Femina, A Work for Every Woman

by John A. Miller

Retroflexion of the Uterus, or the Womb, bent backward.

This plate elucidates the womb bent or turned backward and pressing on the rectum. This condition is generally traceable to the vicious custom of lying on the back after confinement or during childbed. The natural position of the organ, inclined forward and resting on the bladder, is also shown.

As a permanent pathological lesion, this form of displacement is very rare, but as a forerunner of retroflexion it is of frequent occurrence. The length of time that elapses for a version to take on a flexion depends on the degree of induration or stiffness of the uterine walls.

The chronic inflammatory enlargement of the uterus predisposes the organ to posterior displacement, and the displacement favors the development of flexion. This takes place in the following order: After the uterus is displaced backwards, and its cervix has become fixed by inflammatory adhesions, the body of the womb gradually glides down on the posterior pelvic wall, from gravitation and intra-abdominal pressure. And in this very simple manner a retroversion is converted into a retroflexion. The causes, symptoms, and complications that characterize this variety of displacement, with its subsequent modification into flexion, are the same as those of retroflexion, to which the reader is referred.

RETROFLEXION OF THE UTERUS.

This form of uterine displacement exists when the body of the womb is bent towards the posterior wall of the pelvis, which is in an opposite direction to that where it naturally belongs. I have already pointed out, in speaking of the normal position of the uterus, that the body is directed forwards and rests on the bladder, while its cervix points downwards into the pelvic cavity. I now refer you to Plate IV, in which I plainly show the uterus in a directly opposite position to that in health, namely, turned back, resting on and depressing the rectum.

In retroflexion the cervix of the uterus continues to point downwards, into the pelvic cavity, in almost the same direction as in the natural position, while the body is directed backwards, or backwards and downwards. We seldom, if ever, find this condition as a congenital affection, but as an acquired displacement it is undoubtedly more frequently met with in gynecological practice than all other displacements combined. The round ligaments of the uterus were at one time, and are even yet by some, supposed to be the means that retain the womb in its normal anteflected position. Upon this theory a new surgical operation sprung into prominence for the relief of this class of cases. It was reasoned, that if the round ligaments actually tied the uterus down, and retained it in its natural anteflected position, that to shorten these ligaments by opening the inguinal canal in the groin, and drawing them out, would remedy a displacement of the womb, whether a prolapsus or a retroflexion. This operation was performed, it was claimed successfully, and if the view that the round ligaments retain and support the uterus were a correct one, it must be admitted that the operation would have been ideal. I convinced myself, however, of the utter fallacy of this position, in dissections on the cadaver, where in several instances the round ligaments could not be reached without opening the abdominal cavity, and even then it was impossible to trace them. These views were expressed in an article in the American Journal of Obstetrics and Diseases of Women and Children, and as the operation fell shortly afterwards into merited disrepute, I partly claim the credit of having been instrumental in bringing that about. I said:

“That this ligament has nothing to do in fixing the uterus in its normal anteverted position, is proven from many facts which occur in daily practice. The insertion or origin, whichever one chooses to call it, of these cords at the groin, is somewhat irregular and sometimes so rudimentary that it cannot be found upon a most careful and tedious dissection. It may be found divided into a number of processes, one being connected with Poupart’s ligament in the inguinal canal, the other being lost in the labia majora, and another may be traced to the sheath of the rectus muscle.