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Extra resources for The Female Pelvic Floor

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2-12 Longitudinal muscle of the anus (LMA) – origins and insertions. This is an anatomical specimen from a female cadaver, cut away from its bony insertions. Bladder and vagina have been excised at the level of bladder neck. U = urethra; V = vagina. PCM = anterior and lateral portion of the pubococcygeus muscle. These sweep behind the rectum (R) and merge with the contralateral side to form part of the levator plate (LP). PRM = puborectalis muscle; PUL = insertion of pubourethral ligament into PCM; EAS = external anal sphincter.

3. The posterior striated muscles (fast-twitch component) stretch open the outflow tract, greatly reducing urethral resistance, thereby allowing the expulsion of urine. 4. The detrusor contracts, creating a smooth muscle spasm to expel urine. 2 32 2 The Female Pelvic Floor When the afferent stimulus ceases, the fast-twitch posterior muscle fibres relax. The stretched tissues ‘rebound’ to close the urethra. The anterior muscles contract. Because electrical transmission is from smooth muscle (Creed 1979) to smooth muscle, the detrusor ‘spasms’ to expel the urine.

Fig. 2-07 (Above left): Vaginal attachments to ATFP. The vagina is suspended like a trampoline membrane between the Arcus Tendineus Fascia Pelvis (ATFP) ligaments laterally, the anterior part of the cervical ring, and its collagenous extensions onto the cardinal ligament (CL). Fig. 2-08 (Above right): The connective tissue spaces. Perspective: transverse section, horizontal part of vagina just anterior to cervix. PVS = paravesical space; VVS = vesicovaginal space; RVS = rectovaginal space; RRS = retrorectal space; RVF = rectovaginal fascia; U = ureter; PCF = pubocervical fascia; ATFP = Arcus Tendineus Fascia Pelvis; IS = ischial spine; LA = m.

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