Lateral Locations of the Uterus.
The entire uterus is often displaced to the right or the left by a tumor or by an inflammatory exudate. The latter occurs as a product of cellulitis, usually in the left broad ligament, and crowds the organ toward the opposite side of the pelvis. After resolution the ligament, shortened by inflammatory contraction, draws the uterus to the affected side and fixes it there. Lateral displacement from this cause often accompanies laceration of the cervix, the cellulitis having occurred on the side corresponding to the laceration.
Descent or Prolapse of the Uterus.
The nature of this displacement is clearly indicated by its name. It is convenient to distinguish three degrees of descent: In the first the organ is displaced downward and forward until sufficient space has been gained between the cervix and the sacrum to permit the body to turn back into extreme retroversion; in the second the cervix descends to the vulva; in the third the uterus protrudes partially or wholly through the vulva, constituting a condition sometimes called procidentia.
ETIOLOGY AND CLINICAL HISTORY.—Descent may be the result of any or all of the following causes: I. Pressure from above; II. Weakening of the supports; III. Increased weight of the uterus; IV. Traction from below. Either of the above conditions being the primary cause, the others singly or combined may result.
I. Pressure from above may depend upon the presence of a pelvic or abdominal tumor, ascites, fecal accumulations, tight or heavy clothing, etc.
II. The uterine supports may be weakened and relaxed in consequence of subinvolution, senile atrophy, abnormally large pelvis, increased weight of the uterus, pressure from above, traction from below, etc.
III. Increased weight of the uterus may be caused by congestion, subinvolution, hypertrophy, hyperplasia, pregnancy, fluid in the endometrium, uterine tumors, etc.
IV. Traction from below may be due to vaginal cicatrices, abnormally short vagina, falling of the pelvic floor, etc.
Obviously, descent of the vesico- and recto-vaginal walls, or, more comprehensively, the sacral and pubic segments of the pelvic floor, involves also concurrent descent of the uterus. Descent of the vagina, therefore, must be studied in connection with the descent of the uterus. Excessive descent of the vaginal walls usually originates with parturition.