HealthMED - Volume 15 / Number 1 / 2021

A visual method of sexing the hip bone and pelvis

Aida Sarac – Hadzihalilovic1, Emir Beganovic2, Zurifa Ajanovic1, Ilvana Hasanbegovic1, Lejla Dervisevic1
1
Department of Anatomy, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina,
2
Fachklinik fur Amputationsmedizin. Osterhofen, Bayern, Germany.

Abstract height. Also, accurate gender assessment is crucial

at all stages of the identification process allowing
Background/aim: The aim is to examine the
final conclusions to be reached (2-7). On the skel-
correlations between the representation of quali-
eton, it is best to assess gender after puberty after
tative (morphognostic) gender marks on the hip
gender differences develop fully (8, 9). In adults,
bone and pelvis, in relation to the values of the
the bone material in which we find pronounced
index of the upper part of the greater sciatic notch,
gender dimorphism are pelvis and skull. Numer-
based on which gender determination was per-
ous osteological indicators of gender can be ob-
formed, as well as monitor the percentage of in-
served on the pelvis. Differences between the pel-
dividual morphognostic gender marks in relation
vis of a male and a female have been confirmed
to determination of male or female gender (based
by numerous studies using different methods such
on the index).
as morphoscopic and morphometric methods. The
Material and methods: The study was con-
most noticeable differences are found in bone size,
ducted prospectively on 98 adult hip bone of Bos-
greater sciatic notch, auricular surface, acetabu-
nian population, of which 56 were single and 42
lum, and on the pubic bone (10, 11, 12, 13). Some
were within the pelvis. The gender of the bones
authors suggest visualization of ten features on
are determined based on the index of the upper
the pelvis: greater sciatic notch, pubic angle, the
part of the greater sciatic notch. The research is
angle formed by auricular surface and greater sci-
based on the osteoscopic analysis of morphoscop-
atic notch, hip bone, obturator foramen, body of
ic characteristics of the hip bones and pelvis.
ischium, iliac crest, iliac fossa, greater pelvis and
Conclusion: Appearance of sciatic notch, ap-
lesser pelvis (14). Research on the pelvis provides
pearance of bones and auricular surface, morphol-
the most significant results in gender distinction
ogy of pelvic outlet and pelvic constitution stand
for several reasons. Primarily because of the nu-
out as the most powerful indicators of sexual di-
merous details that can be detected and the ability
morphism based on visual method of sexing the
to make comparisons between those details. The
hip bone and pelvis.
largest number of differences are found on the pel-
Key words: Hip bone, pelvis, sexual dimor-
vis throughout all ages, starting from intrauterine,
phism, visual method
i.e. fetal development, all the way to old age (15).

1. Introduction 2. Materials and methods

Assessment of gender based on human skeleton
has its own importance and application in forensic
medicine, anatomy, physical anthropology and ar-
cheology (1). Gender determination is one of the
first steps in biological or forensic anthropological
analysis. The main reason for this is the fact that
other vital information, such as age and height, can
not be obtained adequately without an initial gen-
der assessment, as the male and female skeletons
differ morphometrically. These differences are
determined by the methods of determining age or
The study was designed as a prospective osteo-
scopic and it was conducted in osteological cabinets
at the Department of Anatomy, Faculty of Medi-
cine, University of Sarajevo. Total of 56 individual
hip bones (34 left and 22 right) and 21 pelvis sam-
ple were observed (total of 98 hip bone - 43 right
and 55 left). The pelvis and hip bones belonged to
adults of the population in Bosnia and Herzegovina.
The gender of the hip bones was determined based
on the index of the upper part of the greater sciatic
notch. All hip bones with an index I <0.70, were

8 Journal of Society for development in new net environment in B&H

 HealthMED - Volume 15 / Number 1 / 2021

characterized as reliably male hip bones, and if the

index value was I> 0.70, hip bones were character-
ized as reliably female hip bones (16).
On individual hip bones, the following param-
eters were assessed: bone appearance, appearance
of the iliac fossa, shape and size of the obturator
foramen, appearance of the acetabulum, auricular
surface and greater sciatic notch, and longitudinal-
transverse ratio appearance of hip bones. On the
pelvis a descriptive assessment was performed:
pelvis constitution, appearances of individual
bones, iliac fossa, pelvic cavity, sacrum, pelvic
outlet and pubic symphysis, shape of pelvic inlet,
expression of promontorium, descriptive assess-
ment of distance between pubic tubercles and be-
tween the ischial tuberosities, the appearance of
the pubic arch, the shape and size of the obturator
foramen, the appearance of the acetabulum, and a
description of the pelvic inclination. Figure 1. Hip bones - a-female, b-male deter-
mined by the value of the index of the upper part
of the greater sciatic notch - Osteological Collec-
3. Results
tion of the Department of Human Anatomy, Medi-
3.1. Correlation relations of osteoscopic cal faculty University of Sarajevo
- qualitative (morphognostic) gender
marks for individual hip bones, which are The highest matching coefficient was with: ap-
sexually determined based on the value of pearance of greater sciatic notch b = 0.640, fol-
the index of the upper part of the greater lowed with appearance of bone b = 0.508. Slightly
sciatic notch weaker matching of index of upper part of great-
Kendall’s tau-b (Correlation Coefficient) er sciatic notch was with morphognostic gender
showed a statistically significant level of matching markings: appearance of iliac fossa b = 0.419, ap-
(on the total sample p <0.05) of the index of the pearance of auricular surface b = 0.473 and the ap-
upper part of the greater sciatic notch (male≤0.70 pearance of the hip bone - longitudinal-transverse
/ female> 0.71) and morphognostic gender mark- ratio b = 0.419.
ings. The least match of the index of the upper part
of the greater sciatic notch is with the morphog-

Table 1. Correlation relations of qualitative gender markings with the index of the upper part of the
greater sciatic notch – hip bone
Longitudinal-trans-
Appearance of iliac

Appearanceaof the

verse ratio appear-

obturator foramen

Appearance of the

the greater sciatic

Bone appearance

Shape and size of

ance of hip bones

auricular surface

Appearance of
acetabulum

notch
fossa

Kendall’s tau-b
Index of the upper Correlation-Coefficient 0,508 0,419 0,234 0,373 0,473 0,419 0,640
part of the greater
sciatic notch P. 0,0005* 0,0005* 0,021* 0,001* 0,001* 0,0005* 0,0005*
N 98 98 98 78 53 98 98

Journal of Society for development in new net environment in B&H 9

HealthMED - Volume 15 / Number 1 / 2021

nostic gender markings: the appearance of the ac- 0.71) and morphognostic gender markings: appear-
etabulum b = 0.373 and the shape and size of the ance of aperture pelvic outlet, pelvic constitution,
obturator foramen b = 0.234. bone appearance and iliac fossa appearance.
The highest matching coefficient is with the
3.2. Correlation relations of osteoscopic - following morphognostic gendrer characteristics:
qualitative (morphognostic) pelvic gender appearance of pelvic outlet b = 0.564, appearance
marks, sexually determined based on the of bones b = 0.564, pelvic constitution b = 0.552.
value of the index of the upper part of the Slightly weaker matching coefficient was with
greater sciatic notch morphognostic appearance of iliac fossa b = 0.462.
Kendall’s tau-b (Correlation Coefficient) did not
Kendall’s tau-b (Correlation Coefficient) show a statistically significant level of matching (on
showed a statistically significant level of matching the total sample; p> 0.05; b <0.3) of the index of the
(on the total sample) of the index of the upper part upper part of the greater sciatic notch (male≤0.70 /
of the greater sciatic notch (male≤0.70 / female> female> 0.71) and morphognostic gender markings
Table 2. Correlations in the total sample of indices (I <0.70 / I> 0.70) and morphognostic gender
Index of the upper part of the greater sciatic notch (categories)
Kendall’s tau b
p N
Correlation Coefficient
Constitution of the pelvis 0,552 0,0005* 21/21
Appearance of the bones 0,564 0,0005* 21/21
Appearance of the iliac fossa 0,462 0,003* 42/42
Shape of the pelvic inlet 0,137 0,380 21/21
Shape of the pelvic cavity 0,462 0,003 21/21
Appearance of the sacrum 0,034 0,826 21/21
Promontorium expression 0,070 0,654 21/21
Appearance of the pelvic outlet 0,564 0,0005 21/21
Appearance of the pubic symphysis 0,005 0,972 21/21
Descriptive assessment of the distance be-
0,034 0,826 21/21
tween the pubic tubercles
Descriptive assessment of the distance be-
0,252 0,106 21/21
tween the ischial tuberosities
Appearance of the pubic arch 0,218 0,163 21/21
Shape and size of the obturator foramen 0,137 0,380 42/42
Appearance of the acetabulum 0,311 0,155 22/42
Description of the pelvic inclination 0,222 0,155 21/21

Figure 2. Pelvis (a-female and b-male, osteoscopically determined) - Osteological Collection of the
Department of Human Anatomy, Medical Faculty University of Sarajevo

10 Journal of Society for development in new net environment in B&H

 HealthMED - Volume 15 / Number 1 / 2021

osteoscopically determined: shape of the pelvic in- obturator foramen, appearance of the acetabulum,
let, appearance of pelvic cavity and sacrum axis, ex- appearance of the auricular surface, appearance of
pression of promotorium, appearance of pubic sym- the longitudinal-transverse ratio of the hip bone,
physis, descriptive estimates of distance between and appearance of the greater sciatic notch), the
pubic tubercles, descriptive estimates of distance be- most significant are shown in the tables 3,4 and 5.
tween ischial tuberosity, appearance of pubic arch, Morphognostic gender marks of bone appear-
obturator foramen and pubic inclination. ance (male / female) and the index of the upper
part of the greater sciatic notch I <0.70, coincid-
3.3. Percentage of morphological gender ed in 89.7% of cases. A slightly weaker match,
marks in gender determination based on 57.5%, was with the index of the upper part of the
the index of the upper part of the great greater sciatic notch with value higher of I> 0.71.
sciatic notch This match is statistically significant and corre-
lates with Kendall’s tau-b = 0.508, p <0.0005.
3.3.1. Percentage of morphological gender Morphognostic gender markings of auricular
markers on individual hip bones, in surface appearance (male / female) and upper part
gender determination based on the of greater sciatic notch I <0.70, matched in 79%
index of the upper part of the greater of cases. A slightly weaker, 68%, match was with
sciatic notch greater sciatic notch index greater than I> 0, 71.
This match is statistically significant and corre-
Of the seven examined morphological char- lates with Kendall’s tau-b = 0.473, p <0.0005.
acteristics of the hip bone (bone appearance, ap- Morphognostic gender markings of the hip
pearance of the iliac fossa, shape and size of the bone appearance (male / female) and the index of
Table 3. Percentage of bone appearance in gender determination based on the index of the upper part
of the greater sciatic notch - individual hip bone
Bone appearance
Total
Male Female
Count 52 6 58
(I≤0 ,70) M
Index of the upper part of the % 89,7% 10,3% 100,0%
greater sciatic notch Count 17 23 40
(I>0,71) Ž
% 42,5% 57,5% 100,0%
Table 4. Percentage of the appearance of auricular surface in gender determination based on the index
of the upper part of the greater sciatic notch - individual hip bone
Auricular surface appearance
Total
Male Female
Count 27 7 34
(I≤0 ,70) M
Index of the upper part of the % 79,4% 20,6% 100,0%
greater sciatic notch Count 6 13 19
(I>0,70) Ž
% 31,6% 68,4% 100,0%
Table 5. Percentage of the appearance of the longitudinal-transverse ratio of the hip bones in gender
determination based on the index of the upper part of the greater sciatic notch - individual hip bone
Appearance of the longitudinal-
transverse ratio of the hip bone Total
Male Female
Count 48 10 58
(I≤0 ,70) M
Index of the upper part of the % 82,8% 17,2% 100,0%
greater sciatic notch Count 17 23 40
(I>0,70) Ž
% 42,5% 57,5% 100,0%

Journal of Society for development in new net environment in B&H 11

HealthMED - Volume 15 / Number 1 / 2021

the upper part of the greater sciatic notch I <0.70, ously determined based on the index value of the
coincided in 83% of cases. A slightly weaker match upper part of the greater sciatic notch. These data
of 57.5% was with the index of the upper part of were obtained using Kendall from the tau-b statisti-
the greater sciatic notch higher than I> 0.71. This cal correlation test which shows how important the
match is statistically significant and correlates individually observed features are in determining
with Kendall’s tau-b = 0.419, p <0.0005. gender on the hip bone.
Regarding the percentage of individual quali-
3.3.2. Percentage of individual morphological tative features in determining gender, each of the
gender marks on the pelvis, in gender seven observed traits is statistically significant and
determination based on the index of the correlates with the Kendalls tau-b test. The highest
upper part of the greater sciatic notch degree of matching was recorded in greater sciatic
notch and was 77.6% for males and 87.5% for fe-
Table 6. Percentage of certain qualitative charac- males, and the corresponding Kendalls tau-b coef-
teristics of the pelvis in determining gender ficient was b = 0.64 (gender determined based on
Appearance Pelvis Bone Iliac fossa the index of the upper part of greater sciatic notch).
of the pelvic consti- appear- appear- A study conducted in Bordeaux on individual hip
outlet tution ance ance bones showed that osteoscopically, if the entire hip
Percentage bone is preserved, gender can be determined with
of repre- 80,1% 85,7% 80,1% 80,1% 98% accuracy, including all possible parameters that
sentation can be observed on one hip bone, which relate to
Kendall’s gender dimorphism. In our study, a high percentage
tau b Cor- of correlation b = 0.508 was obtained for the appear-
0,564 0,552 0,564 0,462
relation ance of the bone itself, so that both studies agree.
Coefficient The greater sciatic notch was also observed in this
N 21 21 21 21 study and it was proven that when observed inde-
pendently, with of course a slightly more detailed
Table 7. Percentage of individual qualitative cha- approach, gender can be differentiated with an ac-
racteristics of the pelvis in determining gender, for curacy level of 92% which also coincides with the
male and female separately, defined on the basis of high level of correlation we obtained b = 0.640 (17).
the index of the upper part of the greater sciatic notch Fifteen qualitative features were assessed on the
Index of the upper part of the pelvis. After the Kendalls tau-b correlation test, the
I<0,70 I>0,70
greater sciatic notch most statistically significant of all were: appearance
Appearance of the pelvic outlet 100% 55,50% of pelvic outlet b = 0.564, bone appearance b = 0.564,
Pelvis constitution 100% 66,70% pelvis constitution b = 0.552 and slightly weaker ap-
Bone appearance 100% 55,50% pearance of iliac fossa b = 0.462. Other qualitative
Iliac fossa appearance 83,50% 77,80% characteristics based on the Kendall’s tau b correla-
N 12 9 tion index do not show statistical coincidence with
the index of the upper part of the greater sciatic notch
4. Discussion on the pelvis. Note that the indices were mostly
matched which means, that there were either only
In our sample on individual hip bones, of all male or only female indices on one pelvis, except in
seven assessed qualitative features, greater sciatic three cases. These three cases mostly possessed limit
notch b = 0.640 proved to be the most significant values. The index characterized as male I <0.70 or as
in gender determination, followed by bone appear- female I> 0.70 was obtained by calculating the aver-
ance b = 0.508. Somewhat less significant are gen- age value on both sides of the pelvis.
der markings of iliac fossa b = 0.419, appearance Regarding the percentage of certain qualita-
of auricular surface b = 0.473 and a descriptive as- tive features in confirming gender in our sample,
sessment of the appearance of the hip bone longitu- the most significant were as in Kendall with tau b
dinal-transverse ratio b = 0.419. Gender was previ- coefficient: appearance of pelvic outlet where the

12 Journal of Society for development in new net environment in B&H


degree of matching was 100% in male and 55.5%
in female pelvis (total 80.1%), pelvis constitution
with a degree of matching in male pelvis 100% and
in female pelvis 66.7% (total 85.7%), followed by
bone appearance showing 100% matching in male
pelvis and 55.5% in female pelvis (80.1% in total)
and finally the appearance of the iliac fossa where
the match for male pelvis is 83.5% and for female
pelvis 77.8% (total 80.1%).
Researchers from the University of Saraje-
vo examined the characteristics of the pelvis in
children and adults on radiographs, and came to
slightly different conclusions compared to ours.
The authors report that in male children, and thus
in adults, the most characteristic qualitative fea-
ture is pubic arch, and as for females, in girls it
is the curvature of the sacrum, and in adults the
protrusion of the promontory (18).
According to our statistically processed data,
these three parameters have no statistical signifi-
cance (appearance of the sacrum b = 0.034, p =
0.826; appearance of the promontory b = 0.070, p =
0.654; pubic arch b = 0.137, p = 0.380). However,
it should be emphasized once again that this is a
different methodological approach. The mentioned
research was performed on radiographs, unlike
ours, which was conducted on osteological mate-
rial. Furthermore, the mentioned research, besides
adult participants, also included a group of children
participants, which was not the case in our study,
where we include only pelvis and individual hip
bones of adults, of unknown gender and age. When
it comes to gender determination in different age
groups Rissech et al. found that the length of the
ischium was the most reliable variable (19).
The osteoscopic data listed above in our sample
lead to the conclusion that the percentage match of
most qualitative features with the index of the upper
part of the greater sciatic notch, both on individual
hip bones and on the pelvis, is statistically signifi-
cant and coincides with the Kendall’s tau b correla-
tion coefficient. In addition, a more detailed review
of the tabelar data shows that in all parameters, ex-
cept for greater sciatic notch in individual hip bones,
it can be stated with a higher percentage of certainty
that the same parameter belongs to the male, then
can be confirmed to belong to the female.
In greater sciatic notch, this percentage is on the
female side. This would essentially mean that in
Journal of Society for development in new net environment in B&H
HealthMED - Volume 15 / Number 1 / 2021
osteoscopic gender determination we prove with
greater accuracy that some “male” characteristics
belong to male bones than some “female” charac-
teristics belong to female bones. In this context,
papers should also be considered, which also re-
fer to a number of transitional forms of coxae and
pelvis in a wide range of gender dimorphism rang-
ing between “purely” male and “purely” female
sexual characteristics (20). Precisely this series of
transitional shapes, performing osteometric and
osteoscopic analyses, we noticed in our sample.
By analysing the tabelar data, we concluded
in our study that all parameters had higher values
in men, except for the values for greater sciatic
notch, which are higher in females.
In our study by performing osteometric and
osteoscopic analyses we noticed series of transi-
tional shapes.
5. Conclusion
A statistically significant level of match be-
tween the index of the upper part of the greater
sciatic notch on the basis of which the gender of
the observed hip bone was determined and its
morphognostic gender markings was found in:
appearance of greater sciatic notch, appearance of
bones and appearance of auricular surface
A statistically significant level of match be-
tween the index of the upper part of the greater
sciatic notch on the basis of which the gender of
the observed pelvis was determined and its mor-
phognostic gender marks was found in: pelvic out-
let appearance, bone appearance, pelvis constitu-
tion, and slightly weaker iliac fossa appearance.
We recommend a combination of osteometric
and osteoscopic methods when determining gender
given the large number of transitional forms that are
difficult to classify into one or the other group.
A statistically significant difference, in the ob-
served variables, between the left and right hip
bones was not recorded during the study.
6. Acknowledgement
The authors would like to express their grati-
tude to Assistant Professor Gojak Refet, MD PhD,
Clinical Center University of Sarajevo, Bosnia
and Herzegovina for help with statistical analyses.
13
HealthMED - Volume 15 / Number 1 / 2021
References
1. Sarač-Hadžihalilović A. Anatomically – anthropolog-
ical significance of the skull. English edition (faculty
textbook). Sarajevo: Medical faculty. 2017; 63-65.
2. Trotter M, Gleser GC. A re-evaluation of estimation of
stature based on measurements of stature taken dur-
ing life and of long bones after death. Am J Phys An-
thropol. 1958; 16: 79–123.
3. Meindl RS, Lovejoy CO, Mensforth RP, Walker RA.
A revised method of age determination using the os
pubis, with a review and tests of accuracy of other
current methods of pubic symphysis aging. Am J Phys
Anthropol. 1985; 68: 29–45.
4. Brooks S, Suchey JM. Skeletal age determination
based on the os pubis: a comparison of the Acsadi-
Nemeskeri and Suchey-Brooks methods. Hum Evol.
1990; 5: 227–38.
5. Lovejoy CO, Meindl RS, Pryzbeck TR, Mensforth RP.
Chronological metamorphosis of the auricular sur-
face of the ilium: a new method for the determination
of adult skeletal age at death. Am J Phys Anthropol.
1985; 68: 15–28.
6. Işcan MY. Osteometric analysis of sexual dimorphism
in the sternal end of the rib. J Forensic Sci. 1985; 30:
1090–9.
7. Işcan MY, Loth SR, Wright RK. Metamorphosis at
the sternal rib end: a new method to estimate age at
death in white males. Am J Phys Anthropol. 1984; 65:
147–56.
8. Garvin HM. Adult sex determination: Methods and
application. In: Dirkmaat DC, editor. A Companion
to Forensic Anthropology. Malden, MA: Blackwell
Publishing Ltd. 2012.
9. Osipov B, Harvati K, Nathena D, Spanakis K, Karan-
tanas A, Kranioti EF. Sexual dimorphism of the bony
labyrinth: A new age-independent method. American
journal of physical Anthropology. 2013; 151: 290-
301.
10. Phenice TW. A newly developed visual method of
sexing the os pubis. Am J Phys Anthropol. 1969; 30:
297-301.
11. Iscan MY, Derrick K. Determination of sex from
the sacroiliac joint: a visual assessment technique.
Florida Sci. 1984; 47: 94-98.
12. Ferembach D, Schwidetzky I, Stloukal M. Recom-
mendations for age and sex diagnoses of skeletons. J
Hum Evol. 1980; 9: 517– 549.
14
13. Sutherland LD, Suchey JM. Use of the ventral arc
in pubic sex determination. Journal of forensic sci-
ences. 1991; 36: 501-511.
14. Ferembach D, Schwidetzky I, Stloukal M. Recom-
mendations for age and sex diagnoses of skeletons. J
Hum Evol. 1980; 9: 517– 549.
15. Holcomb, Susan, and Lyle W. Konigsberg. Statistical
study of sexual dimorphism in the human fetal sciatic
notch. Am J Phys Anthropol. 1995; 97(2): 113-125.
16. Jovanović S, Živanović S. Seksualne odlike velikog
sjedalnog usjeka (incisura ischiadica major) kod
čovjeka. Glas. Antropol. Druš. Jug. 1964; 1(1): 21-
26.
17. Bruzek J. A method for visual determination of sex,
using the human hip bone. Am J Phys Anthropol.
2002; 117(2): 157-168.
18. Bubić I, Šečerov D. Seksualni dimorfizam na rent-
genogramima zdjelica kod djece i odraslih. Folia
Anat Iugosl. 1982; 12(1): 55-63.
19. Rissech C, Garcı́ a M, Malgosa A. Sex and age di-
agnosis by ischium morphometric analysis. Forensic
Sci Int. 2003; 135(3): 188-196.
20. Klonovski E. Određivanje spola. In E Klonovski edi-
tor. Uputstva za ekshumaciju i identifikaciju ljudsk-
og skeleta. Sarajevo; Gik “Oko”; 1997; 21-26.
Corresponding author
Aida Sarac - Hadzihalilovic
Department of Anatomy,
Faculty of Medicine,
University of Sarajevo,
Sarajevo,
Bosnia and Herzegovina,
E-mails: aida.sarac@mf.unsa.ba,
aida024@bih.net.ba
Journal of Society for development in new net environment in B&H