Below you will find an overview of the uterine ligaments and their attachment points:
Round ligaments are thin fibro-muscular cords that run from the lateral aspect of the fundus of the uterus and travel anterolaterally through the inguinal ring and canal and connect to the superficial perineal fascia at the labia majora. The round ligaments pass through the two layers of the broad ligament. The round ligaments lengthen from 4-5 inches to up to 18 inches or so during pregnancy! The round ligaments help maintain the anteverted position of the uterus.
Broad ligament: connects the uterus to the lateral walls of the pelvis. The broad ligament is an extension of the peritoneum and envelop the uterus in its folds, so it appears as two flat wide ligaments extending outward laterally. From the picture below you can see how the position of the rib cage and motility /mobility of the digestive organs can affect the ligaments of the organs below via the peritoneum. Everything is connected!
Utero-sacral ligaments: The name implies that the uterosacral ligaments attach the uterus directly to the sacrum, but that is the case only 7% of the time. This study shows, “the origin of the uterosacral ligament from the genital tract extends from the cervix to the upper vagina. The insertion on the pelvic sidewall occurs to the sacrospinous ligament (see image below) and the coccygeus muscle in 82% of all cases, but in only 7% do the uterosacral ligaments insert on the sacrum and 11% the piriformis muscle, the sciatic foramen, or the ischial spine. This suggests that the uterosacral ligaments exhibit greater anatomic variability than their name implies, and this might be an important insight for the understanding of the pelvic organ support mechanism.” This ligament prevents the cervix from moving forward toward the bladder and from prolapsing. Given the attachment points, it makes sense that the position of the femurs, sacrum and pelvis play a supportive role. Can you see the importance of the squat and posterior push off (using the gluteus while walking) for optimal sacral positioning? The gluteal muscles are the main force keeping the sacrum from moving anteriorly. Remember the puppeteer image… sacrum=puppeteer handle thingy, uterosacral ligaments=strings, and the uterus=puppet
Cardinal ligament: Are known as main supporting ligaments of the uterus, upper vagina, and cervix. It attaches in a circular pattern around the cervix and moves laterally to the obturator fascia along the pelvic side walls. Inferiorly it is continuous with the fascia on the upper surface of the levator muscles! The obturator internis attaches to the medial aspect of the greater trochanter (see image above), so the this tells me (I’m guessing, I haven’t seen any studies on this) a neutral femur would help support the cardinal ligament. It also, makes me wonder if “incompetent cervix” has to do with a disruption of flow through the ligament to the cervix due to poor alignment or tight pelvic floor.
Suspensory Ligament of the ovaries: connect the ovaries to the lateral side wall of the lesser pelvis and to the lumbar fascia. These ligaments are extensions of the broad ligaments. The suspensory ligaments of the ovaries are pathways for blood vessels that go to and from the ovaries. These ligaments allow for the ovaries to move like a door on hinges.
Proper ovarian ligament, also called the utero-ovarian ligament is a fibrous ligament connecting the ovary to the lateral side of the uterus.
Pubocervical Ligament is a ligament connecting the cervix to the pubic symphysis. It is thought to provide a supportive role to the uterus.
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