The round ligament of the uterus passes through the inguinal canal alongside the ilioinguinal nerve to insert on the labium majus, maintaining uterine anteversion. It is the embryological equivalent of the gubernaculum testis. During pregnancy it stretches progressively as the uterus enlarges and descends, producing the common round ligament pain syndrome of sharp groin and lower abdominal pain.
| Origin | Anterolateral uterus below the fallopian tube insertions |
|---|---|
| Insertion | Labium majus via the inguinal canal |
| Actions | Maintains the anteversion of the uterus (anterior tipping); transmits force during pregnancy round ligament pain |
|---|
Round ligament pain during pregnancy (diastasis-like groin pain from rapid uterine expansion) is managed with heat, rest, and supportive belts. Endometriosis can implant within the round ligament, producing cyclic groin pain that is reproduced by Valsalva through the inguinal canal. The round ligament is divided during hysterectomy as one of the first steps.
Progressive ligament stretching producing sharp groin and lower abdominal pain during rapid uterine growth in pregnancy, managed conservatively.
