Anatomy 101: An Inside Look at the Female Pelvis

Updated: Mar 30

By Alyssa Brunt, MScPT, BScKIN (HON)

Up until now, you’ve learned about Kegels, when to exercise post-pregnancy, how to keep a clean vulva, and what it means when we have a little leakage with coughing, sneezing, laughing or jumping. Congratulations, you have officially opened the door to understanding the pelvic floor in all its glory. But what do our private parts even look like? How do things look on the inside?

We can’t really begin to fully understand how the pelvic floor works without some visualization. Think about when you first learned about puberty and getting your period. Although slightly horrifying, the concept of bleeding once a month from your vagina was pretty straightforward – we bleed and use a cotton tampon or pad to absorb it. But it wasn’t until our sex-ed teachers brought out those models showing the ovaries and the tubes to the uterus that we really got the big picture on how things work and why we have a period in the first place. After all, seeing is believing. Or so they say.

Unfortunately, the pelvic floor continues to be something that is overlooked. For most women, discussing pelvic health and vaginas is awkward and creates vulnerability, not to mention the social stigma that’s been created around discussing our ‘private’ parts. Masturbation? Oh, hell no. Incontinence? That’s my business. Pain with sex? Don’t even go there, sister. Where is Carrie Bradshaw when we need her?

Today’s blog is all about anatomy. Let’s shed some light on the great unknown area of the female pelvis by looking at how the bones, muscles and connective tissue all work together to create the pelvic floor. Think of this as me breaking the ice. I’ll talk and you just listen

The Bones

Like everything else, our pelvic floor can’t exist without a strong foundation. These muscles line the inside of the pelvis, which is like the framework for the pelvic floor. It’s where all of the muscles and tissues attach and connect. The hip bones run along the sides, the sacrum and tailbone create the back, and the pubic bone makes up the front of the pelvis. The coccyx, or tailbone, sits at the bottom of the sacrum and is made up of 3-5 bones fused together. This little guy provides attachment for some very important ligaments and muscles. Pretty much EVERY-thing in the pelvic floor attaches to the coccyx

In women, the pelvis is generally wider and broader as compared to men for babies of course! This shape helps accommodate a growing baby and allows it to pass through the birth canal.

Organs

The boney pelvis provides protection to organs in the gastrointestinal, urinary and reproductive systems. The uterus, bladder, urethra, rectum, and vagina all sit within the pelvic cavity and on top of the pelvic floor muscles. You can see that the muscles basically act like a hammock or trampoline and prevent organs from dropping down too low from the force of gravity. When they become overstretched from weakness and pregnancy, pelvic organ prolapse can occur.

Ligaments

Ligaments are tough bands of connective tissue that attach bone to bone. They provide a lot of stability and support to the organs, bones, and muscles. Two major ligaments are found in the pelvic floor- the sacrospinous and sacrotuberous ligaments (fancy names, I know).

Why is this important? They run from the back to the front of the pelvis and cross on top of one another. The main nerve in the pelvic floor, called the pudendal nerve, that controls our ability to pee and poo, activate our muscles, and feel sensation in the genital area runs right between these two ligaments. As a result, we can get a lot of pinching and nerve entrapment around here.

Muscles

ATTENTION: picture of vulva straight ahead!

So we’ve talked bones, organs, and ligaments. Now it’s time to look at the muscles. The pelvic floor muscles are just like the other muscles within the body. They can be overstretched, torn, tightened, and even strengthened.

To better understand the layout of the muscles, think of the pelvic floor as an onion or a cake- in that it has layers!

Layer 1: The Vulva

If you were to grab a mirror, hold it between your legs and take a peek (which I strongly encourage!), you’d be looking your vulva. I’m sure we’re all generally familiar with what this looks like but let’s break it down a bit.

  1. Mons pubis: fatty tissue above and slightly on top of the pubic bone, where hair grows after puberty

  2. Clitoris: covered by the clitoral hood, this little angel is the pleasure centre. She’s sensitive, so be careful! Poor movement of the clitoral hood can impact our ability to orgasm

  3. Urethral opening: Just below the clitoris is the opening to the urethra where our urine comes out

  4. Labia majora and labia minora: Labia means lips and along the vulva we can find the larger, labia majora on the outside (outer lips) and the labia minora on the inside (inner lips). The labia can range from a light pinkish colour to black or brown.

  5. Fourchette: At the bottom of the vulva is the fourchette, which is where the labia minora meet

  6. Perineum: the area between the vulva and the anus

  7. Anus: the opening where we excrete waste and feces come out

Layer 2: Muscles for sexual function

If we peeled away the layer of skin making up the vulva, we have our first layer of pelvic floor muscles. These guys are mainly responsible for sexual function! They allow for orgasm, pleasurable sex, and lubrication, so we’d say they’re pretty important. Not only do these muscles help the clitoris (and penis) get erect but they empty the urethra and act as a sphincter (gate) to close the urethra when we’re done peeing.

A little lower down, south of the opening of the vagina, you’ll see the perineal tendon. Ever heard of tearing during childbirth? Yeah, that’s this guy. This tendon stabilizes the entire pelvic floor. It’s like the grand central station of the pelvic floor- everything meets here and all muscles attach here to some degree. This is why tearing during labour can cause a lot of dysfunction in the pelvic floor.

Completely south (i.e Antarctica) you’ll find the anal sphincter. To tighten theses muscles, thinking about holding in gas!

Layer 3: The sphincters

A little further inside, we have our sphincters- circular muscles that control the passage of urine and feces. These muscles are important for making sure we only pee and poop when we want too! Women have a few more muscles that control the urethra, mainly for increased control during pregnancy as growing babies like to push down on the bladder.

Layer 4: The levator ani and pelvic floor muscles

The last layer is pretty much the main event- these are the bowl shaped muscles that keep everything together. Now I won’t go into too much detail here but the main muscles collectively are called the levator ani. They run from the pubic bone all the way to the tailbone. These muscles work alongside other muscles in the hips and are SUPER important for supporting the pelvic organs, helping us control our bowel movements and urination, and rotating the hip.

You may be wondering why there are gaps within the muscles. Gaps in the pelvic floor muscles, called a hiatus allow organs to pass through which is important when it comes to peeing, having a bowel movement and having a baby!

What’s Next?

So that’s the tip of the iceberg for the female pelvis! If you’d like to know more about how the pelvic floor muscles work and what things look like, book a consultation with Alyssa today. She has lots of anatomy models and is eager to answer your questions!

Book an appointment online. Contact us: 416.214.9251, admin@drdarou.com www.darouwellness.com

Photo References

  1. Faghani, Nelly, and Carolyn Vandyken. Level 1: The Physical Therapy Approach to Female and Male Urinary Incontinence. Pelvic Health Solutions, 2018.

  2. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=zm6406

  3. http://advancedocwellness.com/drtaradcblogspotcom/2018/9/5/pelvic-floor-dysfunction-and-pain

  4. https://www.saintlukeskc.org/health-library/anatomy-vulva

  5. Faghani, Nelly, and Carolyn Vandyken. Level 1: The Physical Therapy Approach to Female and Male Urinary Incontinence. Pelvic Health Solutions, 2018.

  6. Faghani, Nelly, and Carolyn Vandyken. Level 1: The Physical Therapy Approach to Female and Male Urinary Incontinence. Pelvic Health Solutions, 2018.

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