Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations

Abstract

A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora, clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes, and ovaries with their visceral fascia. The visceral fascia also called the endopelvic fascia, surrounds the pelvic organs and connects them to the pelvic walls. It is continuous with the paraurethral and paravaginal fascia, which is attached to the perineal membrane. Thus, the internal and external genitalia are closely related to the muscles and fascia, and work as one functioning unit.

Gender does not affect the prognosis of Fournier’s gangrene: a case-matched study

“…However, it is not anteriorly attached, which may cause early extension of infection to the anterior abdominal wall in females. [11] In the present study, female patients had more extensive disease compared to males, and they underwent debridements more frequently than males. Although symptom duration was comparable between the 2 groups, majority of the males had grade I disease (62.50% vs 25.0%), while grade III disease was more frequent among females (43.75% vs 18.75%).…”

A Comprehensive Review of the Clitoris and Its Role in Female Sexual Function

“…As reported earlier in this manuscript, the clitoris is a multicomponent structure containing erectile tissue and is attached to the mons, labia majora, and pubic symphysis by suspensory ligaments [11]. Preserving the bulbs' erectile tissue is paramount for sexual function, and sparing the ligaments is important for anatomical positioning [11].…”

“…The clitoral body is composed of paired corpora, which diverge to form the crura [11][12][13]15,18]. The bilateral crura are the internal extensions of the corpora, which attach to the ischiopubic rami, and surround the urethra [12,15,17].…”

Continence and micturition: An anatomical basis

“…The urogenital hiatus is bounded ventrally by the pubic bone and levator ani, and dorsally by the perineal body (Ashton‐Miller and DeLancey, ). The perineal body is a connective structure into which the levator ani, superficial transverse perineal muscles and perineal membrane attach (Yavagal et al, ). Clinically important functions of the perineal body are summarized in Box (Woodman and Graney, ).…”

“…Urinary bladder mucosa consists of the urothelium, a basement membrane and the lamina propria. The urothelium is a stratified epithelium lining the urinary (Ashton-Miller and DeLancey, 2007;Yavagal et al, 2011;Molinuevo et al, 2012)…”