Many years ago I was impressed by the fact that common operations for perineal repair dealt with fascia only, although operators spoke of catching up muscles which were not actually seen. Examination of perineums repaired in classical ways seemed to indicate that permanently satisfactory results are often missed. The general surgeon likes really to see muscles which he brings together for purposes of repair.
Dissections of ruptured perineums showed that atrophy of most of the muscles and fascia took place rather rapidly when they were thrown out of commission. One muscle, however, remains plump and full because it continues to act in a special function. This is the pubococcygeal portion of the levator ani muscle. If the full free margins of this muscle are exposed and brought together in the mid-line with three or four kangaroo tendon sutures, the most important contractile part of the perineum is strongly restored. A
MORRIS RT. THE FEMALE PERINEUM FROM A GENERAL SURGEON'S POINT OF VIEW. JAMA. 1912;LVIII(20):1508–1509. doi:10.1001/jama.1912.04260050184009