Pelvic organ anatomy
Accompanies the illustrations:
– Pelvic organ anatomy
– Pelvic musculoskeletal anatomy
What is inside the pelvis?
A network of interlocking muscles and strong connective tissue called fascia surrounds the lower pelvic organs and vulva, keeping them in place and allowing them to do their jobs. Fascial structures in the lower pelvis and vulva include endopelvic fascia, suspensory ligament of the clitoris, urogenital diaphragm, and perineal body. Muscles beneath the vulva include the bulbocavernosus, ischiocavernosus, deep and superficial transverse perineal muscles, urethral sphincter, and anal sphincter.
Pelvic organs, from front to back
Urethra – muscular tube that carries urine from the bladder to the outside
Bladder – storage container for urine that sits behind the pubic bone and in front of the uterus, made up of smooth muscle not under voluntary control
Vagina – the muscular canal that connects the cervix and uterus to the outside
Cervix – opening of the uterus that helps keep a pregnancy inside, can be seen during vaginal examination with a speculum
Uterus – the organ that carries a pregnancy and is the source of menstrual bleeding, it sits between bladder and rectum
Fallopian tube – tube that picks up and carries eggs from the ovary to the uterus; this is surgically removed or interrupted to prevent pregnancy
Fimbriae – the specialised end of the fallopian tube; it has many little finger-like projections that can pick up eggs as they exit the ovary during ovulation
Ovary – this organ produces eggs and also makes hormones like oestrogen, progesterone, and small amount of testosterone; surgical removal of both ovaries makes someone menopausal
Rectum – storage container for faeces that sits between the uterus and the sacrum
The clitoris – bigger than you think
The clitoris is about 10cm in length and sits underneath the vulva. It is shaped like an upside-down V. The glans clitoris is the tip of the V, about 1cm in size, and the only part that is visible from outside. The body of the clitoris extends from the glans more deeply into the vulva, then divides into 2 crura (legs) that sit behind the labia minora. Two vestibular bulbs connect into the clitoral body and contain erectile tissue, they sit beside the urethra. The whole organ has many nerve endings for sensation, along with blood vessels to fill up the erectile tissue.
Some people with lichen sclerosus have scarring of the skin over the glans clitoris, so the glans is no longer visible (see Lichen sclerosus). It is important to remember this has NOT affected the clitoris. The organ is still there underneath the skin and continues to function as it always has. It is possible for dead skin cells to be trapped between the clitoral hood and the glans clitoris. Usually this does not cause problems, but sometimes this can build up and cause discomfort. See your doctor or women’s health nurse if there is persistent clitoral pain or an enlarging cyst.
Some people have pain in the area of the clitoris, but the skin looks healthy and there is nothing trapped underneath the hood. In this case, the pain may be from dysfunction of the nearby nerves and muscles. Pain can be ‘referred’ to the clitoral area when the issue is actually somewhere else. A consult with a doctor or pelvic floor physiotherapist may help identify the cause and find a treatment. Don’t worry – the clitoris does not need to be removed in these cases.