Applied anatomy of the pelvic floor

The pelvic floor consists of muscular and fascial structures that provide support to the pelvic viscera and the external openings of the vagina, urethra and rectum. The levator ani muscles that form the floor of the pelvis are attached to the bony pelvic walls and incorporate the perineal body of the perineum in the midline.

THREE LEVELS OF VAGINAL SUPPORT

The uterus and vagina are suspended from the pelvic side walls by endopelvic fascial attachments that support the vagina at three levels (Figures 13.1 and 13.2).

Level 1

The cervix and upper third of the vagina are supported by the cardinal (transverse cervical) and uterosacral ligaments. These suspend the cervix and upper vagina from the pelvic side wall and sacrum.

Level 2

The mid portion of the vagina is attached by fascia laterally to the arcus tendineus of the pelvic side wall.

Level 3

The lower third of the vagina is in direct contact with, and is supported by, the levator ani muscles and the perineal body.

Prevalence of pelvic organ prolapse

Pelvic organ prolapse, also called genital prolapse, is the descent of the pelvic organs into the vagina and is often accompanied by urinary, bowel and/or sexual symptoms.