There are various causes of ovarian prolapse. In some cases it is probable that the position of the ovaries in the bottom of Douglas’s pouch is congenital.
A sudden strain or effort is said to have produced acute prolapse of the ovary.
Anything that increases the weight of the ovary may cause its descent. Prolonged congestion, inflammation, or small ovarian tumors may result in ovarian prolapse.
Subinvolution is the most frequent cause of ovarian prolapse. In pregnancy the ovaries become very much enlarged, especially the left one. The ovarian ligament and the infundibulo-pelvic ligament become much increased in length. If, after labor, involution is arrested or is incomplete for any reason, the conditions favorable for prolapse of the ovary will be present—increased weight of the ovary and relaxation and lengthening of its attachments. Sometimes the cause of the prolapse is in the ligaments alone. The ovary may have returned to its normal size, while the ligaments may have remained subinvoluted, permitting undue freedom of movement.
The left ovary is more frequently prolapsed than the right. There are two reasons for this difference. As has just been said, the left ovary becomes more enlarged during pregnancy, and therefore suffers more from subinvolution, and the arrangement of the veins on the left side is such that venous congestion is very liable to occur.
When prolapse has existed for a long time, secondary changes take place in the ovary as the result of hyperemia, and the condition becomes further aggravated.
Symptoms.—Slight descent of the ovary very often causes no suffering whatever. When, however, the ovary is completely prolapsed, lying in the bottom of Douglas’s pouch, between the posterior wall of the vagina and the rectum, well-marked symptoms usually arise.
The woman suffers pain whenever she is in the erect position. The pain is increased by walking, probably because the ovary is squeezed between the cervix and the sacrum. Coitus sometimes causes intense pain. Defecation causes pain. The pain begins with the movements of the bowels, and often lasts for one or two hours afterward. It is dull and aching in character, and is situated in the normal position of the ovary, radiating thence throughout the pelvis and extending down the thighs. It frequently produces faintness and nausea.
The ovarian pain is markedly increased at the menstrual periods.
The general and reflex disturbances produced by prolapse of the ovary are often very pronounced. There may be headache, indigestion, hysteria, and great mental depression. A reflex pain is often felt in the breast on the same side with the affected ovary.