Enrico Marani

Vision and Waist-to-Hip Ratio

The pelvis plays a central role in the human mating process. Sexual arousal also starts by the pelvic contours, in fact by the waist-to-hip ratio. Men determine the fitness of a female by this ratio. Added visual information of the face strengthens the pelvic sexual arousal. The waist-to-hip ratio is codetermined by buttock fat and muscles. The buttock fat distribution is gender depended and has consequences for gait performance and recognition of persons.

The Pelvis and Herbal Medicine

The use of raw plant extracts to cure pelvic problems in males and females does not work. Despite double-blind, randomized studies that clearly show the ineffectiveness of plant extracts like saw palmetto for prostatitis or black cohosh for menopausal women, well-educated people still use these extracts. Herbal medicine was spread over the world among others by slavery. It is remarkable that meta-analyses that appeared after the double-blind, randomized studies keep reporting significant effect of these plant extracts. Attention is given to placebo studies, in which the effect of the psychodynamic component in the overall therapeutic effect is stressed by phytotherapy. A different approach to study the consequences of plant extracts is system biology.

Innervation of the Mature Human Pelvis

The peripheral nervous system is responsible for pelvic local steering. Certain levels of filling of the bladder activate autonomic but also somatic spinal reflexes. This interaction between autonomic and somatic systems is badly understood. The basic connections of pelvic organs are described in this chapter. This makes it possible to treat autonomic–somatic interactions but also neuromodulation and dorsal rhizotomy.

Anatomy of the Pelvic Wall

The pelvic wall includes the urogenital and pelvic diaphragm. The localization of both structures in the bony pelvis and their interrelation are easily mistaken. Different compartments can be discerned within the pelvic cavity due to connective blades. Sphincters are included in the pelvic wall musculature, except the male urethral sphincter. Inguinal hernias were common in previous ages. Their operation needed surgical landmarks: Scarpa’s, Colles, and Buck’s fascias being even now unclear in terminology and localization. These fascias are still important in modern surgery.

Reflexes or Controller Action

The pelvic organs function by their reflex actions. These loops of signals pass over existing connections, but their hierarchy is only partly known. Surprisingly, en route unknown neuronal stations, called microganglia, are frequently present. Nevertheless, the whole pelvic system contains a general controller mechanism to overcome contradictory actions by separate parts. The pelvic autonomic ganglia are treated in this chapter together with cross-sensitization: the neuronal influence of pelvic separate parts on each other. The endothelium lining the urine system is capable of informing and inducing actions within the local nervous system.

The Subperitoneal and Lower Retroperitoneal Space

The detection of carcinoma’s in the pelvic spaces remains difficult, in spite of modern CT and MRI techniques. These sub- and retroperitoneal spaces are treated in this chapter using two leads: blood vessels present and the testicle that uses these spaces to descent. The surprising result is that the blood vessels of the ovary determine the peritoneal fluid, which is important to let the egg survive during ovulation. The renewed attention for these blood vessels brought out the anatomical description of the subperitoneal arterial plexus of William Turner of 150 years ago.

The Connective Tissue in the Pelvis

The connective tissue in the pelvis appears as blades, ligaments, fascias, and membranes. Enwrapping pelvic organs and bounding them tightly is among others the function of the pelvic connective tissue. Its structures are pillar-like to embrace blood vessels, leave-like for suspending the rectum, and striated for suspension of the anus. Descensus of the pelvic diaphragm is mainly caused by connective tissue weakness leading prolapse.

“Construction Plan” of the Bony Pelvis

The bony pelvis is not a fixed structure. It adapts to phenotypic stresses and underwent evolutionary changes due to bipedal walking. This firm structure is involved in positioning the pelvic organs, conducts forces over its components and demonstrates gender and racial differences.

Male and Female Bladder

The bladder is built from two parts: the detrusor muscle making the dome and the trigone constituting the base. The bladder is not passive but active during storage as it is active during voiding. Uncontrolled detrusor activity occurs in both men and women.

Sexual Organs and Society

Power can be exercised by mutilation of human sexual organs, or like eunuchs, one can conquer power by castration. Sexual anxieties have brought mankind medical-supported mutilations in spermatorrhoea. The removal of the prepuce is debated: In females, it should cure several diseases (high sex drive, hysteria, epilepsia), and in males, it should prevent masturbation and increases social status in Anglo-Saxon countries. Circumcision should prevent in both sexes HIV and HPV for a lifetime. The G-spot is also debated, and phantoms of sexual organs are still difficult to explain.