The operative procedures required in a case of prolapse of the vagina and of the infra-vaginal cervix, with hypertrophy of the infra-vaginal cervix and elongation of the supra-vaginal cervix, are illustrated in [Figs. 71]-[78].
The condition represented in [Fig. 71] is that which is commonly spoken of as “prolapse of the uterus.” It is the usual form of prolapse. It may be cured in the very great majority of cases by the operations which are here depicted.
A great number of mechanical devices have been introduced for the relief of prolapse of the uterus. Every vaginal pessary has been used for this condition. None of these implements cure the disease. All of them, if used continuously, produce ulceration of the vagina and of the cervix from pressure, and must be abandoned until such lesions heal. In those cases of prolapse in which pessaries remain in the vagina and support the uterus, without producing ulceration, operation would effect a cure.
Fig. 79.—Braun’s colpeurynter.
Mechanical supports of this kind are only indicated in women in whom operation is contraindicated on account of old age or for some other reason. Perhaps the best instrument for supporting the uterus in such cases is Braun’s colpeurynter ([Fig. 79]). The uterus should be reduced, and the colpeurynter, well greased and containing about an ounce of water, should be introduced in the vagina and then distended with air. This instrument takes its support evenly from all parts of the vaginal outlet, and is therefore less apt to produce ulceration from pressure than the various pessaries. It should be removed at night.
CHAPTER X.
ANTEFLEXION OF THE UTERUS.
As has already been said, the uterus normally lies with its anterior surface in contact with the posterior surface of the bladder, and with its long axis approximately perpendicular to the long axis of the vagina. The forward inclination of the uterus varies with the degree of distention of the bladder; it is greatest when the bladder is collapsed.