[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Pelvis · Female](https://durgical.com/en/anatomy/region/pelvis/) › Uterosacral ligament [Reproductive system](https://durgical.com/en/anatomy/system/reproductive-system/) · [Pelvis · Female](https://durgical.com/en/anatomy/region/pelvis/) # Uterosacral ligament The uterosacral ligaments run from the cervix back to the sacrum; they hold the cervix up and back and keep the uterus tipped forward. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=pelvis&variant=female&select=uterosacral_ligament&side=r) Opens in the Durgical app, no sign-up needed. ## What it is A band from the back of the cervix around the rectum to the sacrum. ## What it does Pulls the cervix up and back; surgeons stitch the vaginal vault to it to repair a prolapse. Endometriosis is often found on it. ## Key points - The two ligaments raise the rectouterine folds, which form the side borders of the rectouterine pouch - By holding the cervix back toward the sacrum they keep the uterus tipped forward over the bladder, so abdominal pressure pushes it against the bladder rather than down the vagina - A common site of deep endometriosis: nodules and tenderness along it cause deep pain with intercourse and painful periods - The ureters run just lateral to it: stitches placed for vault suspension can kink or catch a ureter, so ureteric flow is checked by cystoscopy ## Key facts **Attaches** Posterolateral cervix and upper vagina, around the rectum, to the front of the sacrum (S2–S4) **Function** Pulls the cervix up and back (level I support); used in uterosacral vault suspension; common site of deep endometriosis ## Relations **Course** From the back and sides of the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) and upper [vagina](https://durgical.com/en/anatomy/vagina/), backward beside the [rectum](https://durgical.com/en/anatomy/rectum/), to the front of the [sacrum](https://durgical.com/en/anatomy/sacrum/) **Medial** [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/) and rectum, which lie between the two ligaments **Lateral** [Ureters](https://durgical.com/en/anatomy/ureter/) and the [inferior hypogastric plexus](https://durgical.com/en/anatomy/inferior-hypogastric-plexus/) **In front** [Cardinal ligament](https://durgical.com/en/anatomy/cardinal-ligament/), with which it blends at the cervix ## How to find it At laparoscopy, pulling the uterus forward makes the two ligaments stand out as peritoneal ridges running back from the cervix on each side of the rectouterine pouch. ## Examination - Rectovaginal examination (one finger in the vagina, one in the rectum): the ligaments are felt as bands behind the cervix; tender nodules along them suggest deep endometriosis ## On imaging Expert transvaginal ultrasound or MRI maps deep endometriosis: a thickened, irregular ligament or a nodule that is dark on T2-weighted images. ## Common problems - Weakened supports allow prolapse. - Endometriosis often grows on the uterosacral ligaments. ## How it is diagnosed Examination and ultrasound; seen directly in laparoscopy. ## Treatment - Uterosacral suspension in prolapse repair. ## Clinical notes - Uterosacral vault suspension and McCall culdoplasty attach the vaginal vault to these ligaments to restore level I support in prolapse surgery or at vaginal hysterectomy - Excision of deep endometriosis here has to spare the ureter and the hypogastric nerves to protect bladder and bowel function ## Related conditions - [Endometriosis](https://durgical.com/en/conditions/endometriosis/) ## Test yourself Think of the answer, then tap the question to see it. ## What is the course of the uterosacral ligament? From the back and sides of the cervix and upper vagina, backward beside the rectum, to the front of the sacrum. ## How do the uterosacral ligaments help keep the uterus anteverted? They hold the cervix back toward the sacrum, so abdominal pressure pushes the uterus onto the bladder rather than down the vagina. ## What do tender nodules along the uterosacral ligament on rectovaginal examination suggest? Deep endometriosis, which causes deep pain with intercourse and painful periods. ## Why is ureteric flow checked by cystoscopy after uterosacral vault suspension? The ureter runs just lateral to the uterosacral ligament, so stitches can kink or catch it. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/uterosacral-ligament/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** ligamentum uterosacrale TA2 3840 **Official Spanish (DeCS)** Ligamento uterosacro **English (TA2)** Uterosacral ligament **Also called** rectouterine ligament · recto-uterine ligament · ligament of Petit ## Related - [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) - [Sacrum](https://durgical.com/en/anatomy/sacrum/) Sources: Terminologia Anatomica (TA2); [Anatomy, Abdomen and Pelvis: Cardinal Ligaments (Mackenrodts, Transverse Cervical, or Lateral Cervical Ligaments)](https://www.ncbi.nlm.nih.gov/books/NBK557384/). ## **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/uterosacral-ligament/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/uterosacral-ligament/