A Text-book of Diseases of Women

by Charles B. Penrose

Unless relieved by pregnancy or by proper treatment, the anteflexion will persist during the menstrual life of the woman. The suffering increases with time. Endometritis, salpingitis, and ovaritis follow old cases of anteflexion.

Sterility usually accompanies well-marked anteflexion. This may be due to the altered direction of the cervix in case of cervical anteflexion, to the obstruction in the cervical canal that interferes with the ingress of spermatozoa, to the generally undeveloped condition of the genital organs, or to the inflammation of the mucous membrane of the cervix and the body of the uterus.

The diagnosis of anteflexion is easily made. The character, position, and time of onset of the pain indicate some obstruction to the escape of menstrual blood. Vaginal examination reveals the sharp angle of flexion at the junction of the body and neck of the uterus.

Treatment.—If in a case of anteflexion pregnancy does occur and runs a normal course the disease will be cured. After labor the uterus does not return to the infantile shape and size. The stimulus of pregnancy brings about full permanent development of that organ. Miscarriage, however, is very apt to occur during the early months of pregnancy, especially in cases of long standing.

Various methods of treatment have been introduced for the cure of anteflexion. The object of all these methods is the straightening and enlargement of the cervical canal. Slow dilatation by graduated bougies has been successfully employed. Gradual straightening of the canal by the introduction of the uterine sound with increasing angle of flexion will also cure some cases, if seen early.

The use of the stem pessary ([Fig. 83]), which is worn continuously in the cervical canal, is dangerous and should not be practised.

Fig. 83.—Stem pessary.

The best method of treatment consists in rapid forcible dilatation with the uterine dilator. Various instruments have been made for this purpose. The principle of all is the same. Two blades are introduced, in contact, in the cervical canal, and are then separated. Two of these instruments should be on hand—a small and a large dilator. The Goodell dilator (Figs. 84, 85) is so made that the blades open parallel with one another, so that the whole of the cervical canal is uniformly stretched.

Fig. 84.—Goodell’s small uterine dilator.

Fig. 85.—Goodell’s large uterine dilator.