[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Spine](https://durgical.com/en/anatomy/region/spine/) › Pubic symphysis [Joints and ligaments](https://durgical.com/en/anatomy/system/joints-and-ligaments/) · [Spine](https://durgical.com/en/anatomy/region/spine/) # Pubic symphysis The pubic symphysis is the joint at the front of the pelvis where the two pubic bones meet; it closes the pelvic ring. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=spine&select=pubic_symphysis&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The joint at the front of the pelvis where the two pubic bones meet, joined by a disc of fibrocartilage. ## What it does Closes the pelvic ring in front and allows a tiny amount of movement, a little more during pregnancy. ## Key points - Open-book pelvic injury: front-to-back compression springs the symphysis apart; widening beyond about 2.5 cm suggests the anterior [sacroiliac ligaments](https://durgical.com/en/anatomy/sacroiliac-ligaments/) are torn as well - The bladder and urethra lie right behind and below the joint: symphysis disruption carries a risk of bladder rupture and, in men, urethral injury (blood at the meatus) - The pubic tubercle, just lateral to the symphysis, separates inguinal hernias (above and medial) from femoral hernias (below and lateral) ## Key facts **Where** Midline, between the bodies of the two pubic bones, front of the pelvic ring **Attaches** Hyaline-covered pubic surfaces joined by fibrocartilaginous interpubic disc; superior pubic and inferior (arcuate) pubic ligaments **Function** Secondary cartilaginous joint (symphysis); closes the pelvic ring in front; very little movement, slightly more in pregnancy (hormonal loosening) ## Relations **In front** [Rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/) and [pyramidalis](https://durgical.com/en/anatomy/pyramidalis/) insert on the pubic crest beside it; [adductor longus](https://durgical.com/en/anatomy/adductor-longus/) arises just below the pubic tubercle; their tendons blend with the anterior pubic ligament **Behind** Retropubic space (of Retzius) with the bladder and its venous plexus; the [prostate](https://durgical.com/en/anatomy/prostate/) in men and the urethra lie just behind the lower part **Above** Superior pubic ligament between the pubic tubercles; the [linea alba](https://durgical.com/en/anatomy/linea-alba/) ends here; the [spermatic cord](https://durgical.com/en/anatomy/spermatic-cord/) or round ligament emerges from the superficial inguinal ring above and lateral **Below** Arcuate (inferior) pubic ligament forms the apex of the pubic arch; the deep dorsal vein of the penis or [clitoris](https://durgical.com/en/anatomy/clitoris/) passes just below it into the [pelvis](https://durgical.com/en/anatomy/region/pelvis/) ## How to find it Felt as a firm midline ridge at the lower end of the [abdomen](https://durgical.com/en/anatomy/region/abdomen/), under the mons pubis, just above the external genitalia; the pubic tubercles lie a short distance to each side. ## Examination - Adductor squeeze test: groin pain or weakness when squeezing the knees together against resistance points to osteitis pubis or adductor-related groin pain - Active straight leg raise (pregnancy-related pelvic girdle pain): lifting a straight leg while lying supine is hard and becomes easier when the pelvis is compressed ## On imaging AP pelvis shows the width and any step; single-leg standing (flamingo) views show vertical shift when the joint is unstable. MRI in osteitis pubis shows bone edema on both sides and sometimes a secondary cleft; CT for fractures of the pelvic ring. ## Common problems - Pain during or after pregnancy (symphysis pubis dysfunction). - Osteitis pubis: groin pain in kicking and running sports. - Widening in pelvic ring injuries. ## How it is diagnosed Exam; X-rays (sometimes standing on one leg) and MRI. ## Treatment - Rest, physical therapy and a pelvic belt; surgical plating for traumatic widening. ## Clinical notes - Osteitis pubis and athletic groin pain in kicking sports reflect repeated pull of the adductors and rectus abdominis in opposite directions across the pubis - A full bladder rises above the symphysis and lifts the [peritoneum](https://durgical.com/en/anatomy/peritoneum/), which lets a suprapubic catheter enter the bladder without crossing the peritoneal cavity - Pelvic binders are centred over the greater trochanters to close an open-book injury and reduce bleeding - In pregnancy hormones such as relaxin soften the joint and it widens slightly; a larger separation around delivery (peripartum diastasis) causes pain over the pubis and a waddling, painful gait ## Anatomical variants - The pubic arch below the joint is wider in women (subpubic angle commonly quoted above 80°) than in men (under about 70°), one of the most reliable signs of sex on a pelvis ## Development The symphyseal face changes with age, from ridged to smooth and rimmed, which forensic anthropology uses to estimate age at death. ## Related conditions - [Shoulder dystocia](https://durgical.com/en/conditions/shoulder-dystocia/) - [Pelvic fracture](https://durgical.com/en/conditions/pelvic-fracture/) ## Test yourself Think of the answer, then tap the question to see it. ## In an open-book pelvic injury, what does widening of the pubic symphysis beyond about 2.5 cm suggest? That the anterior sacroiliac ligaments are torn as well. ## Which organs are at risk when the pubic symphysis is disrupted? The bladder and, in men, the urethra (blood at the meatus), which lie right behind and below the joint. ## What type of joint is the pubic symphysis? A secondary cartilaginous joint: hyaline-covered pubic surfaces joined by a fibrocartilaginous interpubic disc, with very little movement. ## Where is a pelvic binder centred to close an open-book injury of the pubic symphysis? Over the greater trochanters, to close the ring and reduce bleeding. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/pubic-symphysis/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** symphysis pubica TA2 1855 **Official Spanish (DeCS)** Sínfisis pubiana DeCS D011631 **English (TA2)** Pubic symphysis **Also called** symphysis ossium pubis ## Related - [Hip bone](https://durgical.com/en/anatomy/hip-bone/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=12066); [Anatomy, Bony Pelvis and Lower Limb: Pelvic Joints](https://www.ncbi.nlm.nih.gov/books/NBK538523/); [8.3 The Pelvic Girdle and Pelvis](https://openstax.org/books/anatomy-and-physiology-2e/pages/8-3-the-pelvic-girdle-and-pelvis) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/); [17.8 Gonadal and Placental Hormones](https://openstax.org/books/anatomy-and-physiology-2e/pages/17-8-gonadal-and-placental-hormones) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/pubic-symphysis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/pubic-symphysis/