Arnold Kegel's Figure 2: The Three Lower Diaphragms of the Pelvic Floor. The most superficial muscles are shown in green, the muscles of the urogenital diaphragm are in yellow, and the puboccygeus is colored red.
Palpation of the Pubococcygeus for Tone and Function. The index finger introduced to about the second joint and moved about normally meets resistance in all directions (left). When the pubococcygeus is atrophic, the middle third of the vagina is roomy; the walls are thin and feel as though detached from the surrounding structures, particularly anteriorly and laterally (right). Normal patients can voluntarily contract the pubococcygeus firmly about the palpating finger. When atrophy has occurred, no such contractions can be elicited.
Kegel's Figures 17 and 18. Firm pressure on the posterior segment of the puboccygeus (or the levator ani plate) may produce an antagonistic contraction. When repeated several times, the patient will become aware of the function of this muscle.
Source: Arnold H. Kegel, MD, FACS. Stress Incontinence and Genital Relaxation. CIBA Clinical Symposia, Feb-Mar 1952, Vol. 4, No. 2, pages 35-52.
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