Perineal body

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Here is a complete overview of the perineal body drawn from Gray's Anatomy for Students and Campbell-Walsh-Wein Urology.

Perineal Body

Fig. 5.17 - Perineal Body (Gray's Anatomy for Students)

Definition and Location

The perineal body (also called the central perineal tendon) is a poorly defined fibromuscular node located:

At the center of the perineum, in the midline
Just anterior to the anus
Approximately midway between the two ischial tuberosities
Along the posterior border of the perineal membrane, to which it attaches
At the junction between the urogenital and anal triangles of the perineum

It lies at the intersection of pelvic floor structures (from above) and perineal structures (from below). - Gray's Anatomy for Students

Muscles Attaching to the Perineal Body

Eight muscles converge on the perineal body, making it a major structural anchor:

Muscle	Notes
Levator ani (pelvic diaphragm)	Posterior end of the urogenital hiatus connects to it
External anal sphincter	Anterior fibers attach to it
Superficial transverse perineal muscles	Arise from ischial tuberosities and extend medially to stabilize it
Deep transverse perineal muscles	Intersect at the perineal body
Bulbospongiosus	Fixed to it by its most posterior fibers
Ischiocavernosus	Attached posteriorly
Sphincter urethrovaginalis (females)	Attaches to perineal body in women
Sphincter urethrae	Fibers reach the perineal body

Campbell-Walsh-Wein Urology, Superficial Perineal Space

Clinical Significance

In Women

The perineal body is particularly important in females because it serves as the principal anchoring point for pelvic organ support. If it is injured or disrupted:

Prolapse of the vagina, uterus, or bladder may result
This is why episiotomy incisions are directed away from the perineal body during vaginal delivery - to protect it and the external anal sphincter

In Men

The sphincter urethrae does not fuse with the perineal body in men
A fascial plane therefore exists between the perineal body and the external anal sphincter in men (this plane is absent in women)

Obstetric Relevance

Episiotomies are performed to limit tearing of the perineum and the perineal body during difficult vaginal deliveries
After stretching during delivery, the attached muscles typically regain most or all of their tone over subsequent months
Tearing through the perineal body can injure the external anal sphincter, causing fecal incontinence

Surgical Relevance

It serves as a landmark in sacral colpoperineopexy for perineal descent (a continuous graft is placed from the anterior longitudinal ligament of the sacrum down to the perineal body)
Reconstruction of the perineal body is a key step in pelvic floor repair surgery

Summary

The perineal body is ill-defined anatomically but functionally indispensable - it is the fibromuscular keystone of the perineal floor, where muscles from the urogenital triangle, anal triangle, and pelvic diaphragm all converge. Its integrity is central to continence and pelvic organ support, and its disruption - particularly in women during childbirth - is a leading cause of pelvic floor dysfunction.

Gray's Anatomy for Students, p. 514 & 534
Campbell-Walsh-Wein Urology, Superficial Perineal Space

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