Teaching clinical anatomy of the female pelvic floor to undergraduate students: a critical review of neuralgic points

Abstract

Pelvic floor anatomy is complex and its three-dimensional organization is often difficult to understand for both undergraduate and postgraduate students. Here, we focused on several critical points that need to be considered when teaching the perineum. We have to deal with a mixed population of students and with a variety of interest. Yet, a perfect knowledge of the pelvic floor is the basis for any gynecologist and for any surgical intervention. Our objectives are several-fold; i) to establish the objectives and the best way of teaching, ii) to identify and localize areas in the female pelvic floor that are susceptible to generate problems in understanding the three-dimensional organization, iii) to create novel approaches by respecting the anatomical surroundings, and iv) prospectively, to identify elements that may create problems during surgery i.e. to have a closer look at nerve trajectories and on compression sites that may cause neuralgia or postoperative pain. A feedback from students concludes that they have difficulties to assimilate this much information, especially the different imaging techniques. Eventually, this will lead to a severe selection of what has to be taught and included in lectures or practicals. Another consequence is that more time to study prosected pelves needs to be given. 

Keywords

• levator ani nerve
• pelvis
• neuralgia
• pudendal nerve branches
• sacrospinous ligament
• teaching
• variations