Clinical Anatomy of the Female Pelvis

  • Helga FritschEmail author
Part of the Medical Radiology book series (MEDRAD)


The pelvic floor constitutes the caudal border of the human’s visceral cavity. It is characterized by a complex morphology because different functional systems join here. A clear understanding of the pelvic anatomy is crucial for the diagnosis of female pelvic diseases, for female pelvic surgery, as well as for fundamental mechanisms of urogenital dysfunction and treatment.


  1. Aigner F, Zbar AP, Kovacs P, Ludwikowski B, Kreczy A, Fritsch H (2004) The rectogenital septum: morphology, function and clinical relevance. Dis Colon Rectum 47:131–140CrossRefGoogle Scholar
  2. Bastian D, Lassau JP (1982) The suspensory mechanism of the uterus. Surg Radiol Anat 4:147–160Google Scholar
  3. Beer-Gabel M, Teshler M, Barzilai N, Lurie Y, Malnick S, Bass D, Zbar A (2002) Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders. Dis Colon Rectum 45:239–248CrossRefGoogle Scholar
  4. Beets-Tan RGH, Beets GL, Vliegen RFA, Kessels AGH, Van Boven H, De Bruine A, von Meyenfeldt MF, CGMI B, van Engelshoven JMA (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357:497–505CrossRefGoogle Scholar
  5. Berglas B, Rubin IC (1953) Histologic study of the pelvic connective tissue. Surg Gynecol Obstet 97:277–289PubMedGoogle Scholar
  6. Berrocal J, Clave H, Cosson M, Dedodinance P, Garbin O, Jacquetin B, Rosenthal C, Salet-Lizee D, Villet R (2004) Conceptual advances in the surgical management of genital prolapse. J Gynecol Obstet Biol Reprod 33:577–587CrossRefGoogle Scholar
  7. Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high resolution magnetic resonance imaging. Br J Surg 90:355–364CrossRefGoogle Scholar
  8. Cundiff GW, Weidner AC, Visco AG, Addison A, Bump RC (1998) An anatomic and functional assessment of the discrete defect rectocele repair. Am J Obstet Gynecol 179:1451–1457CrossRefGoogle Scholar
  9. DeBlok S (1982a) The connective tissue of the female fetal pelvic region. Acta Morphol Neerl Scand 20:65–92Google Scholar
  10. DeBlok S (1982b) The connective tissue of the adult female pelvic region. Acta Morphol Neerl Scand 20:325–346Google Scholar
  11. DeBlok S, DeJong E (1980) The fibrous tissue architecture of the female perineal region. Acta Morphol Neerl Scand 18:181–194Google Scholar
  12. DeLancey JO (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170:1713–1723CrossRefGoogle Scholar
  13. DeLancey JO (1996) Standing anatomy of the pelvic floor. J Pelvic Surg 2:260–263Google Scholar
  14. Dorschner W, Stolzenburg JV, Neuhaus J (2001) Structure and function of the bladder neck. Adv Anat Embryol Cell Biol 159:III–XII. 1–109PubMedGoogle Scholar
  15. Federative Committee on Anatomical Terminology (1998) Terminologia anatomica: international anatomical terminology. Georg Thieme Verlag, StuttgartGoogle Scholar
  16. Fielding JR, Griffiths DJ, Versi E, Mulkern RV, Lee ML, Jolesz FA (1998) MR imaging of pelvic floor continence mechanisms in the supine and sitting positions. Am J Roentgenol 171:1607–1610CrossRefGoogle Scholar
  17. Fritsch H (1990) Development of the rectal fascia. Anat Anz 170:273–280PubMedGoogle Scholar
  18. Fritsch H (1992) The connective tissue sheath of uterus and vagina in the human female fetus. Ann Anat 174:261–266CrossRefGoogle Scholar
  19. Fritsch H (1994) Topography and subdivision of the pelvic connective tissue. Surg Radiol Anat 16:259–265CrossRefGoogle Scholar
  20. Fritsch H, Fröhlich B (1994) Development of the levator ani muscle in human fetuses. Early Hum Dev 37:15–25CrossRefGoogle Scholar
  21. Fritsch H, Kühnel W (1992) Development and distribution of adipose tissue in the pelvis. Early Hum Dev 28:79–88CrossRefGoogle Scholar
  22. Fritsch H, Kühnel W, Stelzner F (1996) Entwicklung und klinische Anatomie der Adventitia recti. Langenbecks Arch Chir 381:237–243CrossRefGoogle Scholar
  23. Fritsch H, Brenner E, Lienemann A, Ludwikowski B (2002) Anal sphincter complex. Dis Colon Rectum 45:188–194CrossRefGoogle Scholar
  24. Fritsch H, Lienemann A, Brenner E, Ludwikowski B (2004) Clinical anatomy of the pelvic floor. Adv Anat Embryol Cell Biol 175:1–64CrossRefGoogle Scholar
  25. Gasparri F, Brizzi E (1961) Significato anatomo-chirurgico delle formazioni connecttivali del piccolo bacino. Arch Ital Anat Embriol 66:151–169PubMedGoogle Scholar
  26. Gosling J (1999) Gross anatomy of the lower urinary tract. In: Abrams P, Khoury S, Wein AJ (eds) Incontinence. Plymbridge, Plymouth, pp 21–56Google Scholar
  27. Grabbe E, Lierse W, Winkler R (1982) Die Hüllfascien des Rektums. Fortsch Röntgenstr 136:653–659CrossRefGoogle Scholar
  28. Heald RJ (1995) Total mesorectal excision is optimal surgery for rectal cancer. Br J Surg 82:1297–1299CrossRefGoogle Scholar
  29. Höckel M, Horn L-C, Fritsch H (2005) Association between the mesenchymal compartment of uterovaginal organogenesis and local tumour spread in stage IB–IIB cervical carcinoma: a prospective study. Lancet Oncol 6:751–756CrossRefGoogle Scholar
  30. Janssen U, Lienemann A, Fritsch H (2001) Die Bedeutung des M. levator ani – Fossa ischioanalis-Glutaeus maximus (LFG) – Komplexes für den weiblichen Beckenboden. Ann Anat Suppl 183:11CrossRefGoogle Scholar
  31. Khubchandani IT, Sheets JA, Stasik JJ, Hakki AR (1983) Endorectal repair of rectocele. Dis Colon Rectum 26:792–796CrossRefGoogle Scholar
  32. Kocks J (1880) Normale und pathologische Lage und Gestalt des Uterus sowie deren Mechanik. Cohen, Bonn, pp 1–60Google Scholar
  33. Koster H (1933) On the supports of the uterus. Am J Obstet Gynecol 25:67–74CrossRefGoogle Scholar
  34. Kux M, Fritsch H (2000) On the extraperitoneal origin of hernia. Hernia 4:259–263CrossRefGoogle Scholar
  35. Lierse W (1984) Becken. In: von Lanz T, Wachsmuth W (eds) Praktische Anatomie, Bd 2, Teil 8A. Springer, BerlinGoogle Scholar
  36. Ludwikowski B, Oesch-Hayward I, Brenner E, Fritsch H (2001) The development of the external urethral sphincter in humans. BJU Int 87:565–568CrossRefGoogle Scholar
  37. Ludwikowski B, Oesch-Hayward I, Fritsch H (2002) Rectovaginal fascia: an important structure in pelvic visceral surgery? About its development, structure, and function. J Pediatr Surg 37:634–638CrossRefGoogle Scholar
  38. Mackenrodt A (1895) Ueber die Ursachen der normalen und pathologischen Lage des Uterus. Arch Gynaekol 48:393–421CrossRefGoogle Scholar
  39. Niemen K, Heinonen PK (2001) Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years. BJOG 108:817–821Google Scholar
  40. Nobis A (1988) Untersuchungen zur feineren Struktur des retrorektalen Raumes beim Menschen. Inaugural Dissertation, BonnGoogle Scholar
  41. Occelli B, Narducci F, Hautefeuille J, Francke JP, Querleu D, Crepin G, Cosson M (2001) Anatomic study of arcus tendineus fasciae pelvis. Eur J Obstet Gynecol Reprod Biol 97:213–219CrossRefGoogle Scholar
  42. Oelrich TM (1983) The striated urogenital sphincter in the female. Anat Rec 205:223–232CrossRefGoogle Scholar
  43. Pernkopf E (1941) Topographische Anatomie des Menschen. Urban & Schwarzenberg, Berlin; Bd 2, Teil 1: Bd 2, Teil 2Google Scholar
  44. Richardson AC (1993) The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Ggynecol 36:976–983CrossRefGoogle Scholar
  45. Richter K (1998) Gynäkologische Chirurgie des Beckenbodens. In: Heinz F, Terruhn V (eds) Georg Thieme Verlag, StuttgartGoogle Scholar
  46. Richter K, Frick H (1985) Die Anatomie der Fascia pelvic visceralis aus didaktischer Sicht. Geburtsh Frauenheilk 45:282–287CrossRefGoogle Scholar
  47. Sprenger D, Lienemann A, Anthuber C, Reiser M (2000) Funktionelle MRT des Beckenbodens: normale anatomische und pathologische Befunde. Radiologe 40:458–464CrossRefGoogle Scholar
  48. Stelzner F (1989) Die Begründung, die Technik und die Ergebnisse der knappen transabdominalen Kontinenzresektion. Langenbecks Arch Chir 374:303–314CrossRefGoogle Scholar
  49. Stelzner F (1998) Chirurgie an vizeralen Abschlusssystemen. Georg Thieme, StuttgartGoogle Scholar
  50. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911CrossRefGoogle Scholar
  51. Thakar R, Stanton S (2002) Management of genital prolapse. BMJ 324:1258–1262CrossRefGoogle Scholar
  52. Tobin CE, Benjamin JA (1945) Anatomical and surgical study of Denonvilliers fascia. Surg Gynecol Obstet 80:373Google Scholar
  53. Uhlenhuth E, Nolley GW (1957) Vaginal fascia, a myth? Obstet Gynecol 10:349–358PubMedGoogle Scholar
  54. Ulmsten U (2001) The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence. Urologe 40:269–273CrossRefGoogle Scholar
  55. Waldeyer W (1899) Das Becken. Cohen, BonnGoogle Scholar
  56. WEW R, Tucker WG (1986) Thickening of the pelvic fascia in carcinoma of the rectum. Dis Colon Rectum 29:117–119CrossRefGoogle Scholar
  57. Wilson PD, Dixon JS, ADG B, Gosling JA (1983) Posterior pubo-urethral ligaments in normal and genuine stress incontinent women. J Urol 130:802–805CrossRefGoogle Scholar
  58. Woodmann PJ, Graney DO (2002) Anatomy and physiology of the female perineal body with relevance to obstetrical injury and repair. Clin Anat 15:321–334CrossRefGoogle Scholar
  59. Zbar AP, Lienemann A, Fritsch H, Beer-Gabel M, Pescatori M (2003) Rectocele: pathogenesis and surgical management. Int J Color Dis 29:1–11Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and EmbryologyMedical University of InnsbruckInnsbruckAustria

Personalised recommendations