The structure of the human symphysis pubis with special consideration of parturition and its sequelae

Abstract

Review of the structure of the symphysis pubis, based on my extensive study of the pelvic joints ('31) shows changes from age, function, pregnancy hormones and stress of parturition. Primary physiologic shearing clefts and secondary traumatic clefts in cartilage are more frequent in females. Interdigitations in the young osteocartilaginous border secure the vulnerable growth cartilage against increasing shearing forces. The retropubic eminence, ligamentous or cartilaginous, forms earlier in females, later, due to bony lipping in males, secondary to extrusion of disc cartilage. Ovarian and placental hormones in pregnancy cause remodeling and resorption of the posterior margin of the pubic facette and adjacent cortex, making a (variably) deep bony groove for greatly hypertrophied transverse ligaments. Delivery of a mature infant produces traumatic changes leading to extrusion of torn fibrocartilage in any direction, progressively loosening the symphysis, producing cartilage nodules, cysts and reactive bone formation. Older age degenerative arthritis is more frequent in parous females.