The relationship between the pubo‐urethral ligaments and the urogenital diaphragm in the human female

The connective tissue supports of the human female urethra have been investigated in 14 cadavers and 20 fetuses. In all cases the urethra was found to be suspended from the pubic bone by bilaterally symmetrical anterior, posterior and intermediate pubo‐urethral ligaments. The anterior and posterior ligaments were formed by reflections of the inferior and superior fascial layers of the urogenital diaphragm. The intermediate ligament represented a fusion of these fascial layers and no transverse perineal ligament was found. It is suggested that the term pubovesical ligament is a misnomer since this band of connective tissue passes from the pubic bone to the urethra and not to the bladder. It is thus analogous to the puboprostatic ligament of the male. An anatomical defect in the pubo‐urethral ligaments might be a contributing factor to urinary stress incontinence in the female.