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This basic view is very important for all the Perineologist because it shows the real in vivo anatomy of the pelvis.
In fact, the usual descriptions of this area are misleading for 2 reasons:
first, the textbooks of anatomy depict the anatomy as seen during dissection; there is a downwards inclination of the posterior perineum corresponding to the anatomy found during defecation.
second, the posterior perineum is neglected and the anal canal is in direct contact with the sacro-coccygeal junction
These 2 errors have been corrected in our 3d view which corresponds to the images obtained using MRI in normal female patients.
To restore a normal anatomy, the perineologist surgeon must have some anatomical facts in mind; these facts are visible in our 3D view:
there is no part of the pubo-rectal or levator plate muscles between the vagina and the ano-rectum.
the pubo-rectal muscle is included in the top part of the anal sphincter.
the vagina is not rectilinear; there is an angle between its two parts.
this angle is induced by the disposition of the pelvic fascia and its extensions, the pubo-urethro-vaginal ligaments and the utero-sacral ligaments.
the pubo-rectal muscle and the levator plate help the fascia to maintain this vaginal angle, the urethro-vesical and the ano-rectal angle at rest.
the axis of the superior part of the vagina is oriented to S2-S3 and not to the promontori.
the coccyx is the butt hinge joint of the levator plate; it is moving during defecation or contraction of the pubo-rectal muscle.