A Text-book of Diseases of Women

by Charles B. Penrose

In cases of retroversion and retroflexion of the uterus serious derangement of the circulation results. A state of passive congestion follows interference with the venous supply. This congestion produces some enlargement of the uterus and chronic congestion or inflammation of the endometrium. Consequently, in all old cases of retrodisplacement endometritis is an accompaniment.

Retroversion of the uterus causes traction on the vesico-uterine connection, and the neck of the bladder is dragged upon; for this reason irritability of the bladder, characterized by frequent and perhaps painful micturition, is often present in cases of retroversion. It is not uncommon to see women who have received treatment directed to the bladder for conditions of this kind that disappear immediately when the uterus is restored to the normal position.

The pressure of the displaced fundus upon the rectum may also give trouble. Women in this condition often complain of a feeling of obstruction in the rectum. Pressure upon the hemorrhoidal veins results in hemorrhoids.

There usually accompanies retroversions of the uterus a backward and downward displacement of the ovaries—in other words, a prolapse of the ovaries.

The symptoms of retrodisplacement are numerous, and may be referred directly to the altered position of the uterus and the accompanying conditions. There are backache situated in the upper part of the sacrum, and headache situated on the top of the head or in the occiput. These may be considered the two constant symptoms. There is a feeling of weight and dragging in the pelvis, extending down the thighs. Physical weakness, or inability to walk or stand for more than a short time, is often very marked, and seems to be out of all proportion to the lesion of the uterus. The manner in which such weakness of the legs is produced is not very evident. That it is caused directly by the displacement of the uterus, however, is proved by the fact that it disappears as soon as the uterus is restored to its normal position.

The accompanying prolapse of the ovaries produces symptoms referable to these organs, the chief symptom being pain in each ovarian region.

The irritability of the bladder has already been spoken of. Menorrhagia and leucorrhea may be present as a result of the congestion and the chronic inflammation of the endometrium. Menstruation is usually painful. At the menstrual period the backache, headache, ovarian pain, and vesical disturbance are increased. Dysmenorrhea due to obstruction is unusual in cases of retroflexion. Retroflexion usually occurs in parous women, in whom the cervical canal is large, and the flexion therefore does not cause sufficient obstruction to impede the escape of menstrual blood. All the symptoms arising from retroversion of the uterus are ameliorated by the recumbent posture.

The diagnosis of retroversion and retroflexion of the uterus is very easily made by bimanual examination. The abdominal hand fails to find the fundus in the normal position. The vaginal finger feels the cervix uteri directed not backward toward the coccyx, but forward in the direction of the vaginal axis or toward the symphysis pubis. The posterior wall of the cervix and the body of the uterus may be plainly felt inclined backward. In case of retroflexion the angle of flexion may be felt by the vaginal finger.

The accompanying prolapse of the ovaries is usually very easily demonstrated by vaginal touch.

Treatment.—As retroflexion does not usually cause obstruction of the menstrual flow, the treatment need not be directed toward rendering patulous the cervical canal, as in the case of anteflexion. Retroflexion is always associated with retroversion, and the methods that correct the retroversion place the uterus in such a position that the intra-abdominal pressure acts on the posterior face of the uterus and gradually reduces the flexion. Therefore the treatment of retroflexion and of retroversion may be considered together.