Sex
Differences of the Pelvis
The sex differences of the bony pelvis are easily
recognized.
The more obvious differences result from the adaptation of
the female pelvis for childbearing. The stronger muscles in the male are
responsible for the thicker bones and more prominent bony markings (Figs. 6.1
and 6.4).
■■ The
false pelvis is shallow in the female and deep in the male.
■■ The
pelvic inlet is transversely oval in the female but heart shaped in the male
because of the indentation produced by the promontory of the sacrum in the
male.
■■ The
pelvic cavity is roomier in the female than in the male, and the distance
between the inlet and the outlet is much shorter.
■■ The
pelvic outlet is larger in the female than in the male.
In the female the ischial tuberosities are everted and in the male they are turned in.
In the female the ischial tuberosities are everted and in the male they are turned in.
■■ The
sacrum is shorter, wider, and flatter in the female than in the male.
■■ The
subpubic angle, or pubic arch, is more rounded and wider in the female than in
the male.
Pelvic
Joints Changes
Changes with Pregnancy
During pregnancy, the symphysis pubis and the ligaments of the
sacroiliac and sacrococcygeal joints undergo softening in response to hormones,
thus increasing the mobility and increasing the potential size of the pelvis
during childbirth. The hormones responsible are estrogen and progesterone produced
by the ovary and the placenta. An additional hormone, called relaxin, produced
by these organs can also have a relaxing effect on the pelvic ligaments.
Changes with Age
Obliteration of the cavity in the sacroiliac joint occurs in
both sexes after middle age.
Sacroiliac Joint Disease
The sacroiliac joint is innervated by the lower lumbar and sacral
nerves so that disease in the joint can produce low back pain and pain referred
along the sciatic nerve (sciatica). The sacroiliac joint is inaccessible to
clinical examination. However, a small area located just medial to and below
the posterior superior iliac spine is where the joint comes closest to the surface.
In disease of the lumbosacral region, movements of the vertebral column in any
direction cause pain in the lumbosacral part of the column. In sacroiliac
disease, pain is extreme on rotation of the vertebral column and is worst at
the end of forward flexion. The latter movement causes pain because the
hamstring muscles (see page 465) hold the hip bones in position while the sacrum
is rotating forward as the vertebral column is flexed
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