A Text-book of Diseases of Women

by Charles B. Penrose

Many cases of retroversion undoubtedly originate during girlhood as a result of falls, blows, distortion of the body, or sudden efforts at lifting. The origin of the symptoms may be traced in many cases directly to some such cause.

The uterus may be considered to be balanced upon an axis running transversely. Anything that turns the uterus backward, so that the intra-abdominal pressure may act upon the anterior wall, will produce retroversion. It is probable that an over-distended bladder occasionally acts as a cause of retroversion.

Retroversion is not at all rare in single women. It is very often discovered soon after the establishment of the menstrual function, the symptoms of the retroversion, which probably occurred during girlhood, first appearing at this time. Retroflexion, on the other hand, except to the slight extent caused by the retroversion, is unusual in single women.

Parturition is probably the most frequent cause of retroversion and retroflexion of the uterus. If the woman leaves her bed or goes to work too soon after miscarriage or labor, many conditions are present that favor retrodisplacement of the uterus. The uterus is larger and heavier than normal, as a result of imperfect involution: the uterine ligaments are lax; the vagina and the vaginal orifice are relaxed, and the support of the pelvic floor is consequently deficient; the abdominal walls are relaxed and the retentive power of the abdomen is diminished. It will be remembered that these are the causes that favor prolapse of the uterus; in fact, a slight degree of uterine prolapse usually accompanies such cases of retrodisplacement. A certain amount of retroversion must always exist before the uterus can pass along the vagina. It must turn backward, so that its axis becomes parallel to the axis of the vagina.

Retroflexion occurring after miscarriage or labor is sometimes the result of unequal involution in the uterine walls. If the involution takes place more completely in the posterior than in the anterior wall of the uterus, a bending back, or a retroflexion, will occur. Such inequality of involution may result from inflammation about the site of the placenta.

Retroflexion is a disease of the parous woman, as anteflexion is a disease of the single and the sterile woman.

Retroversion may be a direct result of laceration of the perineum. When the pelvic floor is destroyed and the posterior vaginal wall begins to prolapse, it drags upon the posterior wall of the cervix, and may in this way turn the uterus backward.

Retroversion also results from traction of inflammatory adhesions in the pelvis. Cases of chronic inflammation of the Fallopian tubes accompanied by inflammation of the pelvic peritoneum present adhesions between the posterior wall of the uterus and the hollow of the sacrum; these adhesions drag the uterus backward ([Fig. 89]).

Fig. 89.—Retroversion of the uterus, with adhesions binding it to the anterior wall of the rectum and the hollow of the sacrum.