The bony pelvis is composed of the two hip bones, the sacrum, and the coccyx, which are firmly connected by the pubic symphysis (between the pubic bodies of the two hip bones), the sacrococcygeal symphysis (between the coccyx and the sacrum), and sacroiliac joints (between the ilium of the hip bones and the sacrum). Each hip bone consists of the ilium, ischium, and pubic bone. The pelvis connects the lower extremity to the trunk, protects abdominal and pelvic organs, and provides attachment to muscles and ligaments. The pelvic cavity is a space located within the pelvic girdle that contains parts of the gastrointestinal tract and urogenital tract. The pelvic joints and the organs are supported by muscles and ligaments (including the urogenital diaphragm). The pelvic cavity contains anatomical spaces, such as the rectouterine pouch (of Douglas) in women and the rectovesical pouch in men. The pelvic floor, which is composed of muscles and fascia, separates the pelvic cavity from the perineum. It has openings that allow for the passage of the rectum, vagina, and urethra. It furthermore helps maintain fecal and urinary continence and prevents pelvic organ prolapse. The female pelvis, which accommodates the birth canal, is larger and wider than the male. The hip joints (acetabulofemoral joint) are joints located between the head of the femur and the acetabulum of the pelvis that connect the trunk to the lower extremities. The hip joint supports dynamic and static body weight. The gluteal region consists of the gluteal muscles that form the buttocks. The gluteal muscles receive vascular supply from the superior and inferior gluteal arteries.
- The pelvis (pelvic girdle) is the ring-like structure of the axial skeleton that connects the vertebral column with the lower extremities (e.g., femur).
- The bony pelvis surrounds the pelvic cavity.
- The pelvic cavity allows passage of gastrointestinal and urogenital structures into the pelvis.
- The pelvis is largely immobile (unlike the pectoral girdle), which provides stability and proper transfer of weight from the vertebral column to the lower extremities, especially in the upright position.
- The pelvis is composed of the following bones:
- In addition, the bony pelvis is divided by the pelvic brim into:
Development of the pelvis
- The pelvis starts to develop during the 3rd week of gestation.
- Derived from paraxial mesoderm
- Originates from two separate cartilaginous hemipelves
- Events (by weeks) taking place in pelvic development
- 6th week of development: The sacroiliac joint starts to develop.
- 8th week of development: A fully developed pelvis is present in the embryo.
- 9th week of development: The ilium starts to ossify via endochondral ossification.
- 12th week of development: The anterior superior iliac spine (ASIS) and the pubis start to ossify.
- 15th week of development: The ischium starts to ossify.
The anterior superior iliac spine helps to determine the course of the inguinal ligament. In addition, it aids in the identification of the McBurney and Lanz points which are important anatomical locations where localized tenderness is indicative of appendicitis.
- Location: superior rim of the pelvic cavity (upper pelvic aperture)
- Diameters: transverse, oblique, conjugate (anteroposterior), anatomical conjugate, diagonal, straight, median
- Structures passing through the pelvic inlet: ureter, spermatic cord, round ligament of the uterus, suspensory ligament of the ovary, middle sacral vessels, gonadal vessels, iliolumbar vessels, lumbosacral trunk, sympathetic trunk, obturator nerve
- Location: lower pelvic aperture. It is narrower than the pelvic inlet.
- Diameters: sagittal and intertuberous
- See “Birth canal” below for more information on pelvic diameters.
Types of pelvises
- See “Birth canal” below for more information on the types of pelvises.
Differences between the male and female pelvis
Bigger, thicker, and heavier
Smaller, thinner, and lighter
|Sacrum||Longer and narrower||Shorter and wider|
|Pelvic cavity||Narrower and deeper||Wider and shallower|
|Pelvic outlet||Smaller pelvic outlet|| |
|Obturator foramen||Round||Triangular or oval|
- Triangular muscular sheet located on the anterior part of the pelvic outlet, between the superior and inferior fascia (perineal membrane). It is external and inferior to the pelvic diaphragm.
- Separates the upper pelvis from the deep perineal sac.
|Deep transverse perineal muscle|| |
|Urethral sphincter|| |
|Perineal membrane|| |
|Superficial perineal layer|
|Deep urogenital diaphragm layer|
|Ligament||Anatomy and function|
|Anterior sacroiliac ligament|
|Posterior sacroiliac ligament|
|Greater sciatic foramen|| || |
|Lesser sciatic foramen|
- The pelvic cavity is the space located within the pelvic girdle.
- The superior opening is formed by the pelvic inlet, whereas the inferior opening is formed by the pelvic outlet.
- The pelvic outlet is bounded by the pelvic floor, which functions to maintain pelvic organs in place. The division between the pelvic inlet and outlet is demarcated by the pelvic brim.
- The pelvic cavity contains parts of the gastrointestinal tract (e.g., colon and rectum), urogenital tract (e.g., ureters, bladder, uterus), major blood vessels (e.g., iliac arteries and their branches), and nerves (e.g., pudendal nerve). In addition, the pelvic cavity contains muscles that attach to the spine and the lower limbs (e.g., psoas and iliacus muscles)
|Rectovesical pouch (only in males)|
|Rectouterine pouch of Douglas (only in females)|| |
|Vesicouterine pouch (only in females)|
|Rectovesical space (only in males)|
|Ischiorectal fossa (ischioanal fossa)|
|Retropubic space of Retzius|
Overview of the pelvic floor
- A complex structure located in the opening of the pelvic outlet.
- Funnel-shaped structure
- Attached to the lesser pelvis
- Separates the perineum from the pelvic cavity
- Above: pelvic cavity
- Below: perineum
- Contains two openings
- Contains the perineal body (central tendon of the perineum)
- Fibromuscular structure
- Between the anal and urogenital hiatus
|Fascial layers of the levator ani and coccygeus muscles also form part of the pelvic floor.|
- The female pelvis is larger and wider than the male pelvis.
- The female pelvis is divided into:
- True pelvis: below the linea terminalis (pelvic edge); comprises the bony canal: the ileum (superior-laterally), ischium (inferior-laterally), pubis (anteriorly), sacrum, and coccyx (posteriorly)
- False pelvis: above the linea terminalis; consists of the abdominal wall (anteriorly), lumbar vertebrae (posteriorly), iliac fossae (laterally)
- The birth canal is the passage, consisting of the mother's bony pelvis and soft tissues (i.e., uterus, cervix, vagina, vulva, and pelvic floor), through which a fetus passes during vaginal delivery. It is described in terms of:
- Pelvic form
- 3 pelvic regions
- 4 pelvic planes
- Soft tissue structures
Pelvic form, pelvic regions, and pelvic planes
|Pelvic form|| |
|Pelvic regions||Pelvic inlet|| |
|Pelvic cavity (mid-pelvis)|
|Pelvic outlet|| |
|Pelvic planes||Plane of the pelvic inlet|| |
|Plane of greatest pelvic dimension (mid-cavity)|
|Plane of least pelvic dimension (obstetric outlet)|
|Plane of the anatomical outlet|| |
|Soft tissue structures|
|Branches / Origin||Area of supply|
|Internal iliac artery|| |
|Superior rectal artery|| |
For details on the sacral plexus see learning card on
|Structure||Branches and area of supply|
|Autonomic nerves|| |
|Pudendal nerve (S2–S4)|| |
Course along the internal iliac vessels and drain into the following lymph nodes:
|Lymph nodes||Area of drainage|
Internal and external iliac lymph nodes
- Definition: The hip joint (acetabulofemoral joint) is a joint between the head of the femur and the acetabulum of the pelvis.
- Function: connects the axial skeleton to the lower extremities, and functions to support static (e.g., standing) and dynamic (e.g., walking, running) weight
- Type of joint: ball-and-socket synovial joint
- Movements: flexion and extension, lateral and medial rotation, abduction and adduction → the combination of these movements results in circumduction
- Articular capsule: fibrous capsule that attaches to the margin of the acetabulum, the transverse acetabular ligament, and the neck of the femur.
For muscles of the hip joint and their blood supply and innervation, see the learning card on .
- Cup-like structure on the lateral side of the bony pelvis that articulates with the round femoral head
- Covered by the acetabular labrum
- Ring of cartilage that provides an articular surface for the femoral head
- Stabilized by capsular ligaments
- Surrounded by the fibrous capsule
- Receives blood supply from:
- Innervated by:
|Iliofemoral ligament|| |
|Ischiofemoral ligament|| |
|Pubofemoral ligament|| |
|Transverse acetabular ligament|| |
|Round ligament of the head of femur|
- The gluteal region consists of a group of muscles that form the buttocks
- Gluteal muscles arise from the pelvic girdle, are innervated by nerves that leave the pelvis through the greater sciatic foramen, and receive vascular supply from the superior and inferior gluteal arteries.
Action occurs at the hip joint
Superficial gluteal muscles
|Gluteus maximus|| |
|Gluteus medius|| |
|Tensor fascia latae|| |
|Deep gluteal muscles||Piriformis|| || |
|Obturator internus|| || |
|Superior gemellus|| || || |
|Inferior gemellus|| || |
|Quadratus femoris|| || || |