Male Pelvic Anatomy

Original Editor - Stacy Schiurring based on the course by Pierre Roscher
Top Contributors - Stacy Schiurring, Kim Jackson, Lucinda hampton and Jess Bell

Introduction

Knowing the theory of the anatomy and the physiology of the male pelvis is the first step in becoming clinically competent. -Pierre Roscher PT

It is essential to have some sort of pelvis model when treating men’s health patients to aid in understanding and comfort with treatment concepts and interventions.  It is a powerful teaching aid.  A 2018 study by Meyer et al. found that the use of a virtual 3D pelvis model during the training of medical professions was effective and valid in learning needed anatomy.  These findings suggest that a virtual 3D pelvis model, such as on a smart phone or computer app, could be used in the clinic as part of patient education when a physical model is not available.

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Pelvis Musculoskeletal Overview

The pelvis does not function alone.  It is highly interconnected with the musculoskeletal features of the hips and the gluteal musculature.  Together, these areas support the internal organs and core muscles.  The physiology of the male pelvic floor involves pelvic organ support, bowel and bladder control and sexual functioning. This article will focus on the male pelvis as associated with the pelvic floor.  For more information on the greater pelvic girdle, please read here.

Osteology

The human pelvis is a bony ring formed by two bilateral innominate bones, made from the ilium, ischium, and pubis, and the sacrum.  The innominates articulate with each other anteriorly at the public symphysis and posteriorly with the sacrum at the sacroiliac joints.  The coccyx extends from the distal sacrum and functions as an attachment to ligaments and tendons.

The stability of the pelvis comes from two mechanisms: force closure and form closure. Force closure stability comes from the anatomy of the pelvis, through the interconnections of the bony surfaces themselves.  Form closure comes from the compressive forces of the muscles, ligaments, and fascia.

Ligaments of the Male Pelvis

1. Iliolumbar ligament:  
   1. composed of thick and strong fibrous bands of connective tissue originating from L5  transverse process to the posterior part of the inner lip of the iliac crest
   2. functions to stabilize and strengthen the lumbosacral joint, and limit the rotational movement at the lumbosacral joint
   3. dysfunction can lead to back pain (lecture)
2. Sacrospinous ligament:
   1. composed of a triangular band of connective tissue that attaches to the ischial spine of the ischial bone and the lateral side of the sacrum and coccyx
   2. the sacrospinous ligament divides the greater sciatic notch to the greater sciatic foramen and the lesser sciatic foramen
3. Sacrotuberous ligament:
   1. composed of a fan-shaped fibrous band of connective tissue that attaches to the sacrum and the upper coccyx to the tuberosity of the ischial tuberosity
   2. location of possible pudendal nerve entrapment (lecture)

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