328 



MUSCLES OF THE PERINEUM. 



The levator ani arises in front from the posterior surface of the 

 pubis, near the symphysis and midway between its upper and lower 



Fiff. 228. 



Fig. 228. — SaPERFiciAL view op 

 THE Muscles of the Perin.kuii 

 IN the Male (modified from 

 Bourgery). (A. T.) i 



a, crest of tlie pnliis ; h, coccyx ; 

 c, placed on the tuberosity of the 

 ischium, points by tlie line to the 

 greater sacro-sciatic ligament ; x , 

 the anus; 1, placed on the sjwngy 

 body of the urethra in front of the 

 bulbo-cavernosus muscles ; 2, the 

 central point of the perinjeum ; 3, 

 ischio-cavernosus ; 4, transversus 

 perinEei ; 5, levator ani ; from 2 to 6, 

 elliptical sphincter of the anus ; sur- 

 rounding X , is the circular sphincter ; 

 6, coccygeus muscle ; 7, adductor 

 longus ; 8, gracilis ; 9, adductor 

 magnus ; 10, semitendinosus and 

 biceps ; 11, on the left side, the 

 gluteus maximus entire ; 11', the 

 same cut ou the right side, so as to 

 expose a part of the coccygeus muscle. 



borders ; behind from the spine of tlie ischium, and between those 

 points from the pelvic fascia along the line of attachment of the obturator 

 fascia. Some of its fibres are also traceable upwards in the substance 

 of the pelvic fascia above the level of the obturator. From this exten- 

 sive origin the fibres of the levator proceed downwards and inwards 

 towards the middle line of the floor of the pelvis. Its posterior fasciculi 

 are inserted upon the side of the lower end of the coccyx ; the bundles 

 immediately in front of the coccyx unite in a median raphe with those 

 of the opposite sides as far forward as the margin of the anus ; the 

 middle and larger portion of the muscle is prolonged upon the lower 

 part of the rectum, where it is connected with the fibres of the external 

 sphincter, and slightly with those of the internal ; and lastly, the 

 anterior muscular bundles pass between the rectum and the genito- 

 urinary passages, and, descending upon the side of the prostate, unite 

 beneath the neck of the bladder, the prostate, and the neighbouring part 

 of the urethra, with corresponding fibres from the muscle of the oppo- 

 site side, and blend also with those of the external sphincter and deep 

 transverse perineal muscles. 



The anterior portion of the levator ani, which arises from the ramus 

 of the pubis, close to the symphysis and above the pubic arch, and also 

 from the adjacent fascia, is sometimes separated at its origin jjy areolar 

 tissue from the rest of the muscle. From this circumstance, and from 

 its connection with the prostate gland, it was described by Santorini, 

 and since by Albinus and Soemmerring, as a distinct muscle, under tiie 

 name of the levator 2^rostaict. Its fibres pass backwards parallel with 

 the middle line. 



liclaiwns. — The upper or pelvic surface of the levator ani is in contact with 

 the recto-vesical fascia, the capsule of the prostate, and the lower end of the 



