A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
[Illustration: FIG. 19.--Dissection of female perineum: on the left
side the perineal muscles are exposed by the reflection of the perineal
fascia; on the right side the muscles and the superficial layer of the
triangular ligament have been removed, thereby exposing the deep layer
of the ligament. _S. V._, Sphincter vaginæ muscle.]
The vagina passes through these structures. They surround and support
the ostium vaginæ as the fascia and muscles surround and support the
opening of the rectum or the anus. The muscles and fasciæ are attached
in the median line between the anus and the vagina, and therefore
this part of the body, which is called the perineum, is supported
or maintained in its proper position by these various structures.
The transversus perinæi arises from the ramus of the ischium and is
inserted in the perineum. The bulbo-cavernosus, or sphincter vaginæ,
arises in the perineum and is inserted in and about the clitoris. The
inner fibers of the levator ani arise from the symphysis pubis and are
inserted in the perineum and the lower part of the vagina (Fig. 20).
When these muscles contract, their action, therefore, is to draw the
perineum upward and forward. At the same time the anus is drawn upward
and forward, and so also is the posterior margin of the ostium vaginæ
and the lower portion of the posterior vaginal wall.
[Illustration: FIG. 20.--Dissection of female perineum, showing the
deeper structures after removal of the levator and sphincter ani
muscles.]
The vagina has no circular sphincter like the anus, but the vaginal
month is kept closed by the action of the transversus perinæi,
sphincter vaginæ, and levator ani muscles, which draw the perineum
forward, and thus keep the posterior vaginal wall in apposition with
the anterior wall.
[Illustration: FIG. 21.--Muscular floor of the pelvis seen from above.]
This sling of muscles and fascia, which surrounds and supports the
opening of the vagina, may readily be felt in the nulliparous woman by
introducing the finger in the vagina and pressing backward and outward
toward the ischio-rectal fossa. We then feel plainly, immediately
within the ostium vaginæ, a firm resisting band of tissue, apparently
about half an inch broad, embracing the posterior portion of the lower
vagina. This band is formed by the inner edges of the various muscles
and planes of fascia that have been described.
[Illustration: FIG. 22.--Sagittal section showing relations of the
several layers of fascia within the pelvic floor (Dickinson).]
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