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Section X: Women's Health

Clinical Anatomy of the Pelvis and Perineum

Pelvic Types

There are four basic pelvic types (see figure below), identified originally by Caldwell and Malloy in 1933, that have distinct shapes and therefore different effects on their suitability for childbirth. The average woman has a gynecoid pelvis; others may have a variation or mixture of types rather than pure android, anthropoid, or platypelloid types.

The four Caldwell-Malloy pelvic types. Differences in shape, inlet, midpelvis, and outlet dimensions are shown. Adapted from: Ward, SL, and Hisley, SM: Maternal-Child Nursing Care. FA Davis, Philadelphia, 2009, p 123.

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For detailed anatomy of the pelvic girdle, refer to figures on pp. 691 and 692.

The muscles of the female pelvic floor. Adapted from: Ward, SL, and Hisley, SM: Maternal-Child Nursing Care. FA Davis, Philadelphia, 2009, p 116.

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Innervation and arterial blood supply of perineum.

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Ligaments and fascia of the perineum.

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External female genetalia (vulva).

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Female Reproductive Cycle

Levels of the hormones secreted from the anterior pituitary are shown relative to one another and throughout the cycle. Changes in the ovarian follicle are depicted. The relative thickness of the endometrium is also shown. Adapted from: Ward, SL, and Hisley, SM: Maternal-Child Nursing Care. FA Davis, Philadelphia, 2009 p 126.

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Gynecological Care

Pelvic Floor Dysfunction (PFD)

The American Physical Therapy Association's (APTA's) Section on Women's Health (SOW) has defined pelvic floor dysfunction (PFD) based on common symptoms and functional presentation, as shown in Table 10.1.

Table 10.1Types of Urinary Incontinence and Their Relation to Pelvic Floor Dysfunction
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Table 10.1 Types of Urinary Incontinence and Their Relation to Pelvic Floor Dysfunction
Type Description Symptoms Causes
Stress urinary incontinence (SUI) Involuntary loss of urine with an increase in intra-abdominal pressure

  • Loss of urine with cough, sneeze, or laughter

  • Urethral hypermobility

  • Pelvic floor muscle weakness or damage

  • Decreased estrogen during menopause
Urge urinary incontinence (UUI) Involuntary loss of urine in conjunction with a strong desire to void

  • Frequent urination

  • Nocturia

  • Urgency

  • Leaking when hearing water run

  • Changing body position (lying to sitting)

  • Detrussor muscle instability

  • Bladder irritation from cystitis

  • Pelvic nerve damage
Overflow urinary incontinence (OUI) Involuntary urine loss associated with overdistension of the bladder

  • Chronic dribbling of urine

  • Urinary frequency

  • Decreased detrussor contractility (e.g., from medication, diabetic neu-ropathy, other neurological disorders)

  • Overstretched detrussor ...

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