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Supports of uterus with diagram Support of uterus with diagram

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A detailed anatomical diagram of the supports of the uterus, showing a sagittal and anterior view of the female pelvis. Label the following structures clearly: Round ligament of the uterus (running to inguinal canal), Broad ligament of the uterus (peritoneal fold to lateral pelvic wall), Cardinal ligament / Transverse cervical ligament / Mackenrodt ligament (most important, extending laterally from cervix to pelvic wall), Uterosacral ligament (rectouterine ligament, posterior to sacrum), Pubocervical ligament (anterior), Pelvic floor / Levator ani muscle (primary mechanical support below). Use color coding for each ligament type. Add a title: "Supports of the Uterus". Clean medical textbook style.

Here is a complete, well-sourced overview of the supports of the uterus, with textbook diagrams.

Supports of the Uterus

The uterus is maintained in its normal anteverted, anteflexed position within the pelvis by a combination of muscular supports (pelvic floor) and ligamentous/fascial supports. The pelvic floor muscles are the primary support; the ligaments act as secondary checks.

Generated Diagram

Supports of the Uterus - Labeled Anatomical Diagram

Textbook Diagrams (Gray's Anatomy for Students)

Fig. 5.59A - Pelvic Fascia in Women - showing transverse cervical, uterosacral, and pubocervical ligaments:
Pelvic Fascia Ligaments - Gray's Anatomy
Round ligament of the uterus passing through the inguinal canal:
Round Ligament of Uterus - Gray's Anatomy for Students

Classification of Uterine Supports

Supports are divided into:
  1. Primary support - Pelvic floor muscles
  2. Secondary support - Ligaments and peritoneal folds

1. Pelvic Floor Muscles (Primary / Most Important)

The levator ani muscle complex (pubococcygeus, iliococcygeus, puborectalis) along with the perineal body forms the true foundation of uterine support. The pelvic floor acts like a hammock that bears the weight of pelvic organs. All ligaments are secondary to this muscular support.
"The uterus is mainly supported by the pelvic floor muscles, not by the abovementioned ligaments." - Color Atlas of Human Anatomy Vol. 2, Internal Organs

2. Ligamentous Supports

A. Cardinal Ligament (Transverse Cervical Ligament / Mackenrodt's Ligament) - MOST IMPORTANT LIGAMENT

  • A condensation of connective tissue (fascia) extending laterally from the cervix and vaginal vault to the lateral pelvic wall
  • The most important ligament for uterine support clinically
  • Travels at the base of the broad ligament
  • Contains uterine vessels within it
  • Prevents downward descent of the uterus

B. Uterosacral Ligament (Rectouterine Ligament / Sacrouterine Ligament)

  • A peritoneal fold bounding the rectouterine pouch (pouch of Douglas)
  • Formed by dense subperitoneal connective tissue + nerves of the inferior hypogastric plexus
  • Runs from the cervix posteriorly to the posterolateral pelvic wall / sacrum
  • Holds the cervix upward and backward
  • Also called the rectouterinus ligament; contains (debated) smooth muscle

C. Pubocervical Ligament

  • Extends from the cervix anteriorly to the pubic symphysis
  • Supports the anterior aspect of the uterus and bladder neck

D. Round Ligament of the Uterus

  • Arises near the uterine horns, passes through the inguinal canal, ends in subcutaneous fat of the labia majora
  • Contains smooth muscle cells
  • Derived from the gonadal fold; is a continuation of the suspensory ligament of the ovary
  • Maintains the anteverted position of the uterus (keeps fundus tilted forward)
  • Provides little real mechanical support; becomes fibrotic tissue by the time it exits the inguinal canal

E. Broad Ligament of the Uterus

  • A double peritoneal fold stretching from the lateral margin of the uterus to the lateral pelvic wall
  • Contains: uterine tubes (mesosalpinx), ovaries (mesovarium), connective tissue (parametrium), blood vessels, lymphatics, nerves
  • More of a peritoneal drape than a true mechanical support
  • Limits lateral displacement of the uterus

Summary Table

LigamentAttachmentDirectionClinical Role
Cardinal (Mackenrodt's)Cervix → lateral pelvic wallLateralMost important - prevents prolapse
UterosacralCervix → sacrumPosteriorHolds cervix up and back
PubocervicalCervix → pubisAnteriorAnterior support
Round ligamentUterine horn → labia majora (via inguinal canal)AnterolateralMaintains anteversion
Broad ligamentUterus → lateral pelvic wallLateralPeritoneal drape; contains vessels
Pelvic floor (levator ani)-BelowPrimary mechanical support

Clinical Relevance: Uterine Prolapse

When pelvic floor muscles weaken (e.g., after childbirth, with aging, or increased intra-abdominal pressure), the ligaments - especially the cardinal and uterosacral ligaments - become overstretched and fail, leading to:
  • Uterine prolapse (descent of the uterus into or beyond the vagina)
  • Cystocele (anterior wall prolapse)
  • Rectocele (posterior wall prolapse)
Surgical repair targets the cardinal and uterosacral ligaments (e.g., sacrohysteropexy, sacrocolpopexy).
Sources: Color Atlas of Human Anatomy Vol. 2, Internal Organs (Thieme); Gray's Anatomy for Students, 5e
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