Pelvis, Pelvic Diaphragm and Perineum

Question 1

Greater/false pelvis

Answer 1

Extend from iliac crests inferiorly to pelvic brim

Question 2

Lesser/true pelvis

Answer 2

Extending from pelvic brim to pelvic floor

Question 3

Pelvic brim

Answer 3

Plane marked by sacral promontory, arcuate line, pectineal line and pubic crest

Question 4

Female Pelvis

Answer 4

Lighter
Subpubic angle is ~90 degrees
Shallow greater pelvis
Wider and shallower true pelvis
Oval & rounded pelvic brim
Larger pelvic outlet
Straighter sacrum

Question 5

Male Pelvis

Answer 5

Heavier
Subpubic angle is ~60 degrees
Deep greater pelvis
Narrow and deeper true pelvis
Heart-shaped pelvic brim
Smaller pelvic outlet
Anteriorly-concave sacrum

Question 6

MVA Pelvic Fracture

Answer 6

Posterior translation at pubic symphysis causing break of superior/inferior rami

Question 7

Jumping accident Fracture

Answer 7

Displacement of femur through acetabulum

Question 8

Muscles of pelvic floor

Answer 8

Levator ani

Coccygeous

Question 9

What are the pelvic floor muscles innervated by?

Answer 9

Mostly S4, but some S3 and S5

Question 10

Levator ani includes

Answer 10

Puborectalis
Pubococcygeus
Iliococcygeus

Question 11

Pelvic Diaphragm

Answer 11

Essential for maintaining proper positioning of pelvic organs and maintaining abdominal pressure

Question 12

Perineal Body

Answer 12

Thick connective tissue mass that serves as site for insertion of urogenital muscles

Question 13

Perineal Membrane

Answer 13

Support external genitalia

Question 14

Defecation

Answer 14

Puborectalis muscle runs posterior to anorectal junction, maintaining fecal continence
Relaxation of puborectalis is essential to defecation

Question 15

Kegel Exercise

Answer 15

Isometric contraction of pubococcygeous muscle and pelvic diaphragm to prevent incontinence
Also thought to prevent injury and prevent uterine prolapse and incontinence

Question 16

Birthing

Answer 16

Pubococcygeous must stretch, likely torn
Compromised pubococcygeous function can lead to incontinence or prolapse
Puborectalis serves as sling, rarely torn

Question 17

Vaginismus

Answer 17

Involuntary spasm of muscles surrounding vagina

Question 18

Vaginismus Causes

Answer 18

Sexual trauma or abuse
History of discomfort with intercourse
Anxiety with intercourse

Question 19

Vaginismus Treatment

Answer 19

Education
Counseling
Behavioral exercise
Vaginal dilation exercise

Question 20

External Anal Sphincter

Answer 20

Skeletal muscle under voluntary control innervated by S4 through inferior rectal nerve

Question 21

Internal Anal Sphincter

Answer 21

Smooth muscle innervated by both sympathetic/parasymphathetic fibers from pelvic splanchnic nerves

Question 22

Urogenital Triangle

Answer 22

Pubic symphysis to ischial tuberosities

Question 23

Anal Triangle

Answer 23

Ischial tuberosities to tip of coccyx