Biomechanical analysis of female pelvic floor anatomy: A novel integrative framework

To re-evaluate the anatomy and biomechanics of the female pelvic floor using a novel “dynamic interaction–overall mechanical balance” framework, aiming to improve the understanding of the pelvic floor dysfunction pathogenesis. A narrative review was conducted by searching PubMed, MEDLINE, Web of Science, and Google Scholar databases. Articles published between January 1950 and December 2024 were retrieved using relevant Medical Subject Headings terms. Two reviewers independently screened titles, abstracts, and full texts. A total of 67 peer-reviewed English-language studies, including observational, experimental, and review articles, were included. The comparative analysis between humans and quadrupedal animals demonstrated that bipedal evolution reshaped pelvic morphology and load transmission, increasing mechanical demands on the human pelvis. The pelvic floor operates as a dynamic system in which skeletal structures redistribute vertical loads into lateral forces, while soft tissues provide adaptive support through coordinated displacement. Key mechanisms include moment redistribution, and “self-locking” and “interlocking” interactions between pelvic organs (bladder, uterus, and rectum) and supporting structures (pelvic diaphragm and perineal body). Neuromuscular coordination further ensures continence and organ stability. Importantly, soft tissue strength alone is insufficient; physiological homeostasis relies on integrated interactions between bones, muscles, fascia, and neural control. The pelvic floor is a dynamic biomechanical system rather than a static anatomical structure. The proposed framework highlights the importance of integrated mechanical balance in maintaining function and offers new insights into the mechanisms of pelvic floor dysfunction, with potential implications for improved diagnosis and surgical reconstruction strategies.