The Female Pelvic Floor Fascia Anatomy: A Systematic Search and Review.

Mélanie Roch,Mélanie Morin,Marie-Pierre Cyr,Nathaly Gaudreault,Gabriel Venne,Nathalie J Bureau

doi:10.3390/life11090900

Abstract

The female pelvis is a complex anatomical region comprising the pelvic organs, muscles, neurovascular supplies, and fasciae. The anatomy of the pelvic floor and its fascial components are currently poorly described and misunderstood. This systematic search and review aimed to explore and summarize the current state of knowledge on the fascial anatomy of the pelvic floor in women. Methods: A systematic search was performed using Medline and Scopus databases. A synthesis of the findings with a critical appraisal was subsequently carried out. The risk of bias was assessed with the Anatomical Quality Assurance Tool. Results: A total of 39 articles, involving 1192 women, were included in the review. Although the perineal membrane, tendinous arch of pelvic fascia, pubourethral ligaments, rectovaginal fascia, and perineal body were the most frequently described structures, uncertainties were identified in micro- and macro-anatomy. The risk of bias was scored as low in 16 studies (41%), unclear in 3 studies (8%), and high in 20 studies (51%). Conclusions: This review provides the best available evidence on the female anatomy of the pelvic floor fasciae. Future studies should be conducted to clarify the discrepancies highlighted and accurately describe the pelvic floor fasciae.

Highlights

Up to 47% of women suffer from at least one pelvic floor disorder, including chronic pelvic pain, urinary incontinence, and pelvic organ prolapse [1,2]
It is clear from this review that the complexity of the fascial anatomy reaches a paroxysm in the pelvic region
We reported that the Perineal Membrane (PM), Perineal Body (PB), Tendinous Arch of Pelvic Fascia (TAPF), tendinous arch of levator ani (TALA), pubourethral ligaments, pubovesical ligament, and Rectovaginal Fascia (RVF) can be clearly visualized with an MRI assessment

Summary

Introduction

Up to 47% of women suffer from at least one pelvic floor disorder, including chronic pelvic pain, urinary incontinence, and pelvic organ prolapse [1,2]. The pelvic floor fasciae are thought to contribute to urethral and pelvic organ support, thereby preventing incontinence and prolapse [13,14,15,16,17,18,19]. Corrections made to the pelvic floor connective structures form the basis of modern surgical procedures for incontinence and prolapse [15,18,20,21,22,23,24]. The very intimate relationship between the fasciae, muscles, and neurovascular structures implies that these alterations in the fasciae could contribute to muscle tension and nerve sensitization [27]

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Discussion

Conclusion