membrane which covers
the introitus in virgin.

4/1/2022 ANC Module 26

 External Genitalia…
3.The Bartholin's ducts and glands:-
are situated in the superficial
perineal pouch posterior to the
vestibular bulb.
• It secretes abundant alkaline mucus
during sexual excitement which helps in
lubrication.

4.Vestibuler bulb:- are bilateral masses of

erectile tissues situated beneath the
mucus membrane called vestibule.

• Each bulb lies on either side of the

vaginal orifice deep to the labia majora
and minora and anterior to bartholin’s
glands.
4/1/2022 ANC Module 27
 External Genitalia…
Blood supply:- The vulva is supplied with
blood from two main arteries
♥ The femoral artery in the upper part of the
thigh.
♥ The internal pudendal artery running along
the pubic arch.
 The blood drains through corresponding
veins.
 Lymphatic drainage:- some drainage in to
the inguinal glands and some is in to the
external iliac glands.
Never supply:- is from the branches of
pudendal nerve and the perineal nerve.
4/1/2022 ANC Module 28
 Internal genitalia
♥ The vagina
 Is a tube (canal) which extends from the
vulva to the uterine cervix.
 It is longer in posterior wall (9cm) than
anterior (7cm).
 The vault of the vagina is divided in to
four fornices by the projection of the
cervix.
 Anterior
 Posterior
 Two lateral fornices
• The posterior fornix is the largest.
• The vaginal walls are pink in appearance
and thrown in to small folds known as
rugae.
4/1/2022 ANC Module 29
 The vagina…
 Structures
 Vaginal wall is composed of four layers.
- The layers from in to out wards are :

i. Mucus coat lined by stratified squamous

epithelium.

ii. Sub mucous layer

iii. Muscular layer – inner circular and outer

longitudinal

iv. Fibrous coat

4/1/2022 ANC Module 30
 The vagina…
Contents
• There are no glands situated in the wall of the vagina.
• The vagina contains a small amount of fluid which
is derived from two sources;
 Alkaline mucus which secrete from the glands of the
cervix,
 The vaginal blood vessels which allow serous fluid
to transude through the vaginal wall into its lumen.

• The vaginal fluid is acidic in reaction having a PH of

about 4.5 during reproductive life.

4/1/2022 ANC Module 31

 The vagina…
Relations
 Anterior – The bladder and the urethra
 Posterior - Lowest 2/3 perineal body
- Middle third rectum
- Upper third pouch of Douglas.
 Lateral - Upper 2/3 pelvic fascia at the base of the
broad ligament.
- Lowest third -two levator ani muscles
-bulbo-cavernosus muscles.
 Superior – Uterine cervix
 Inferior – Hymen and the structures of the vulva

4/1/2022 ANC Module 32

 The vagina…
Blood supply
 Arterial supply from the vaginal, the uterine
(descending branch), the middle
haemorrodial, the inferior vesical and
pedundial arteries
 The vein drains in a corresponding manner.
Lymphatic drainage
 The lowest 2/3 drain to the horizontal
inguinal groups along with those of the
vulva.
 Upper 1/3 drain to the internal iliac and
sacral glands.
Nerve supply
• is from the sympathetic and pelvic
4/1/2022
splanchnics nervesANC Module 33
 The vagina…
Functions

 Entrance for spermatozoa

 Exit for menstrual flow and products of

conception

 Helps to support the uterus

 Organs for sexual intercourse

 Helps to prevent infection

4/1/2022 ANC Module 34

 The Uterus
Is a hollow, flattened, muscular pear
shaped organ situated between the
bladder and rectum in non pregnant
state.
It is normally anteverted and ante
flexed
It measures 8cm in length 5cm width
and 2-3 cm thick. Its weight is
approximately 57gm in non-pregnant
state.

4/1/2022 ANC Module 35

 The Uterus…
 It consists of the following parts.
a) Body or corpus
• Comprise the upper 2/3 of the uterus
• Lies between the isthmus and the opening
of the fallopian tubes.
b) Cervix
 Forms the lower third of the uterus and
measures about 2.5 cm in length.
 It is conical in shape
 The cervix projects through the anterior
wall of the vaginal which divides it in to an
upper is the supravaginal portion and lower
is the infravaginal portion.

4/1/2022 ANC Module 36

 The Uterus…
Supra vaginal cervix – lies out side and above the
vagina
 Superiorly it meets the border of the uterus at the
isthmus.
 Is separated in front from the bladder by parametrium.
 Posteriorly it is covered by the peritoneum.

Infra vaginal cervix- is the part which projects in to

the anterior vaginal wall between the anterior and
posterior fornices.

4/1/2022 ANC Module 37

 The Uterus…
c) The internal os-opens in to the cavity of the uterus
 It dilates during labor.
 Incompetence of the cervix at this level results in
spontaneous abortion.

d) The external os – opens in to the vagina at the lower

end of the cervical canal.

e) The cervical canal – lies between the internal and

external os.
 It is fusiform in shape.

4/1/2022 ANC Module 38

 The Uterus…
Functions of the cervix
• It helps to prevent infection entering the uterus.
• It dilates and withdraws during labor to enable vaginal
delivery of the fetus and placenta.

4/1/2022 ANC Module 39

 The Uterus…
f) The funds- is the domed upper wall between the
insertions of the fallopian tubes.
g) The cornua- are the upper outer angles of the uterus
where the fallopian tubes join.
h) The cavity- is a potential space between the anterior
and posterior walls
 It is triangular in shape the base of the triangle being
upper most.
i) The isthmus- is a narrow area between the cavity and
the cervix which is 7 mm long.
 It enlarges during pregnancy to form the lower
uterine segment.

4/1/2022 ANC Module 40

4/1/2022 ANC Module 41
 The Uterus…
 Structures
1. The mucous membrane (tunica
mucosa) – Endometrium
 Forms a lining of ciliated epithelium on a
base of connective tissue or stroma.
 The epithelial cells are cubical in shape
and dip down to form glands which
secrete alkaline mucus.

4/1/2022 ANC Module 42

 The Uterus…
 The cervical endometrium is thinner
than that of the body and is folded in
to a pattern known as the arborvitae
(tree of life), this assist the passage
of the sperm.
 Here the epithelial cells are tall and
columnar in shape.

4/1/2022 ANC Module 43

 The Uterus…
2.The muscular coat (tunica muscularis)-
Myometrium.
 It is thick in the upper part of the uterus and is
more sparse in the isthmus and cervix.

 Its fibers are outer longitudinal, middle interlacing

oblique and inner circular.

 Its muscle fibers are embedded in collagen fibers

which enable to stretch in the labor.

4/1/2022 ANC Module 44

 The Uterus…
3.The serous coat (tunica serosa)- Perimetrium
(mesometrium).
 Is derived from the peritoneum; it invests the
fundus and the whole of the intestinal surface
of the uterus, covers the vesical surface as
only far as the junction of the body and
cervix.

4/1/2022 ANC Module 45

 The Uterus…
♦ The form, size and situation of the uterus vary at
different periods of life and under different
circumstances.
 In the fetus:- the uterus is contained in the
abdominal cavity projecting beyond the superior
aperture of the pelvis.
• The cervix is considerably larger than the body.
At puberty- it is pyriform in shape and weights from
14 to 17 gm.

4/1/2022 ANC Module 46

 The Uterus…
In the adults- the position of the uterus depends on
the condition of the bladder and rectum.
 When the bladder is empty the entire uterus is
directed forward and is at the same time bent on
itself at the junction of the body and cervix, so that
the body lies up on the bladder.

 as the bladder fills the uterus gradually becomes

more and more erect until with a fully distended
bladder the fundus may be directed back ward
toward the sacrum.

4/1/2022 ANC Module 47

 The Uterus…
During menstruation:-the uterus is enlarged, more
vascular, and its surface rounder; the external orifice
is rounded, its labia swollen, and the lining membrane
of the body thickened, softer, and of a darker color.
During pregnancy- the uterus becomes enormously
enlarged.

4/1/2022 ANC Module 48

 The Uterus…
 By 12th week of pregnancy it rises out of the
pelvis and becomes abdominal organs, by 38th
week it reaches the xiphisternum.

 It is not longer anteverted and anteflexed but it

is becoming vertical.

 At full term the uterus is 30cm in length, 23

cm wide and 20cm thick.

 Its weight has increased from 57gm to

1000gm.
4/1/2022 ANC Module 49
 The Uterus…
After parturition-the uterus nearly regains its usual
size, weighing about 42gm; but the cavity is larger
than in the virgins state, its vessels are tortuous, and
its muscular layers are more defined; the external
orifice is more marked, and its edges present one or
more fissures.

4/1/2022 ANC Module 50

 The Uterus…
In old age - the uterus becomes atrophied, and
denser in texture, a more distinct separates the
body and cervix.
• The internal orifice is frequently, and the
external orifice occasionally, obliterated,
while the lips almost entirely disappear.

4/1/2022 ANC Module 51

 The Uterus…
♠ Relations
ANTERIOR- uterovesical pouch and
bladder.
POSTERIOR- recto uterine pouch of
douglas and the rectum.
LATERAL- broad ligaments, the fallopian
tubes and ovaries.
SUPERIOR- the intestines
INFERIOR- the vagina.

4/1/2022 ANC Module 52

 The Uterus…
♥ uterine supports (ligaments)
 Transverse cervical ligaments and (mackenrodt’s)
 Uterosacral ligaments
 Pubocervical ligaments
 Broad ligaments
 Pass from the sides of the uterus to the lateral walls of
the pelvis.
 Together with the uterus it forms a septum across the
female pelvis dividing the cavity in to two portions.

4/1/2022 ANC Module 53

 The Uterus…
Blood supply
 From the uterine artery, a branch of the hypo gastric
artery.
 Veins drains to the corresponding manner.
Lymphatic drainage
 lymph is drained from uterine body to the internal
illiac glands and also from the cervical area to many
other pelvic lymph glands.
Nerve supply
 from autonomic nervous system, sympathetic and
parasympathetic via sacral plexus

4/1/2022 ANC Module 54

 The Uterus…
Function of the uterus
 To prepare a bed for the fertilized ovum.
 To nourish the fertilized ovum for the gestation
period
 To expel the product of conception at full term.
 To involutes following child birth

4/1/2022 ANC Module 55

 Fallopian tubes
Are paired structures which are
attached with the lateral angle of
uterine cavity.
They run along the upper margin of
the broad ligament and 10 cm in
length.
 It has four portions
1.The interstitial portion- is 1.25 cm
long and lies within the wall of the
uterus.
Its lumen is 1mm wide
4/1/2022 ANC Module 56
 Fallopian tubes…
2.The isthmus – is another narrow part which extends
for 2.5 cm from the uterus.
 It acts as reservoir for spermatozoa because its
temperatures is lower than other.
3.The ampulla- is the wider portion where fertilization
usually occurs & it is 5 cm in length.
4.The infundibulum- is the funnel shaped fingered end
which is composed of many processes know as
fimbriae.

4/1/2022 ANC Module 57

4/1/2022 ANC Module 58
 Fallopian tubes…
Relations
♥ Anterior, posterior and superior the peritoneal
cavity and the intestine
♥ Lateral the side walls of the pelvis.
♥ Inferior the broad ligaments and ovaries.
♥ Medial the uterus.

4/1/2022 ANC Module 59

 Fallopian tubes…
Layers of the tube
• It consists of three coats
1.The external or serous coat- is the peritoneum.
2.Middle or muscular coat- consists of inner circular
and outer longitudinal layer of smooth muscles which
helps for peristaltic movement of the fallopian tube.
3.The internal or mucous coat- is line by columnar
and ciliated epithelium.
 Beneath the lining is a layer of vascular connective
tissue.

4/1/2022 ANC Module 60

 Fallopian tubes…
Support - by the infundibulo pelvic ligaments.
 These ligaments are formed from folds of the broad
ligament and run from the infundibulum of the tube
to the side walls of the pelvis.

Blood supply:- is via the uterine and ovarian

arteries; venous return is by the corresponding veins.

Lymphatic drainage- is in to the lumbar gland.

Nerve supply– is from the ovarian plexus.

4/1/2022 ANC Module 61

 Fallopian tubes…
Functions
Propels the ovum towards the
uterus.
Receives the spermatozoa as
they travel up wards
Provides a site for fertilization
Supplies the fertilized ovum with
nutrition during its continued
journey to the uterus.
4/1/2022 ANC Module 62
 The ovaries
Are two nodular bodies which
produce ova and hormones estrogen
and progesterone.
Position
They are attached to the back of the
broad ligament within the peritoneal
cavity.
Size 3 cm in length, 2 cm in width
and about 1 cm in thickness and
weight from about 6gm.

4/1/2022 ANC Module 63

 The ovaries…
Relations
 Anterior the broad ligament.
 Posterior the intestine.
 Lateral the infudibulo pelvic ligaments and
the side walls of the pelvis.
 Superior the fallopian tubes.
 Medial the uterus and ovarian ligaments.

4/1/2022 ANC Module 64

 The ovaries…
Supports
• From above by the ovarian ligament
medially, and the infundibulo pelvic
ligaments laterally.
• Attachment of ovary
Infundibulo pelvic ligament to the
pelvic wall.
Ovarian ligament to the uterus.
Mesooverium to the broad ligament.

4/1/2022 ANC Module 65

 The ovaries…
Structures
• The ovary is composed of medulla and cortex
covered with germinal epithelium.
 The medulla- is the central portion and point
of entry for blood vessels, lymphatic and
nerves.
The hilum where these vessels enter lies just
where the ovary is attached to the broad
ligament and this area is called the
mesovarium.

4/1/2022 ANC Module 66

 The ovaries…

 The cortex- is the functioning part of the

ovary
It contains the ovarian follicles in different
stage of development surrounded by stroma.
The outer layer is formed of fibrous tissue
known as tunica albuginea.
Germinal epithelium lies over the tuinica
albuginea.

4/1/2022 ANC Module 67

4/1/2022 ANC Module 68
 The ovaries…
Blood supply
 Is from the ovarian arteries and drains by the
ovarian veins.
Lymphatic drainage- is to the lumbar glands.
Nerve supply- is from the ovarian plexus.

4/1/2022 ANC Module 69