The pelvic floor is formed by the pelvic diaphragm and the perineal membrane. The pelvic diaphragm consists of the levator ani and coccygeus muscles, which attach superiorly to the pelvic wall. The levator ani muscles originate from the pelvic wall and join together in the midline, forming a U-shaped defect anteriorly. The coccygeus muscles are triangular shaped and overlie the sacrum and coccyx. The perineal membrane is a thick fascia attached to the pubic arch, with a thin space above it called the deep perineal pouch containing muscles and vessels. The perineal body is a connective

1. Pelvic floor and Perineal
body
Themba Hospital FCOG(SA) Part 1 Tutorials
By Dr N.E Manana

2. Pelvic floor
• The pelvic floor is formed by :
1. The pelvic diaphragm and
2. The perineal membrane and muscle of the deep perineal pouch
Pelvic diaphragm
• Is the muscular part of the pelvic floor, it is bowl shaped, attached
superiorly to the pelvic wall
• It consists of the levator ani and the coccygeus muscles
• Its circular line of attachment passes between the sciatic foramen,
greater sciatic above and lesser sciatic below

3. • 5.34

4. Pelvic diaphragm
Levator ani
• The muscles originating from the pelvic wall, course medially and inferiorly
and join together in the midline
• Attachment to the pelvic wall follows a contour which include; posterior
pubic body, tendinous arch over the obturator internus muscle and ischial
spine
• In females the muscle blend together posterior to the vagina and around
the anus in anal aperture in both sexes (Anococcygeal ligament)
• Anteriorly they form a U-shaped defect (Urogenital hiatus)
• Levator ani has 3 collections of fibers: 1. Pubococcygeus, 2. Puborectalis
and 3. Iliococygeus muscles

5. Pelvic diaphragm
Coccygeus
• The are 2 muscles, one on each side, triangular in shape, overlying the SSL
• The base is attached to the lateral margins of the coccyx and sacrum, and
the apex is attached to the tips of the ischial spines
• They are innervated by the branches of the anterior rami of S4-S5
• Participate in supporting the posterior aspect of the pelvic floor

6. • Table 5.2

7. Perineal membrane and deep perineal pouch
• The perineal membrane is a thick fascia, triangular shaped, attached to the
pubic arch
• Orientated in a horizontal plain, with a free posterior margin
• Anterior the a small gap between the membrane and the inferior pubic
ligament
• The is a thin space above it termed the deep perineal pouch, which
contains skeletal muscles and neurovascular elements
• The pouch is open above, only enclosed by the urogenital hiatus, therefor
contributing to the pelvic floor
• It provides attachment for roots of the external genitalia and assoc muscles

8. Perineal membrane and deep perineal pouch
• 5.36

9. Perineal membrane and deep perineal pouch
• Anterior a group of muscle fibers surround the urethra (External
urethral sphincter)
• Two additional groups are assoc with the urethra and the vagina;
sphincter urethrovaginalis and compressor urethrae
• Together they facilitate closure of the urethra
• Deep transverse perineal muscle parallels the free margin of the
perineal membrane and joins with its partner in the midline
• They stabilise the perineal body

10. Perineal body
• Is an ill defined but important connective tissue structure into which
muscles of the pelvic floor and perineum attach
• It is in the midline along the posterior border of the perineal
membrane which it is attached to
• It is also attached to the posterior end of the urogenital hiatus
• Muscle attached: 1. Deep transvers perineal muscle, 2. Sphincter
urethrovaginalis, 3. External anal sphincter, 4. Superficial transverse
perineal muscle and 5. the Bulbospongiosus muscles

11. • Pic 5.68

12. Thank you