Anatomic relationship between the vaginal apex and the bony architecture of the pelvis: a magnetic resonance imaging evaluation.
OBJECTIVE
This study was undertaken to define anatomic relationships between the vaginal apex and the ischial spines and sacrum for nulliparous women with normal support.


METHODS
We retrospectively evaluated the magnetic resonance images of 11 consecutive women who underwent pelvic imaging at Johns Hopkins. Coordinates were recorded for the posterior fornix, sacrum, ischial spines, and cervical vaginal junctions. We calculated vector distances with means, SDs, and 95% CIs. Intraclass correlation coefficients tested interobserver reliability and the Wilcoxon signed rank test compared right- and left-sided measurements.


RESULTS
Mean age was 30.4 +/- 9.1 years. The cervical vaginal junction was 1.6 +/- 0.5 cm superior, 1.1 +/- 0.5 cm anterior, and 4.7 +/- 0.4 cm medial to the ipsilateral ischial spine. The posterior fornix was 1.0 +/- 1.0 cm anterior and 5.3 +/- 0.8 cm inferior to the second sacral vertebra. There was excellent interobserver reliability (interclass correlation coefficients = 0.997, P < .001) and no detectable difference between sides.


CONCLUSIONS
Consistent relationships exist between the vaginal apex and ischial spines and sacrum, which may be useful in reconstructive pelvic surgery.
Gutman
Robert E
RE
Johns Hopkins Medical Institution, Baltimore, MD, USA.
Pannu
Harpreet K
HK
Cundiff
Geoffrey W
GW
Melick
Clifford F
CF
Siddique
Sohail A
SA
Handa
Victoria L
VL
D000328:Adult; D002584:Cervix Uteri / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010384:Pelvic Bones / Q000033:anatomy & histology*; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D014621:Vagina / Q000033:anatomy & histology*