Muscles of the Perineum

Good grief, are there enough of them???

We spent yesterday going over each and every muscle in detail, reviewing it’s anatomic location, insertion, origin and purpose, and by the end of the class, I seriously thought my brain was going to explode. The bulbocavernosus. The ischiococcygeus. The pubococcygeus, which is composed of the pubovaginalis, puborectalis and pubococcygeus proper. Who the hell comes up with these names??? And then, about halfway through the class, the professor reminded us that the names should actually be *helpful*, because they generally tell you exactly where the muscle starts (its origin) and where it ends (its insertion). For example, the pubovaginalis starts at the symphysis pubis (aka the pubic bone) and ends wrapped snugly around the vagina. Pubo…vaginalis. Well, that’s all well and good, but then, what do you do about muscles like the ischiocavernosus, which doesn’t start anywhere near the ischium? Or the iliococcygeus, which doesn’t actually originate from the ilium, either? So you see, not nearly as helpful as one might have originally hoped.

If any of you midwives out there have any advice on how to more easily (and less painfully) keep all of these muscles straight, or handy mnemonics, etc. etc. please share them! We were given patterns and instructions on making felt models of all the muscles, which sounds like a helpful study aid. I bought a ton of felt yesterday, and will be cutting out muscles at some point today. I’ll keep all of you posted.

I am curious, though: when you are repairing a laceration, do you really think about the muscles in terms of their names, and what is supposed to go where? Or is it more a matter or just suturing together what looks like it’s supposed to go together? It seems like the bulbocavernosus, the superficial transverse muscle and the external anal sphincter (which all converge at the central point of the perineum) are the muscles that get torn the most. In my felt model, these muslces will be blue, purple and orange, respectively, but when you’re actually suturing a real woman, it’s not as if all the muscles are conveniently colored like that. And I have seen some pretty jagged lacerations. How in the world are you supposed to make sense of them??

Anyway, off to cut felt. And then critique a research article for my research class. Followed by reading and note-taking for Pelvice Assessment of Women, and then more of my never-ending reading for Primary Care, if I have any energy left over. The busy, adventure-filled life of a student! Homework ahoy!

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