The vaginal support structures are those muscles,

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

s, ligaments,

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

s, membranes and fascia, of the

pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the lev ...

that maintain the position of the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

within the pelvic cavity and allow the normal functioning of the vagina and other reproductive structures in the female. Defects or injuries to these support structures in the pelvic floor leads to

pelvic organ prolapse Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. In m ...

. Anatomical and congenital variations of vaginal support structures can predispose a woman to further dysfunction and prolapse later in life. The urethra is part of the anterior wall of the vagina and damage to the support structures there can lead to incontinence and

urinary retention Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladd ...

Pelvic bones

The support for the vagina is provided by muscles, membranes, tendons and ligaments. These structures are attached to the

hip bone The hip bone (os coxae, innominate bone, pelvic bone or coxal bone) is a large flat bone, constricted in the center and expanded above and below. In some vertebrates (including humans before puberty) it is composed of three parts: the ilium, isch ...

s. These bones are the pubis, ilium and ischium. The interior surface of these pelvic bones and their projections and contours are used as attachment sites for the fascia, muscles, tendons and ligaments that support the vagina. These bones are then fuse and attach to the sacrum behind the vagina and anteriorly at the

pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubi ...

. Supporting ligaments include the sacrospinous and sacrotuberous ligaments. The sacrospinous ligament is unusual in that it is thin and triangular.

Pelvic diaphragm

The muscular pelvic diaphragm is composed of the bilateral

levator ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...

and coccygeus muscles and these attach to the inner pelvic surface. The iliococcygeus and pubococcygeus make up the levator ani muscle. The muscles pass behind the rectum. The levator ani surrounds the opening which the urethra, rectum and vagina pass. The pubococcygeus muscle is subdivided into the pubourethralis, pubovaginal muscle and the puborectalis muscle. The names describe the attachments of the muscles to the urethra, vagina, anus, and rectum. The names are also called the pubourethralis, pubovaginalis, puboanalis, and puborectalis muscles and sometimes the pubovisceralis since it attaches to the viscera.

Urogenital diaphragm (perineal membrane)

The urogenital diaphragm, or

perineal membrane The perineal membrane is an anatomical term for a fibrous membrane in the perineum. The term "inferior fascia of urogenital diaphragm", used in older texts, is considered equivalent to the perineal membrane. It is the superior border of the su ...

, is present over the anterior pelvic outlet below the pelvic diaphragm. The exact structure description is controversial. Despite the controversy, MRI imaging studies support the existence of the structure. Superficial and inferior muscles of the perineum (urogenital diaphragm): * ischiocavernosus * bulbocavernosus * superficial transverse perinei The perineum attaches across the gap between the inferior pubic rami bilaterally and the perineal body. This grouping of muscles constricts to close the urogenital openings. The perineum supports and functions as a sphincter at the opening of the vagina. Other structures exist below the perineum that support the anus.

Perineal body

The perineal body is a pyramidal structure of muscle and connective tissue and part of it is located between the anus and vagina. It is a tendon that is formed at the point where the

bulbospongiosus muscle The bulbospongiosus muscle (bulbocavernosus in older texts) is one of the superficial muscles of the perineum. It has a slightly different origin, insertion and function in males and females. In males, it covers the bulb of the penis. In fema ...

superficial transverse perineal muscle The transverse perineal muscles (transversus perinei) are the superficial and the deep transverse perineal muscles. Superficial transverse perineal ...

, and external anal sphincter muscle converge to form this major supportive structure of the pelvis and vagina. Below this, muscles and their fascia converge and become part of the perineal body. The lower vagina is attached to the perineal body by attachments from the pubococcygeus, perineal muscles, and the anal sphincter. The perineal body is made up of smooth muscle, elastic connective tissue fibers, and nerve endings. Above the perineal body are the vagina and the uterus. Damage and resulting weakness of the perineal body changes the length of the vagina and predisposes it to rectocele and enterocele.

Endopelvic fascia and connective tissue

The vagina is attached to the pelvic walls by endopelvic fascia. The peritoneum is the external layer of skin that covers the fascia. This tissue provides additional support to the pelvic floor. The endopelvic fascia is one continuous sheet of tissue and varies in thickness. It permits some shifting of the pelvic structures. The fascia contains elastic collagen fibers in a 'mesh-like' structure. The fascia also contains fibroblasts, smooth muscle, and vascular vessels. The cardinal ligament supports the apex of the vagina and derives some of its strength from vascular tissue. The endopelvic fascia attaches to the lateral pelvic wall via the arcus tendineus.

Anterior vaginal support

Not all agree to the amount of supportive tissue or fascia exists in the anterior vaginal wall. The major point of contention is whether the vaginal fascial layer exists. Some texts do not describe a fascial layer. Other sources state that the fascia is present under the urethra which is embedded in the anterior vaginal wall. Despite disagreement, the urethra is embedded in the anterior vaginal wall.

Lateral and mid support structures

The midsection of the vagina is supported by its lateral attachments to the arcus tendineus. Some describe the pubocervical fascia as extending from the pubic symphysis to the anterior vaginal wall and cervix. Anatomists do not agree on its existence.

Complications

Vaginal support structures can be damaged or weakened during childbirth or pelvic surgery. Other conditions that repeatedly strain or increase pressure in the pelvic area can also compromise support. Examples are: * chronic constipation * chronic or violent coughing * heavy lifting * being overweight or

obese Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

External links

''Vagina'', Anatomical Atlases, an Anatomical Digital Library (2018)

References

{{Portal bar, Anatomy Human female reproductive system Women and sexuality Women's health Anatomy Gynaecology