PELVIS 629 



upper fascia of the uro-genital diaphragm which is now seen from the 

 front. Pass a finger into the vagina, and note that both the urethra 

 and the vagina pass through the upper fascia of the uro-genital diaphragm 

 which is reflected backwards along their borders. 



Divide the upper fascia of the uro-genital diaphragm on both sides, and 

 again note that, at the sides of the urethra and the vagina, it is continuous 

 round the anterior border of the levator ani with the visceral layer of the 

 pelvic fascia. 



Divide the pubes on each side with the saw along a line commencing 

 on the margin of the pubic arch, below the attachment of the arcuate 

 ligament, and terminating above at the lateral border of the tubercle of the 

 pubis. Pass the knife behind the pubis and separate the visceral layer of 

 the pelvic fascia from its attachment to the bone between the saw cuts. 

 The separated piece of bone may now be removed and should be kept for 

 the examination of the ligaments of the symphysis (see pp. 618, 650). If 

 necessary a further portion of the margin of the pubic arch may be 

 removed on each side to give room for the examination of the relations of 

 the vagina and the urethra. The dissector should now make his final 

 examination of the pelvic fascia. Tracing the upper surface of the visceral 

 layer medially, he will find that it spreads out on the infero-lateral surfaces 

 and anterior border of the bladder, and that in front of the bladder it 

 covers the front of the urethra and the vagina. The latter part presents 

 a free border where it was detached from the back of the pubes, and 

 beneath this border the dorsal vein of the clitoris can be traced towards 

 the bladder, where it joins the vesical plexus. In this part of the fascia 

 the two thickened bands which form the medial pubo-vesicat ligaments 

 will be noted. If the dissector next traces the fascia medially, following 

 its lower surface, he will find that it passes behind the rectum, and he will 

 thus demonstrate that the visceral layer of the pelvic fascia splits as it 

 passes towards the medial plane, one layer, the vesical, passing on to the 

 bladder and in front of the urethra and vagina, and a second layer, the 

 rectal, which passes behind the rectum. There is, however, a third layer, 

 the recto-vaginal, which crosses between the rectum and the vagina. To 

 demonstrate this layer the dissector should divide the vesical layer in the 

 medial plane in front of the bladder and turn the lateral halves towards 

 the lateral walls of the pelvis. In this way he will expose the urethra 

 and the anterior wall of the vagina, the two being closely bound together, 

 and when the lateral border of the vagina is reached he will find that the 

 vesical layer of the fascia blends with a deeper layer which passes behind 

 the vagina ; this is the recto-vaginal layer. On the anterior wall of the 

 vagina, and more particularly along its lateral border, the dissector should 

 note a plexus of veins, the vaginal plexus. 



The recto-vaginal layer of the pelvic fascia should also be displayed 

 from below. To do this the dissector must cut transversely through the 

 tissue of the perineal body, which lies in front of the anal orifice, until 

 he reaches the junction of the anal passage with the rectum. When 

 this point is attained he will find that he can quite easily separate the 

 rectum from the vagina with his finger, and that intervening between 

 the two is the recto-vaginal layer of fascia which he previously exposed 

 from above. 



Before terminating his study of the visceral layer of the 

 pelvic fascia the student should note that the floor of the pelvic 

 cavity of the female is 'formed, as in the male, by the levatores 

 ani and the coccygei muscles, and the upper and lower fascial 



