The ligaments of the female reproductive tract are an intricate web of structures that have one primary purpose- to support the female viscera in the pelvis. This intricate network of ligaments serves to provide a conduit for neurovascular structures and securely holds the uterus, fallopian tubes, and ovaries in place. Traditionally, the ligaments of the female reproductive tract can be divided into three categories- the broad ligament, uterine ligaments, and ovarian ligaments. Despite being composed of soft tissue, these ligaments are incredibly durable, and their purpose is vital to the proper functioning of the female reproductive system. In this article we shall look at the attachments and anatomical relations of the ligaments of the female reproductive tract.
The broad ligament is the largest of the three and is composed of a flat sheet of peritoneum. It covers the internal female genitalia both anteriorly and posteriorly, extending from the lateral pelvic walls on both sides. The broad ligament can be further divided into three subsections- the mesometrium, mesovarium, and mesosalpinx. The mesometrium surrounds the uterus, running laterally to cover the external iliac vessels and the proximal part of the round ligament of the uterus. The mesovarium projects from the posterior surface of the broad ligament and attaches to the hilum of the ovary, enclosing its neurovascular supply; however, it does not cover the surface of the ovary itself. The mesosalpinx originates superiorly to the mesovarium, enclosing the fallopian tubes.
The broad ligament connects directly to the uterus, fallopian tubes, and ovaries. It also contains the ovarian and uterine arteries, as well as three other ligaments of the female reproductive tract- the ovarian ligament, round ligament of the uterus, and the suspensory ligament of the ovary (also known as the infundibulopelvic ligament).
The ovarian ligament attaches to the ovary inferiorly, connecting it to the side of the uterus. Structurally, it is a fibrous band of tissue situated within the broad ligament. It joins the uterus just below the origin of the fallopian tubes. The suspensory ligament of the ovary extends outwards from the ovary to the lateral abdominal wall. It is composed of a fold of peritoneum, and as such, is considered part of the broad ligament in some sources. This ligament contains the ovarian vessels and nerves (ovarian artery, ovarian vein, ovarian nerve plexus, and lymphatic vessels).
The uterus is supported by several ligamentous structures. These can be divided into three categories- those attaching to the superior aspect (which are supported by the broad ligament and round ligament), those attaching to the middle aspect (which are supported by the cardinal, pubocervical, and uterosacral ligaments), and those attaching to the inferior aspect (which are supported by the levator ani, perineal membrane, and perineal body).
The round ligament is a remnant of the embryonic gubernaculum. It originates at the uterine horns (the points at which the fallopian tubes enter the uterus) and attaches to the labia majora, passing through the inguinal canal.
In conclusion, the ligaments of the female reproductive tract are an intricate network of structures that provide numerous advantages to the female body- most notably, to protect, secure, and support the internal female genitalia in the pelvis. This network of ligaments is composed of three main categories- the broad ligament, uterine ligaments, and ovarian ligaments. These ligaments are incredibly tough and durable, and they provide a conduit for neurovascular structures within the female reproductive tract. With this article, we have sought to provide an overview of the attachments and anatomical relations of the ligaments of the female reproductive tract.
The broad ligament is a flat sheet of peritoneum that is associated with the uterus, fallopian tubes and ovaries. It extends from the lateral walls of the pelvis along both the anterior and posterior surfaces, and serves to cover the internal female genitalia.
The broad ligament can be divided anatomically into three distinct regions- Mesometrium, Mesovarium and Mesosalpinx. The Mesometrium surrounds the uterus and is the largest subdivision of the broad ligament. It collapses over the external iliac vessels, forming a folded cover, and it also encloses the proximal portion of the round ligament of the uterus. The Mesovarium is part of the broad ligament that is associated with the ovaries, projecting from the posterior surface of the ligament and attaching to the hilum of each ovary to enclose the neurovascular supply. The Mesovarium does not, however, cover the surface of the ovary itself. The Mesosalpinx is superior to the Mesovarium and encloses the fallopian tubes.
The broad ligament is related to multiple structures within the female pelvis. It is attached to the uterus, ovaries and fallopian tubes. The ovarian and uterine arteries are also stored within the broad ligament and provide their respective organs with necessary supply. Besides these major organs, three other ligaments of the female reproductive tract are located within the broad ligament- the ovarian ligament, the round ligament of the uterus and the suspensory ligament of the ovary (also called the infundibulopelvic ligament).
The ovary is supported by two main ligaments – the ovarian ligament and the suspensory ligament of the ovary. The ovarian ligament is attached to the ovary inferiorly and connects it to the side of the uterus. This is a fibrous band of tissue located within the broad ligament, and it joins the uterus just below the origin of the fallopian tubes. The suspensory ligament of the ovary is an extension from the ovary to the lateral abdominal wall. The purpose of this ligament is to house the ovarian vessels and nerves, including the ovarian artery, ovarian vein, ovarian nerve plexus and lymphatic vessels.
The uterus is supported by a number of ligamentous structures which attach it to different locations. On its superior aspect, it is supported by the broad ligament and the round ligaments. The middle aspect of the uterus is held up by the cardinal, pubocervical and uterosacral ligaments. The inferior aspect of the uterus is supported by the structures in the pelvic floor - the levator ani, perineal membrane and perineal body.
The round ligament is a remnant of the embryonic gubernaculum and originates at the uterine horns. It attaches to the labia majora and passes through the inguinal canal. During pregnancy, it is under an increased force from the expanding uterus and is known to be a source of pain.
Also called the lateral, transverse cervical or Mackenrodt’s ligaments, the cardinal ligaments are situated along the inferior border of the broad ligament and contain the uterine artery and veins. These ligaments arise from the side of the cervix and the lateral fornix of the vagina. They provide attachment to the lateral pelvic wall at the level of the ischial spines and some fibers of the cardinal ligaments are intertwined with fibers from the uterosacral ligaments. During a hysterectomy for a malignancy, the cardinal ligaments are often removed since they are a common reservoir for cancerous cells.
The pubocervical ligaments are bilateral structures that attach the cervix to the posterior surface of the pubic symphysis. The main functions of these ligaments are to provide support for the uterus within the pelvic cavity.
The uterosacral ligaments are also bilateral fibrous bands that attach the cervix to the sacrum. Additionally known as the recto-uterine ligaments or sacrocervical ligaments, this ligament is responsible for providing support to the uterus and holding it in place.
