Anatomic considerations

This chapter focuses on the functional anatomy of the pelvic floor and relations to female genital cosmetic surgery. The endopelvic fascia is the most important system that maintains the integrity of the axes supporting the bladder, urethra, uterus, vagina, and rectum in their respective anatomic relationships. DeLancey has divided the supports of the vagina into three levels as follows: the upper third of the vagina to the cardinal-uterosacral complex (level I), the middle third of the paravagina to the arcus tendineus fascia pelvis (ATFP) (level II), and the lower third of the vagina to the perineal membrane, levator ani muscles, and perineal body (level III). Understanding functional anatomy of the pelvic organs and the mechanism of pelvic floor support are essential to surgically correct pelvic organ prolapse (POP) and incontinence, both urinary and fecal. Identifying an underlying anatomical defect is highly critical to a successful site-specific surgical correction of POP.