Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve

Sohail A. Siddique, Robert E. Gutman, Miguel Antonio Schoen, Francisco Rojas, Victoria L Handa

Research output: Contribution to journalArticle


We describe the anatomy of the uterosacral ligament with respect to the sacral plexus. In six adult female embalmed cadavers, we identified the uterosacral ligament and its lateral nerve relations. Using the ischial spine as the starting point and measuring along the axis of the uterosacral ligament, we noted that the S1 trunk of the sacral plexus passes under the ligament 3.9 cm [95% confidence interval (CI), 2.1-5.8 cm] superior to the ischial spine. The S2 trunk passes under the ligament at 2.6 cm (95% CI; 1.5, 3.6 cm), the S3 trunk passes under the ligament at 1.5 cm (95% CI; 0.7, 2.4 cm), and the S4 trunk passes under the ligament at 0.9 cm (95% CI; 0.3, 1.5 cm) superior to the ischial spine. The pudendal nerve forms lateral to the uterosacral ligament. Our data demonstrate that the S1-S4 trunks of the sacral plexus, not the pudendal nerve, are vulnerable to injury during uterosacral ligament suspension.

Original languageEnglish (US)
Pages (from-to)642-645
Number of pages4
JournalInternational Urogynecology Journal and Pelvic Floor Dysfunction
Issue number6
Publication statusPublished - Nov 2006



  • Peripheral neuropathy
  • Pudendal nerve
  • Sacral plexus trunks
  • Uterosacral ligament
  • Uterosacral ligament suspension

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology

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