Anatomy of the Pelvis

You could ask ten women what a vagina is, and I guarantee that they would all have a different definition.  Most of us were taught about our anatomy during the Summer heading into Freshman year of high school, and let’s get serious, we were far more interested in who the hot upperclassmen were and what fashions were in style.  That being said, most of us were never re-educated in what our vulva is, and forget about even knowing what your pelvic floor is (‘Huh??  We have muscles down there?’) ! Instead we either fondly, or ignorantly, turn to other names to refer to “down there” and don’t ever really think about it.

I was at a conference last year that included a presentation by a vulvar dermatologist (yes, a woman that dedicates her entire medical career towards skin and mucosal issues involving the vulva) that put up a slide that had all the slang names she has encountered to describe a vagina:

Bearded clam                                    Beaver                                                Box

Camel toe                                         Cha-cha                                             Crotch

Downtown                                    Fanny                                                Hoo-hoo

Kitty                                                Love of Venus                                  Muffin

Pink canoe                                    Pink sausage wallet                      Pink taco

Poonani                                         Promised land                                 Pussy

Queef                                                Snatch                                              Squeeze box

Sweetness of Venus                   Tunnel of love                                 VaJayJay

I, of course, had to take a picture of that slide and send it out to my girlfriends with the title “just another day in the life of my job…”  My friend Steph still talks about that being one of the best texts she has ever received!

All humor aside, it is very clear to me that women are just not in touch with their anatomy; yet it is this very part of our body that goes through drastic alterations during hormonal changes encountered throughout our lives… not to mention the physical effects of pregnancy and childbirth!  So many think of “down there” as just being the vagina (whatever that means to folks) and neglect that we have other amazing structures, like the pelvis and pelvic floor muscles.

If we are going to dedicate a whole month to pelvic health (and we intend to do just that!) we need to be straight about what exactly we are talking about.

Step back!  I’m about to unleash my inner-anatomy nerd!

The pelvic girdle is made of five different bones: 2 pubic bones, 2 ischia, 2 ilia, 1 sacrum, and 1 coccyx (tailbone). The ilia attach to the right and left sides of the sacrum to create 2 sacroiliac (SI) joints.

pelvis

Along the entire bottom of the pelvic girdle are your pelvic floor muscles. These muscles are often neglected despite all the hard work they do.  They:

  • Control bladder and bowel function (so you don’t leak urine or stool)
  • Allow for pleasure with intercourse (because sex should never be painful)
  • Hold up abdominal/pelvic organs (so your bladder, uterus or rectum doesn’t start falling through your vagina.  Too frank?  Sorry, but that’s some serious stuff!)
  • Support and stabilize the pelvic girdle (They’re an integral player in the core team that is often overlooked)

bladder

Quite a lot of responsibility for such little muscles that most women don’t even know about!

If that is enough for you to get the big picture, then you can stop reading. If you are a dork like me, and like more information, then keep reading about the nitty-gritty of “who” the pelvic floor muscles are.

The first muscle layer, the superficial urogenital diaphragm, surrounds the vaginal opening.  It consists of 2 superficial transverse perinei, 2 bulbocavernosus and 2 ischiocavernosus muscles.

Just deep to the superficial urogenital diaphragm is a second layer of muscle and connective tissue that primarily supports the urethra and contributes to continence.

Deeper inside the pelvis are the levator ani muscles, attaching like a hammock to the pubic bones in the front and the tailbone in back.  They consist of 2 pubococcygeus, 2 puborectalis, and 2 iliococcygeus muscles.

pelvis2

There are other key players that support and overlap with the levator ani called the obturator internus and coccygeus muscles. The obturators are my favorite muscles in the entire body! They are found along the inside of the pelvis, just next to the levator ani.  I can still remember in anatomy cadaver lab being told I didn’t really need to know about this muscle individually, because “it’s an inner hip muscle that works with other hip muscles as a group and is too hard to isolate.” Now, I’m convinced that every woman could benefit from work on her obturators, as they are not just hip muscles, but rather huge contributors to pelvic floor support and function!  The coccygeus muscles attach the coccyx and ischium together and their job is to stabilize the tailbone.

Even if you don’t remember all the muscles specifically, I hope you can at least have a new appreciation for the pelvis and the pelvic floor, and how important they are to our daily function.  And if nothing else, perhaps can see how – although easier – referring to “down there” as a VaJayJay just doesn’t do it justice!

–Victoria Yeisley, DPT

 Victoria Yeisley, DPT, specializes in pelvic floor physical therapy, with the focus on perinatal health, pelvic pain, sexual dysfunction and voiding dysfunctions.  She currently practices with Northwestern Memorial Physician’s Group in Chicago, IL, along with a progressive group of OB-GYNs and midwives.  Victoria will be relocating to Atlanta, GA this Summer, where she is excited to join the team at One on One Physical Therapy.  This is her first year participating with Share MayFlowers…but stay tuned, she plans on staying around for a long time!!!

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