

CHANGES OF POSITION OF THE UTERUS. 145 



the reposition. Corresponding to this, the annoyance caused by the 

 disease is usually slight, and it is only when the uterus is otherwise 

 diseased and enlarged, or when it swells up at the menstrual period, 

 that compression of the pelvic organs and tension of Douglas's liga- 

 ments cause pain in the small of the back, pressure in the pelvis, 

 difficult micturition, desire to go to stool, and pain during defeca- 

 tion. On vaginal examination, we find the portio vaginalis directed 

 backward toward the hollow of the sacrum, and passing the finger 

 forward we come without interruption upon the body and fundus, 

 which lie against the anterior part of the vagina. 



Retroversion depends on the same causes as anteversion. A con- 

 tinued pressure from before backward, tense adhesions on the pos- 

 terior surface of the uterus or tumors in its posterior wall, cause a 

 sinking of the fundus uteri into Douglas's space, and a prominence 

 of the vaginal portion toward the symphysis pubis. The retrover- 

 sion that occurs independently during the first months of preg- 

 nancy, an$ soon after confinement, is a very important disease ; 

 that occurring at other times is generally only a subordinate result 

 of other diseases of the uterus or other pelvic organs. The symp- 

 toms of retroversion are analogous to those of anteversion, and they 

 also depend on the pressure of the horizontally-displaced uterus on 

 the pelvic organs, particularly on the rectum and bladder. 



Descent and prolapse of the uterus depend chiefly on relaxation 

 of the parts that maintain the uterus in position, particularly its 

 ligaments, the pelvic fascia, and the vagina. If, during this relaxa- 

 tion, a stronger pressure from above downward act on the uterus, 

 the latter is pressed down, inverts the vagina, and passes deeper 

 into it, and the result is a descent. If part of the uterus protrude 

 from the vulva, we speak of a prolapse ; when the entire uterus lies 

 outside of the vulva, it is called a prolapsus completus. Relaxation 

 of all the parts that should maintain the uterus in position occurs 

 most frequently in the puerperal state ; and it is the abdominal 

 pressure that most often presses the uterus downward. Poor wo- 

 men, who cannot take care of themselves after confinement, but are 

 obliged to do hard work that causes abdominal pressure a few days 

 subsequently, are peculiarly liable to descents and prolapses. As 

 every descent of the uterus inverts the vagina, and each prolapse of 

 the uterus induces' prolapse of the vagina, so, on the other hand, 

 prolapse of the vagina may give rise to descent or prolapse of the 

 uterus. If the lower end of the vagina be prolapsed, as a result 

 of rupture of the perinseum during delivery, or from some other 

 cause, the upper end exercises traction on the uterus, which either 

 results in elongation of the vagina or descent of the uterus. De- 



