The sacrospinous ligament connects the lateral sacrum and coccyx to the ischial spine, converting the greater sciatic notch into the greater sciatic foramen (above) and the lesser sciatic notch into the lesser sciatic foramen (below).
Creates the boundaries of the greater and lesser sciatic foramina, provides posterior pelvic ring stability supplementing the sacroiliac ligaments, is the primary attachment point for vaginal vault suspension in prolapse surgery, and is palpated to guide pudendal nerve block.
Sacrospinous fixation (Richter procedure) — suturing the vaginal apex to the sacrospinous ligament — is the most common vaginal vault prolapse repair. The suture is placed 2cm medial to the ischial spine to avoid the pudendal nerve and vessels that pass around the spine.
The vaginal apex is sutured to the right sacrospinous ligament 2cm medial to the ischial spine to avoid the pudendal neurovascular bundle, restoring apical vaginal support after hysterectomy.
The pudendal nerve wraps around the ischial spine at the sacrospinous ligament — the landmark for transvaginal or transperineal pudendal nerve block for perineal anaesthesia and chronic pelvic pain.
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