akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2025.615akusherstvo-2495Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫAnatomy and function of closing muscle complex of the vagina in health and pelvic organ prolapseАнатомия и функция мышечного комплекса, замыкающего влагалище, в норме и при пролапсе тазовых органовhttps://orcid.org/0000-0001-9524-8962ДиккеГ. Б.DikkeG. B.

Дикке Галина Борисовна, д.м.н., проф.

190013 Санкт-Петербург, Московский проспект, д. 22, литера М

Galina B. Dikke - MD, Dr Sci Med, Prof.

22 Liter M, Moskovskiy Prospekt, Saint Petersburg 190013

https://orcid.org/0000-0001-7415-4633МакацарияА. Д.MakatsariyaA. D.

Макацария Александр Давидович - д.м.н., проф., академик РАН.

Scopus Author ID: 57222220144. WoS ResearcherID: M-5660-2016.

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Alexander D. Makatsariya - MD, Dr Sci Med, Prof., Academician of RAS.

8 bldg. 2, Trubetskaya Str., Moscow 119048

https://orcid.org/0000-0001-5474-1080ЗиганшинА. М.ZiganshinA. M.

Зиганшин Айдар Миндиярович - д.м.н., проф. Scopus Author ID: 57693505600. WoS ResearcherID: V-1442-2017. eLibrary SPIN-code: 2037-3120.

450008 Уфа, ул. Ленина, д. 3

Aidar M. Ziganshin - MD, Dr Sci Med, Prof. Scopus Author ID: 57693505600. WoS ResearcherID: V-1442-2017. eLibrary SPIN-code: 2037-3120.

3 Lenin Str., Ufa 450008

Zigaidar@yandex.ruhttps://orcid.org/0000-0002-8145-990XШайхиеваЭ. А.ShaikhievaE. A.

Шайхиева Элина Айдаровна

450076 Уфа, ул. Гафури, д. 74

Elina A. Shaikhieva - MD.

74 Gafuri Str., Ufa 450076

https://orcid.org/0000-0001-8404-1042БицадзеВ. О.BitsadzeV. O.

Бицадзе Виктория Омаровна - д.м.н., проф., профессор РАН. Scopus Author ID: 6506003478. WoS ResearcherID: F-8409-2017.

119048 Москва, ул. Трубецкая, д. 8, стр. 2

Victoria O. Bitsadze - MD, Dr Sci Med, Prof., Professor RAS. Scopus Author ID: 6506003478. WoS ResearcherID: F-8409-2017.

8 bldg. 2, Trubetskaya Str., Moscow 119048

ЧОУ ДПО «Академия медицинского образования имени Ф.И. Иноземцева»РоссияInozemtsev Academy of Medical EducationRussian FederationФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian FederationФГБОУ ВО «Башкирский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияBashkir State Medical University, Ministry of Health of the Russian FederationRussian FederationГБУЗ «Республиканский медико-генетический центр» Министерства здравоохранения Республики БашкортостанРоссияRepublican Medical Genetic Center, Ministry of Health of the Republic of BashkortostanRussian Federation202506072025193408422Copyright © Dikke G.B., Makatsariya A.D., Ziganshin A.M., Shaikhieva E.A., Bitsadze V.O., 20252025Дикке Г.Б., Макацария А.Д., Зиганшин А.М., Шайхиева Э.А., Бицадзе В.О.Dikke G.B., Makatsariya A.D., Ziganshin A.M., Shaikhieva E.A., Bitsadze V.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/2495Introduction

Introduction. In modern literature, the pelvic floor muscles are presented by showing their anatomical location and indicating relevant attachment points, but their combined anatomical, topographic and functional significance is described insufficiently, which the current review was aimed at.

Aim

Aim: to determine the physiological significance and anatomical units of the vagina occlusor muscle complex, topography and functions in health and in pelvic organ prolapse (POP).

Materials and Methods

Materials and Methods. The search for English-published literary sources was conducted in the international publication databases PubMed/MEDLINE, Google Scholar, Cochrane Library, and Russian-language eLibrary resource by using keywords «pelvic floor», «genital fissure», «vagina», «sphincters», «pelvic organ prolapse», «urinary incontinence», «anal incontinence» with unlimited search depth. The inclusion eligibility criteria were as follows: systematic reviews, full-text original studies examining pelvic floor anatomy and physiology containing the results of pathological, clinical and instrumental methods devoted to the anatomy and physiology of the pelvic floor, as well as monographs and textbooks. Total 53 publications were included in the descriptive review.

Results

Results. Unlike animals, as well as the closing apparatus of the urethra and rectum consisting of internal and external sphincters, the muscle complex that compresses the genital slit and the lower third of the vagina includes five muscles. The m. bulbospongiosus of the superficial layer of the pelvic floor and m. transversus perinei superficialis, located in the perineal body, allow to keep the genital fissure closed. The external urethral sphincter located in the middle layer covers the ventral surface of the urethra and ensheath the distal part of the vagina, forming m. sphincter urethrovaginalis, that contracts to narrow both the urethra and the vagina. The deep layer is presented by m. levator ani, the medial and anterior bundles of which – m. pubovaginalis, pass along the sides of the vagina, whereas the m. puborectalis located laterally bends around the rectum as a U-shaped muscular sling – both of them close the gap between the medial legs of m. levator ani, narrowing the lower third of the vagina. All of such muscles have a close anatomical connection with adjacent organs due to their common embryonic development, and determine the stability and functional activity of the entire pelvic organs complex. Altering integrity of the specified muscle complex (rupture, in-labour overstretching) or its structural degradation characterized by loss of tone and contraction force, results in failed closing genital fissure, increased distance between the medial parts of m. levator ani in the lower third of the vagina and the loss of supporting and closing functions of the pelvic floor as well as POP development. Moreover, dysfunction of the constrictor muscles anatomically associated with neighbouring organs due to their common embryonic development, contributes to emergence of urinary and anal incontinence, despite the integrity of relevant sphincters.

Conclusion

Conclusion. The muscle complex that compresses the genital fissure and the lower third of the vagina is characterized by the lack of the circularmuscle and consists of five muscles having a close anatomical connection with adjacent pelvic organs. Damage to this muscle complex results in combined anatomical, topographic and functional changes in the pelvic floor, manifested by descent/prolapse of the pelvic organs and urinary/anal incontinence.

Введение

Введение. В современной литературе мышцы тазового дна представлены описанием их анатомического расположения и указанием на точки их прикрепления, но их совокупная анатомо-топографическая и функциональная значимость описана недостаточно.

Цель

Цель: определить физиологическое значение и анатомические единицы мышечного комплекса, замыкающего влагалище, их топографию и функции в норме и при пролапсе тазовых органов (ПТО).

Материалы и методы

Материалы и методы. Поиск зарубежных литературных источников проводился в международных базах публикаций PubMed/MEDLINE, Google Scholar, Cochrane Library, русскоязычных – в поисковой системе eLibrary с неограниченной глубиной поиска по ключевым словам «тазовое дно», «половая щель», «влагалище», «сфинктеры», «пролапс тазовых органов», «недержание мочи», «анальная инконтиненция», «pelvic floor», «genital fissure», «vagina», «sphincters», «pelvic organ prolapse», «urinary incontinence», «anal incontinence». В обзор были включены работы, удовлетворявшие критериям включения: систематические обзоры, полнотекстовые оригинальные исследования, содержащие результаты патологоанатомических, клинических и аппаратных методов исследований, посвященных анатомии и физиологии тазового дна, а также монографии и учебники. Всего в описательный обзор включены 53 публикации.

Результаты

Результаты. В отличие от животных, а также замыкательного аппарата уретры и прямой кишки, представленных внутренними и наружными сфинктерами, мышечный комплекс, сжимающий половую щель и нижнюю треть влагалища, состоит из 5 мышц. Мышцы m. bulbospongiosus поверхностного слоя тазового дна и m. transversus perinei superficialis, расположенная в теле промежности, позволяют удерживать сомкнутой половую щель. Находящийся в среднем слое наружный сфинктер уретры покрывает вентральную поверхность уретры и охватывает дистальный отдел влагалища, образуя m. sphincter urethrovaginalis, сокращение которого приводит к сужению как уретры, так и влагалища. Глубокий слой представлен m. levator ani, медиальные и передние пучки которой – m. pubovaginalis проходят по бокам влагалища, а латеральнее расположенная m. puborectalis огибает прямую кишку в виде мышечной стропы U-образной формы; обе они смыкают щель между медиальными ножками m. levator ani, суживая нижнюю треть влагалища. Все указанные мышцы имеют тесную анатомическую связь с соседними органами, что обусловлено их единым эмбриональным развитием, и определяют стабильность и функциональную активность всего комплекса тазовых органов в целом. Нарушение целостности указанного комплекса мышц (разрыв, перерастяжение время родов) или деградация их структуры, характеризующаяся потерей тонуса и силы сокращений, приводит к невозможности смыкания половой щели, увеличению расстояния между медиальными отделами m. levator ani в нижней трети влагалища и потере поддерживающей и замыкательной функций тазового дна и развитию ПТО. Кроме того, нарушение функции мышц-констрикторов, анатомически связанных с соседними органами, что обусловлено общностью их эмбрионального развития, способствует развитию мочевой и анальной инконтиненции, несмотря на целостность их сфинктеров.

Заключение

Заключение. Мышечный комплекс, сжимающий половую щель и нижнюю треть влагалища, характеризуется отсутствием круговой мышцы и представлен 5 мышцами, имеющими тесную анатомическую связь с соседними тазовыми органами. Повреждение этого комплекса мышц приводит к сочетанным анатомо-топографическим и функциональным изменениям тазового дна, проявляющихся опущением/выпадением тазовых органов и мочевой/анальной инконтиненцией.

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