S10.1 Pelvic Floor

Question 1

Describe the structure an openings of the pelvic floor

Answer 1

Muscular and fibrous tissue diaphragm, separates pelvic cavity from perineum.
Openings: urogenital hiatus anteriorly (Urethra and Vagina), rectal hiatus centrally. Perineal body is between these.

Question 2

What is the blood supply of the pelvic floor?

Answer 2

Internal and external pudendal arteries

Question 3

What is the lymphatic drainage of the pelvic floor?

Answer 3

Inguinal glands

Question 4

What is the nerve supply of the pelvic floor?

Answer 4

Pudendal nerve S2-S4

Question 5

What are the functions of the pelvic floor?

Answer 5

Support the pelvic organs
Maintain intra-abdominal pressure
Facilitate defacation and micturition
Facilitate childbirth

Question 6

How does the the pelvic floor support pelvic organs?

Answer 6

Cardinal ligaments hold the cervix and upper vagina in place.
Uterosacral ligaments maintain antiverted position of uterus.

Lower half of the vagina is supported by fusion of the vaginal endopelvic fascia to the perineal body posteriorly, the levator ani laterally and the urethra anteriorly

Question 7

Describe the muscles of the pelvic floor

Answer 7

Levator ani (S2-S4), formed from;
Puborectalis, pubococcygeus, iliococcygeus

Coccygeus (anterior rami of S4-5)
Ischiocavernosus and bulbospongiosus

Question 8

What are the attachments of the levator ani?

Answer 8

Anterior - pubic bones
Lateral - fascia of obturator internus
Posterior - ischial spines

Pierced by anal canal centrally

Question 9

What is the urogenital diaphragm?

Answer 9

Triangular sheet of dense fibrous tissue, attaches medially to urethra, vagina and perineal body.

Question 10

What is pelvic organ prolapse?

Answer 10

Refers to loss of support for the uterus, bladder, colon or rectum, leading to prolapse of one of these organs into the vagina.

Question 11

What are the 4 types of prolapse? Explain them

Answer 11

Anterior compartment – cystocele prolapse (bladder)

Middle compartment – uterine prolapse

Post-hysterectomy vault prolapse – prolapse of the vaginal cuff following a hysterectomy (removal of the uterus)

Posterior compartment – Rectum can prolapse into posterior vagina to produce rectocele, or loops of bowel can prolapse forming an enterocele

Question 12

Describe the risk factors and management of prolapse

Answer 12

Risk factors: age, pregnancies, obesity

Management: pessaries, surgery

Question 13

What is an episiotomy?

Answer 13

Cut made into vagina to aid in child delivery.

Complications: haemorrhage, infection

Question 14

Define female genital mutilation

Answer 14

All procedures involving partial or total removal of the external female genitalia, or injury to the female genital organs, whether for cultural or non-therapeutic reasons.
Due to religion, culture, chastity

Question 15

What are some complications of FGM?

Answer 15

Complications: haemorrhage, severe pain, sepsis, HIV, urinary retention.
Late complications: fertility issues, chronic pain, keloid scar, dysmenorrhoea, flashbacks

Question 16

Describe the 4 different types of FGM

Answer 16

Type 1: partial or total removal of clitoris
Type 2: partial or total removal of clitoris + labia minora
Type 3: narrowing of vaginal office by appositoning labia minora and/or majora
Type 4: other harmful procedures to female genitalia for non-medical purposes eg piercing

Question 17

What are the laws regarding FGM?

Answer 17

Illegal in UK.
Once vagina cut has been opened e.g during childbirth, must not be reinfibulated (sealed) even if the woman requests it.
Requires identification, put into database, report if <18.