The anomalous position of the uterus is considered to be when, having deviated, it goes beyond the physiological position and has a permanent character, and is also accompanied by violations of the normal relationships between its individual parts.
The classification of incorrect positions of the genital organs provides for the following clinical forms.
1. Displacement of the uterus along the vertical plane:
a) lifting up (elevatio uteri) - its bottom is located above the entrance to the small pelvis, and the neck is above the spinal line;
b) prolapse of the uterus (descensus uteri) - the external pharynx of the vaginal part of it is below the spinal line, without leaving the genital slit when straining;
c) prolapse of the uterus (prolapsus uteri) - complete, when the cervix and body are located below the genital slit, and incomplete - only the vaginal part of the cervix comes out of it (with this form, it is often observed to be lengthened).
When the uterus is inverted (inversio uteri), its mucous membrane is outside, the serous one is located inside.
When turning (rotatio uteri), there is a rotation of the uterus to the right or left in a half turn, around the vertical axis.
Twisting of the uterus (torsio uteri) is characterized by the rotation of its body in the region of the lower segment with a fixed neck along the vertical axis.
2. Displacement of the uterus along the horizontal plane:
a) displacement of the entire uterus from the center of the pelvis to the left, to the right anteriorly or posteriorly (Lateropositio sinistra, dextra, antepositio, retropositio);
b) inclination (versio uteri) - the wrong position of the uterus, when the body is displaced in one direction, and the neck in the other;
c) the inflection of the uterus (flexio uteri) in the presence of an open obtuse angle between the body and its neck is physiological. With a pathological inflection, it is acute (hyperanteflexia) or open posteriorly (retroflexia).
Displacement of the uterus occurs as a result of pathological processes that occur outside of it (inflammation of the fiber or uterine peritoneum, tumors, accumulation of blood, etc.).
With pathological anteflexia, the cause is more often developmental anomalies, less often inflammatory processes and tumors of the genital organs, a violation of menstrual function is clinically observed according to the type of hypomenstrual syndrome with algomenorrhea. These phenomena, on the one hand, are due to a violation of the endocrine function of the ovaries, and on the other hand, a low threshold of pain sensitivity. With hyperanteflexia as a result of infantilism, infertility can be observed.
Treatment should be aimed at eliminating the underlying disease. In pathological anteflexia resulting from inflammation, anti-inflammatory treatment is recommended. If hyperanteflexia is a consequence of ovarian hypofunction, appoint:
a) general strengthening treatment (physiotherapy exercises, resort and sanatorium, rational nutrition with the mandatory inclusion of vitamins A, C, groups B, E);
b) physiotherapeutic procedures that improve the circulation of the genital organs; c) hormones in accordance with the degree of underdevelopment of the genital organs.
Retroflexion is usually combined with retroversion of the uterus. The reasons for this anomaly are varied: a) weakening of the suspension, supporting and fixing apparatus of the uterus; b) inflammatory diseases that cause the formation of adhesions and scars both in the area of the uterus and in the tissues surrounding it; c) insufficiency of ovarian function and general disturbances in the body, leading to a decrease in the tone of the uterus; d) multiple, often following each other childbirth, complicated by surgical intervention, as well as debilitating general diseases, causing relaxation of the tone of the uterus and its ligamentous apparatus, pelvic floor and abdominal wall; e) atrophy of the uterus and a decrease in its tone in old age; e) tumors of the ovaries, located in the vesicouterine space, or the uterus, emanating from its anterior wall.
With a pronounced retroflexion, the uterine appendages descend, located near or behind it. In this case, due to the inflection of the vessels, congestion in the small pelvis can be observed.
Retroflexion of the uterus can be mobile or fixed. The latter arises as a result of a previously transferred inflammatory process.
Retroflexion of the uterus is not an independent disease and in many women it is found by chance, since it does not give any symptoms. However, in some cases it is accompanied by characteristic symptoms: pain in the lower abdomen and lumbosacral region; frequent and painful urination; constipation and pain during defecation; disorders of menstrual function; infertility due to concomitant inflammation of the genitals.
Diagnosis of posterior displacement of the uterus is not difficult. During the study, the vaginal part of the cervix is detected anteriorly and often below the normal level, its body is located posteriorly (determined through the posterior vaginal fornix). Between the body and the neck there is an angle open posteriorly. It is necessary to differentiate the backward bend of the uterus with its subserous fibromyoma, ovarian tumor, saccular tumor of the tube, tubal pregnancy, abscess or hemorrhage in the retrouterine cavity. In difficult cases of diagnosis, a rectal examination should be used.
With the exclusion of the diagnosis of acute or subacute inflammation and retrouterine hemorrhage, a careful attempt to manually remove the uterus from retroflexion to anteflexion can be made. At the same time, forced bringing it forward is strictly prohibited.
Treatment of retrodeviations of the uterus should be aimed at eliminating the cause that caused this condition.
In case of infantilism, good nutrition, physical exercises, water procedures and a complex of other therapeutic agents are recommended. If retroflection has arisen as a result of inflammatory changes in the genitals, an energetic anti-inflammatory treatment is carried out, including physiotherapy, mud therapy and other means. With concomitant functional neuroses, psychotherapy is carried out, sleeping pills, ataractics and bromides are prescribed.
In the absence of complaints by the patient and violations of the functions of adjacent organs, local treatment is not recommended, special treatment is required in cases where retrodeviations of the uterus are accompanied by the formation of adhesions. In these cases, gynecological massage is used, and sometimes surgical treatment.
Contraindications to gynecological massage are acute and subacute inflammatory processes in the small pelvis, sactosalpinx, significant pain during gynecological examination, menstruation, pregnancy, hypersensitivity of the patient.
The course of treatment consists of 15-20 sessions. After the first session, which lasts 3-5 minutes, it is necessary to take a break for 3-4 days to find out if the inflammatory process has aggravated. In the absence of contraindications, gynecological massage is continued, increasing the duration of the session to 6 minutes. It is recommended to combine it with the use of physiotherapeutic procedures or mud therapy.
If systematic repeated conservative treatment does not give a positive effect, there are indications for surgical intervention.
Elevation of the uterus (elevatio uteri) is physiological in childhood; pathological is observed with the accumulation of menstrual blood on the basis of atresia of the hymen, large tumors of the vagina and rectum, emerging submucosal fibroids, encysted inflammatory tumors, etc.
Complaints of patients do not depend on lifting it up, but on those conditions that determine this situation. Therefore, the treatment is reduced to the fight against them.
Downward displacement of the vagina and uterus can occur simultaneously, although uterine prolapse is not always accompanied by downward displacement of the vagina.
Distinguish between the omission of the anterior wall of the vagina (descensus patietis anterioris vaginae), the back (descensus parietis posterioris vaginae) or both together (descensus parietum vaginae). In these cases, it goes beyond the entrance to the vagina. In case of prolapse of the anterior wall of the vagina (cystocele), posterior (rectocele), or a combination of their walls, it partially or completely exits the genital gap and is located below the pelvic floor. Complete prolapse of the vagina is accompanied by prolapse of the uterus.
When lowered, its vaginal part of the cervix is below the interspinal line, with incomplete prolapse, it leaves the genital gap, but the body of the uterus is above the pelvic floor muscles. With complete prolapse of the entire uterus (body and cervix), together with the everted vagina, they are located below the introitus vaginae.
The main role in the etiology of these conditions is played by irrationally performed childbirth, accompanied by trauma to the birth canal, which was not timely restored. Secondary causes leading to prolapse and prolapse of the genital organs include a delay in their development, age-related atrophy of the uterus, ligaments, pelvic floor muscles, etc.
The downward displacement of the uterus progresses with lifting and carrying weights.
In most cases, prolapse and prolapse of the uterus and vagina are a single pathological process.
The walls of the vagina that have fallen out become dry, the mucous membrane is coarsened, the connective tissue swells. Its folds gradually smooth out and the mucous membrane takes on a whitish color. Trophic ulcers with sharply defined edges often form on it, and there is often a purulent plaque at the bottom. Prolapse of the uterus is accompanied by kinking of the vessels, as a result of which the outflow of venous blood is difficult and stagnation of the underlying sections occurs. The vaginal part of the cervix swells, it increases in volume, its elongation (elongatio colli uteri) is often observed - the length of the uterine cavity together with the cervix reaches 10-15 cm.
With complete prolapse of the uterus, a violation of the topography of the ureters, their compression and expansion in the area of the renal pelvis and the development of an ascending urinary tract infection are possible.
The clinic of prolapse of the uterus and vagina is characterized by a protracted and progressive course. Bladder prolapse is usually diagnosed when a catheter is inserted into the urethra. A rectal examination makes it possible to identify the rectocele.
The prolapsed genitals make it difficult to walk, perform physical work, there are pains in the sacrum (often associated with traumatization of trophic ulcers) and frequent urge to urinate due to incomplete emptying of the bladder. Recognition of their omission and loss is not difficult. Treatment is reduced to general strengthening gymnastics and exercises that strengthen the muscles of the abdominal press and pelvic floor (tilts of the body, lateral turns, flexion and extension of the legs when lying down, spreading and bringing the knees together while raising the pelvis, bringing them together with overcoming resistance, arbitrary rhythmic retractions of the perineum, etc. .). Along with this, good nutrition and water procedures are recommended. When performing physical work associated with lifting weights, it is necessary to change working conditions.
The orthopedic method of treatment consists in the introduction of various pessaries into the vagina. Most often, ring-shaped ones of various sizes are used (made of plastic, ebonite or metal covered with rubber), less often - saucer-shaped ones. The pessary is inserted into the vagina with an edge in a standing position, in depth it is turned so that it rests on the muscles of the levators. However, it should be noted that their treatment is not rational, since the selection of a suitable pessary is difficult. In addition, they cause irritation of the walls of the vagina, the appearance of bedsores and easily fall out. The most radical in these cases is the surgical method of treatment.
Prevention of prolapse of the vagina and uterus consists in the timely and correct restoration of the integrity of the muscles of the pelvic floor and perineum after childbirth, physical education during and after pregnancy, especially exercises that help strengthen the abdominal muscles and pelvic floor muscles.
Anomalies in the development of female genital organs
Embryonic development of the genital organs occurs in close relationship with the development of the urinary tract and kidneys. Therefore, anomalies in the development of these two systems often occur simultaneously. Kidneys develop in stages: pronephros (head kidney), primary kidney (wolf body) and final kidney. All these formations come from nephrogenic strands located along the spine. The pronephros quickly disappears, turning into the bladder - subsequently the excretory duct (wolfian passage) of the primary kidney (wolf body). Wolf bodies in the form of rollers are located along the spine, changing as they develop and turning into other formations. Their remnants in the form of thin tubules are preserved in the wide (between the tube and the ovary), funnel-pelvic ligaments and in the lateral sections of the cervix and vagina (Gartner's course). From these residues, cysts can subsequently develop. The reduction of wolf bodies and passages occurs in parallel with the development of the final kidney, which originates from the nephrogenic section of the coital cord. Wolf passages turn into ureters.
The development of the ovaries originates from the epithelium of the abdominal cavity between the rudiment of the kidney and the spine, occupying the area from the upper pole to the caudal end of the Wolf body. Then, due to the differentiation of the cells of the genital ridge, the germinal epithelium arises. From the latter, large cells are released that turn into primary eggs - ovogonia, surrounded by follicular epithelium. From these complexes, primordial follicles are then formed in the formed ovarian cortex. As they form, the ovaries gradually descend into the small pelvis along with the rudiment of the uterus.
The uterus, tubes and vagina develop from the Müllerian passages that arise in the area of the urogenital folds, quickly separating from them (4-5 weeks of intrauterine development). Cavities soon form in the folds. The Müllerian passages, located along the wolf ducts, descend into the urogenital sinus. Merging with its ventral wall, they form a mound - the rudiment of the hymen. The middle and lower parts of the Müllerian passages merge, grow together and form a single cavity (10-12 weeks of the prenatal period). As a result, tubes form from the upper separate sections, the uterus from the merged middle ones, and the vagina from the lower ones.
The external genital organs develop from the urogenital sinus and the skin of the lower body of the embryo. At the bottom of the torso of the embryo, a cloaca is formed, where the end of the intestine flows, the Wolf passages with the ureters developing in them, as well as the Müller passages. The cloaca is divided by the septum into dorsal (rectum) and ventral (genitourinary sinus) sections. From the upper part of the urogenital sinus, the bladder is formed, from the lower part - the urethra and the vestibule of the vagina. The urogenital sinus is separated from the rectum and divided into anal (the anus is formed in it) and urogenital (the external opening of the urethra is formed in it) sections, and the part between them is the rudiment of the perineum. In front of the cloacal membrane, a genital tubercle is formed - the rudiment of the clitoris, and around it - genital ridges - the rudiments of the labia majora. A groove is formed on the back surface of the genital tubercle, the edges of which turn into small labia.
Malformations of the genital organs usually occur in the embryonic period, rarely - in the postnatal period. Their frequency increases (2-3%), which was especially noted in Japan 15-20 years after the nuclear explosions in Hiroshima and Nagasaki (up to 20%). The causes of the abnormal development of the genital organs are considered to be teratogenic factors that act in the embryonic, possibly fetal and even postnatal periods. Teratogenic factors can be divided into external and internal. External include: ionizing radiation; infections; medicines, especially hormonal; chemical; atmospheric (lack of oxygen); alimentary (irrational nutrition, vitamin deficiency) and many others that disrupt the processes of metabolism and cell division. Internal teratogenic effects include all pathological conditions of the maternal organism, especially those that contribute to violations of hormonal homeostasis, as well as hereditary ones.
It is possible to classify the malformations of the female genital organs according to the severity: mild, not affecting the functional state of the genital organs; medium, violating the function of the genital organs, but allowing the possibility of childbearing; severe, excluding the possibility of performing a childbearing function. In practical terms, classification by localization is more acceptable.
Malformations of the ovaries, as a rule, they are caused by chromosomal disorders and are accompanied or contribute to pathological changes in the entire reproductive system, and often in other organs and systems. The most common of these anomalies is gonadal dysgenesis in various forms (pure, mixed, and Shereshevsky-Turner syndrome). These are severe defects that require special treatment and lifelong hormone replacement therapy. This group also includes Klinefelter's syndrome, when the body is formed according to the male type, but with some signs of intersexualism, the manifestations of which may be, for example, gynecomastia. The complete absence of one or both ovaries, as well as the presence of an additional third (although it is mentioned in the literature) practically does not occur. Insufficient anatomical and functional development of the ovaries can be primary or secondary and is usually combined with the underdevelopment of other parts of the reproductive system (variants of sexual infantilism, ovarian hypofunction).
Anomalies in the development of the tubes, uterus and vagina are the most frequent and practically important, they can be in the form of moderate and severe forms. From pipe anomalies can note their underdevelopment as a manifestation of genital infantilism. Rare anomalies include their aplasia, rudimentary state, additional holes in them and additional tubes.
Aplasia of the vagina(aplasia vaginae) (Rokitansky-Küster syndrome) is one of the most common anomalies. It is a consequence of insufficient development of the lower sections of the Müllerian passages. It is accompanied by amenorrhea (both true and false). Sexual life is violated or impossible. Surgical treatment: bougienage from the lower section; creation of an artificial vagina from a skin flap, sections of the small, sigmoid colon. Recently, it is formed from the pelvic peritoneum. A vagina is created in an artificially formed canal between the rectum, urethra and the bottom of the bladder. Often, vaginal aplasia is combined with signs of delayed development of the uterus, tubes and ovaries. Other variants of the anomaly of the vagina are combined with malformations of the uterus.
Malformations of the uterus occur most frequently among the defects of the genitals. Of the uterine defects that develop in the postnatal period, one can note hypoplasia, infantilism, which are combined with the abnormal position of this organ - hyperanteflexia or hyperretroflexia. A uterus with such defects differs from a normal uterus in smaller body sizes and a longer neck (infantile uterus) or a proportional decrease in the body and neck. Normally, the body of the uterus accounts for 2/3, and the cervix - 1/3 of the volume of the uterus. With infantilism and uterine hypoplasia, depending on the severity, there may be amenorrhea or algomenorrhea. The latter symptom is especially often observed when these defects are combined with hyperflexia. Treatment is carried out similarly to that for ovarian hypofunction, with which these defects are combined. Algodysmenorrhea often disappears when the angle between the cervix and the body of the uterus is straightened with the help of Hegar's dilators. Uterine malformations formed in the embryonic period due to violations of the fusion of the Müllerian passages include combined malformations of the uterus and vagina (Fig. 17). The most pronounced form is the presence of completely independent two genital organs: two uterus (each with one tube and one ovary), two necks and two vaginas (uterus didelphus). This is an extremely rare defect. Such doubling is more common in the presence of a connection between the walls of the uterus (uterus duplex et vagina duplex). This type of vice can be combined with others. For example, with partial atresia of one of the vaginas, haematocolpos is formed. Sometimes the cavity of one of these uterus ends blindly, and its neck and second vagina are absent - there is a doubling of the uterus, but one of them is in the form of a rudiment. In the presence of separation in the area of the body of the uterus and a tight connection in the area of \u200b\u200bthe cervix, a bicornuate uterus is formed - uterus bicornis. It happens with two necks (uterus bicornis biccollis), and the vagina has a normal structure or there is a partial partition (vagina subsepta) in it. Bicornuity can be expressed slightly, only in the bottom area, where a depression is formed - the saddle uterus (uterus arcuatus). The saddle uterus may have a complete septum, extending to the entire cavity (uterus arcuatus septus) or partial, in the area of the bottom or neck (uterus subseptus). In the latter case, the outer surface of the uterus may be normal. Duplication of the uterus and vagina may not cause symptoms. With their good development (on both or one side), menstrual, sexual and reproductive functions may not be impaired. In such cases, treatment is not required. In the case of obstructions, which in childbirth may represent the septa of the vagina, the latter are dissected. With atresia of one of the vaginas and the accumulation of blood in it, surgical treatment is indicated. Of particular danger is pregnancy in a rudimentary uterus (an ectopic pregnancy option). With a belated diagnosis, it ruptures, accompanied by massive bleeding. This pathology requires urgent surgical treatment.
Diagnosis of anomalies in the development of the ovaries, uterus, tubes and vagina is carried out according to clinical, gynecological and special (ultrasound, radiography, hormonal) studies.
Ginatresia- violation of the patency of the genital canal in the area of the hymen (atresia hymenalis), vagina (atresia vaginalis) and uterus (atresia uterina). It is believed that they can be congenital and acquired in the postnatal period. The main cause of congenital and acquired anomalies is an infection that causes inflammatory diseases of the genitals, and the possibility of their development due to defects in the Müllerian passages is not excluded.
Atresia of the hymen usually manifests itself during puberty, when menstrual blood accumulates in the vagina (haematocolpos), uterus (haematometra) and even in the tubes (haematosalpinx) (Fig. 18). During menstruation, cramping pains and malaise occur. Painful sensations can be permanent due to compression of adjacent organs (rectum, bladder) by the “blood tumor”. Treatment is a cruciform incision of the hymen and removal of the contents of the genital tract.
Vaginal atresia can be localized in different departments (upper, middle, lower) and have different lengths. Accompanied by the same symptoms as hymen atresia, including the absence of menstrual blood and malaise during menstruation (molimina menstrualia). Treatment - surgical.
Uterine atresia usually occurs due to overgrowth of the internal pharynx of the cervical canal, due to traumatic injuries or inflammatory processes. The symptoms are similar to those of lower gynatresia. Treatment is also surgical - opening the cervical canal and emptying the uterus.
Rice. one 7. Scheme of various malformations of the uterus: a- double uterus; b - doubling of the uterus and vagina; v- bicornuate uterus G - uterus with septum; d- uterus with incomplete septum; e - unicornuate uterus; well- asymmetrical bicornuate uterus (one horn is rudimentary).
Malformations of the external genital organs are manifested in the form of hermaphroditism. The latter can be true or false. True hermaphroditism is when there are functioning specific glands of the ovary and testis (ovotestis) in the gonad. However, even in the presence of such a structure of the sex glands, usually the elements of the male gland do not function (there is no process of spermatogenesis), which in fact almost excludes the possibility of true hermaphroditism. Pseudohermaphroditism is an anomaly in which the structure of the genital organs does not correspond to the gonads. Female pseudohermaphroditism is characterized by the fact that in the presence of ovaries, uterus, tubes and vagina, the external genitalia resemble male in structure (of varying severity). There are external, internal and complete (external and internal) female pseudohermaphroditism. External female pseudohermaphroditism is characterized by clitoral hypertrophy and the presence of fusion of the labia majora along the midline like the scrotum with pronounced ovaries, uterus, tubes and vagina. With internal hermaphroditism, along with pronounced internal female genital organs, there are wolf passages (excretory ducts of the testes) and paraurethral glands - homologues of the prostate gland. The combination of these two variants represents complete female hermaphroditism, which is extremely rare. There are also defects in which the rectum opens into the vestibule of the vagina below the hymen (anus vestibularis) or into the vagina (anus vaginalis). Of the defects of the urethra, hypospadias is rarely noted - the complete or partial absence of the urethra and epispadias - the complete or partial splitting of the anterior wall of the clitoris and urethra. Correction of defects of the external genitalia is achieved only by surgery, and not always with full effect.
The content of the article
The position of the abdominal organs, including the pelvic organs, is relatively constant due to the balance that is provided in the abdominal cavity by the diaphragm, muscles of the anterior abdominal wall and pelvic floor. At the same time, the uterus with ovaries and fallopian tubes has some physiological mobility, which contributes to the normal course of pregnancy and childbirth and the proper functioning of the bladder and intestines. Excessive mobility, or limitation of the mobility of the uterus, are pathological phenomena. The position of the genitals changes with age. During childhood, the uterus is located higher than during puberty. In old age, due to atrophy of the genital organs, the uterus is located deep in the pelvic cavity and deviates backwards. Typical for the uterus is considered to be the position of the genital organs of a healthy sexually mature non-pregnant woman, who is in a vertical position with the bladder and rectum emptied: the uterus is placed in the center of the small pelvis at the same distance from the symphysis and sacrum and from the right and left iliac bones, the bottom of the uterus is located at the level of the plane of entry into the small pelvis, the vaginal part of the cervix is at the level of the ischial spines, the opening of the uterus is adjacent to the back wall of the vagina and the uterus is facing anteriorly and upwards, the vaginal part of the cervix is down and slightly backwards; an obtuse angle is formed between the body and the cervix, open anteriorly (physiological anteflexia).
Anomalies in the position of the uterus are considered such deviations of its position that go beyond the physiological position and are of a stationary nature, as well as a violation of the normal relationships between the individual parts of the uterus (body and cervix).
Classification of anomalies in the position of the genital organs
The classification of anomalies in the position of the genital organs is based on the clinical forms of uterine deviation and does not include data related to etiology or pathogenesis. Elevation of the uterus (elevatio uteri). The uterus is displaced upward, its bottom is located above the plane of entry into the small pelvis, the vaginal part of the cervix is above the spinal plane, and is unattainable or difficult to reach during vaginal examination. Elevation of the uterus does not need special treatment: after the elimination of the causes of elevation, the uterus occupies a physiological position.Descent of the uterus (descentus uteri)
The uterus is located below the normal level, the vaginal part of the cervix (external os) is below the spinal plane, but does not protrude from the genital slit.Uterine prolapse (prolapsus uteri)
The uterus is displaced downward, partially or completely extends beyond the genital gap. There are incomplete and complete prolapse of the uterus.Incomplete prolapse of the uterus (prolapsus uteri partialis seu incom-pletus)
Only the vaginal part of the cervix comes out of the genital slit, the body of the uterus is located outside the genital slit. With incomplete prolapse, the ratio between the size of the body and the cervix can be preserved, but can also be violated due to the lengthening of the cervix (elongatio colli uteri).Complete prolapse of the uterus (prolapsus uteri totalis seu completus)
Uterine prolapse is considered complete when the cervix and body of the uterus are located below the genital gap, usually accompanied by the wrong side of the walls of the vagina. With complete prolapse of the uterus, elongation of the cervix usually does not occur, the ratio between the size of the body and the cervix is preserved.Eversion of the uterus (inversio uteri). With the wrong side of the uterus, the serous membrane is located inside, the mucous membrane is outside, the body of the uterus is below the cervix (the uterus turns inside out like a finger of a glove), into the vagina. The displacement of the uterus around the longitudinal axis can be in two forms:
1. Rotation of the uterus (rotario uteri). Rotation of the uterus (body and cervix) around the vertical axis, right or left.
2. Torsion of the uterus (torsio uteri). It will rotate the body of the uterus along the vertical axis in the region of the lower segment with a motionless cervix.
Displacement of the uterus in a horizontal plane
The displacement of the entire uterus (body and neck) relative to the leading axis of the pelvis (positio uteri) can be in four forms:1) antepositio - the entire uterus is displaced anteriorly;
2) retropositio - the uterus is displaced backwards;
3) dextropositio - the uterus is displaced to the right;
4) sinistropositio - the uterus is displaced to the left.
Tilt of the uterus (versio uteri)
In this position, the body of the uterus is displaced in one direction, and the cervix in the opposite direction, moreover, the body and cervix lie in the same plane. With physiological anteversion, the body of the uterus is deviated anteriorly, and the cervix - backwards and downwards, with a woman in a vertical position, the body of the uterus is located above the cervix.
Incorrect inclinations of the uterus:
a) anteversio will be pathological if it remains constant, and is so pronounced that the body of the uterus is directed anteriorly and downwards, and the cervix backwards and upwards;
b) retroversio - the body of the uterus is tilted backwards, the vaginal part is anteriorly;
c) dextroversio (lateroversio dextra) - the body of the uterus is directed to the right and up, the cervix to the left and down;
d) sinistroversio (lateroversio sinistra) - the body of the uterus is directed to the left and up, the neck is to the right and down.
Inflection of the uterus (flexio uteri). The presence of an angle in the area of the transition of the body of the uterus to the cervix. Normally, there is an obtuse angle between the body and the cervix, open anteriorly - physiological anteflexia. The body of the uterus is turned anteriorly, the cervix backwards and downwards.
Inflection in this case can be pathological:
a) anteflexio pathologica, hyperanteflexio - the anterior inflection will be expressed, the angle between the body and the cervix is not obtuse, but acute (acute-angled anteflexia), and this angle does not straighten, does not level out;
b) retroflexio - the angle between the body and the cervix is open backwards, the vaginal part of the cervix is facing anteriorly and downwards, the body of the uterus is backwards, with a sharp degree of retroflexion - backwards and downwards;
c) lateroflexio dextra - the angle between the body and the neck is open to the right;
d) lateroflexio sinistra - the angle between the body and the cervix is open to the left. Presented??classification is a schematic designation of existing anomalies in the position of the uterus.
Position anomalies often occur in connection with inflammatory processes and neoplasms localized in various parts of the genital organs, as well as against the background of general disorders and extragenital diseases. So, inflammatory effusion, accumulation of blood and tumors located behind the uterus contribute to the displacement of the entire uterus anteriorly (antepositio). With the localization of pathological processes in front of the uterus, its displacement occurs backwards (retropositio). With inflammatory effusions in parametric tissue, tumors of the appendages and other unilateral pathological processes, the uterus is displaced in the opposite direction - to the right or left of the pathological process. In the final stages of inflammatory diseases, the uterus as a whole can shift in the direction where the cicatricial adhesive process is most pronounced. Inflammatory processes and tumors that affect the body of the uterus contribute to the emergence of its pathological inclination.
For example, lateroversio uteri can occur with a unilateral ovarian tumor or salpingo-oophoritis in that the upper body of the uterus shifts to the side wall of the pelvis, and the cervix in the opposite direction. In the final stages of inflammation of the appendages and peritoneal cover of the tubes, as a result of scarring and wrinkling, the body of the uterus leans towards the pathological process, and the vaginal part of the cervix in the opposite direction (the body to the right, the cervix to the left and vice versa). A similar effect in the formation of adhesions after surgery on the uterine appendages. Tumors of the ovary and uterus can cause the uterus to rotate (rotatio) and even torsion (torsio). The origin of these rare anomalies is usually associated with unilateral growth of subserous fibroids or with an intraligamentary location of the ovarian tumor. The above diseases of the genital organs (inflammatory processes, tumors, etc.). With their appropriate location, they can cause pathological dislocation of the uterus. However, in the occurrence of these position anomalies, general disturbances that have occurred in the body are of great importance.
Thus, incorrect positions of the uterus (positions, tilts, kinks, turns, etc.). Usually it is a consequence of pathological processes localized outside of it. The disorders observed in them usually do not depend on the displacement of the uterus, but on the underlying disease that caused this position anomaly. Therefore, many displacements of the uterus have no independent clinical significance. The most important clinical significance are downward displacement of the uterus (omission and prolapse), retrodeviation (posterior displacement, mainly retroflexion) and pathological anteflexia. With anomalies in the position of the female genital organs, the most important in terms of frequency and clinical significance are omitted and prolapse of the walls of the vagina, which is often accompanied by a downward displacement of the uterus; There is much in common in the origins of these anomalies.
Retroflexion and retroversion of the uterus (retroflexio et retroversio uteri)
Retroversion is observed in ovarian tumors that press on the anterior surface of the uterus (upper arm of the lever). In this case, the body of the uterus deviates backwards, and the vaginal part of the cervix - anteriorly. Retroversion can occur when the upper body of the uterus is connected by parametric adhesions to the serosa of the rectum.With infantilism or hypoplasia of the genital organs, a mobile retroversion of the uterus is sometimes observed, associated with weakness of the sacro-uterine ligaments and shortening of the anterior fornix of the vagina. With a shortened anterior fornix, the cervix deviates anteriorly, and the body of the uterus posteriorly. As an independent anomaly of the position of the uterus, retroversion is rarely observed. Usually this anomaly is associated with retroflexion. Retroversion usually precedes retroflexion, the transition of the uterus from its normal position to retroflexion occurs through the stage of retroversion. Retroflection is characterized by the fact that the angle between the body and the cervix is open backwards, the body of the uterus is tilted backwards, the cervix is directed anteriorly. In contrast to the normal position, the body of the uterus is in the back of the pelvis, the cervix is in the front. The bladder is not covered by the uterus, the intestinal loops are located in the excavatio vesi-couterina and put pressure on the anterior surface of the uterus and the posterior wall of the bladder. The bladder is slightly pushed down along with the anterior wall of the vagina. The latter circumstance contributes to the prolapse of the genital organs, especially when the ligamentous apparatus of the uterus, the muscles of the pelvic floor and the anterior abdominal wall are relaxed. With retroflexion, the uterine appendages often descend, located at the uterus or behind it. With a sharp degree of inflection of the uterus, venous congestion may occur, as a result of the simultaneous inflection of the vessels, especially the thin-walled veins of the uterus. However, venous stasis may not be.
The degree of inflection of the uterus posteriorly is different. With a pronounced retroflexion, the angle between the body and the cervix will not be blunt, but sharp, the body of the uterus is located in the recto-uterine pocket, the bottom of the uterus may be located below the level of the vaginal part of the cervix. The retroflexed uterus can be mobile (retroflexio uteri inobilis), or fixedly attached by adhesions to neighboring organs, usually to the peritoneum of the rectum (retroflexio uteri fixata).
Etiology: before the bend and inclination of the uterus backwards, there are various causes that violate the tone of the uterus, cause relaxation of it, increasing, fixing and supporting the apparatus, as well as inflammatory diseases accompanied by the formation of a compound:
1. Decreased tone of the uterus and its connection with infantilism and hypoplasia of the genital organs contributes to the occurrence of retroflection. With relaxation of the sacro-uterine and round ligaments, the cervix moves anteriorly, and the body posteriorly. A decrease in the tone of the uterus and ligamentous apparatus is facilitated by insufficiency of ovarian function and other general disorders observed with a delay in the development of the body.
2. Weakening of tissue tone and stability in connection with constitutional features (asthenic constitution), birth trauma and improper involution of the genital organs, weakening of the body (diseases, aging). Retroflexion of the uterus contributes to asthenia, characterized by insufficient muscle tone and connective tissue. In women with an asthenic constitution, there is a reduced tone of the uterus, its ligamentous apparatus and pelvic floor muscles. Under these conditions, there is excessive mobility of the uterus. The uterus, straightened and displaced posteriorly with a full bladder, slowly returns to its original position, the intestine gets between the bladder and the uterus and begins to put pressure on its front surface. First, an inclination is formed, and then a posterior bend of the uterus, which is also facilitated by the weakness of the abdominal wall. When the tone of the abdominal muscles is relaxed, the conditions that balance the weight of the internal organs change (the function of the abdominal wall, pelvic floor and diaphragm is impaired), and the influence of intracranial pressure on the genitals increases. The gravity of the internal organs is transmitted to the anterior surface of the uterus, which contributes to the formation of retroflexion. Multiple births, especially complicated by surgical interventions and infection, can cause a decrease in the tone of the uterus, its ligaments, pelvic floor muscles and abdominal wall. Under these conditions, retroversion and retroflexion of the uterus may occur.
Slow involution of the uterus and other parts of the reproductive apparatus may be the cause of posterior deviation of the uterus due to a simultaneous decrease in tone. The occurrence of retroflexia is facilitated by postpartum infection and prolonged stay of the woman in labor in bed. Violation of the muscles and packing of this pelvic floor during childbirth is one of the important reasons for the origin of retro-deviation of the uterus. The pelvic floor is excluded from the complex of factors that ensure the preservation of the normal position of the uterus. The mass of the internal organs is balanced for some time by the compensatory function of the abdominal wall, but this function may be insufficient. The force of the mass of the internal organs is directed to the pelvic area, with the prolonged existence of these conditions, the ligamentous apparatus of the uterus relaxes and prerequisites for retroversion and retroflexion arise. Prolonged and debilitating diseases can cause a decrease in tissue tone and contribute to retrodeviation of the uterus in the presence of additional unfavorable conditions. Retroversion and retroflection are often observed in old age due to atrophy of the uterus and a decrease in its tone.
3. Inflammatory processes, accompanied by the formation of adhesions between the body of the uterus and the peritoneum of the posterior wall of the small pelvis (the peritoneum covering the rectum and lining the Douglas space), causes retroflexion of the uterus. In this case, a fixed retroflexion of the uterus usually occurs.
4. Retroflections can cause ovarian tumors located in the excavatio vesico-uterina, as well as myoma nodes growing on the anterior wall of the uterus. Elevation (elevation) of the uterus (elevatio uterine). When shifted upward, the uterus is completely or upper part located above the plane of the entrance to the pelvis, the vagina is removed, the neck is difficult or not reached at all. Physiological elevation of the uterus is observed in childhood, as well as with simultaneous overflow of the bladder and rectal ampulla. Pathological elevation occurs when the accumulation of menstrual blood in the vagina (haema-tocolpos) due to atresia of the hymen or lower vagina. The uterus can be displaced upwards with bulky tumors of the vagina and rectum, with submucosal fibroids that are born, with limited inflammatory effusions, tumors, or accumulation of blood in the Douglas space. The uterus also rises with tumors located between the sheets of the broad ligament. Elevation of the uterus is observed when irrigating it with the anterior abdominal wall after operations (caesarean section, artificially created elevation during ventricular fixation), less often after inflammatory diseases.
Incorrect positions of the female genital organs
Violations of the normal arrangement of the genital organs in women are quite common and can be a manifestation of a wide variety of pathological processes. Main reasons their occurrence are:
Inflammatory processes in the genitals;
Adhesions in the pelvis;
Underdevelopment of the internal genital organs;
Congenital anatomical features;
Weakness of the pelvic floor muscles;
Tumors localized both in the genitals and in the bladder or in the rectum;
Weakness of the ligamentous apparatus of the uterus.
When determining the correct or incorrect location of the female genital organs, the focus is on the position of the uterus and somewhat less on the vagina. The appendages of the uterus (ovaries and tubes) are very mobile and move, as a rule, along with it under the influence of changes in intra-abdominal pressure, filling or emptying the bladder and intestines. Significant displacement of the uterus occurs during pregnancy. It is characteristic that after the termination of these factors, the uterus relatively quickly returns to its original position. In childhood, the uterus is located much higher, and in old age (due to the developing atrophy of the pelvic floor muscles and ligaments) it is lower than in the reproductive period of a woman's life.
In the treatment of incorrect positions of the female genital organs, an important role belongs to therapeutic exercises. When doing it, you need to remember a few rules.
Rules for performing therapeutic exercises
1. Unpleasant sensations, and even more so pain during exercise, should not be. At the end of the gymnastics, only pleasant muscle fatigue should be felt.
2. Should be engaged at least 5 times a week. Exercises can be performed both in the morning and in the evening, but always at least 2 hours before or 2 hours after a meal.
3. Start with fewer repetitions of the exercise, gradually increasing to more. Follow proper breathing. Focusing on well-being, include pauses for rest in the complex.
4. If you experience pain and other unpleasant phenomena, be sure to consult your doctor.
5. The control of a gynecologist is desirable in the first days of classes in order to take into account the response of the body to the load, as well as at the end of the course of treatment (after 1–1.5 months), when favorable changes can be noted during an internal study.
Therapeutic exercises with incorrect positions of the uterus
Normal position of the uterus along the midline of the pelvic cavity, moderately inclined forward (see Fig. 2). TO abnormal positions of the uterus include:
Its displacement forward (Fig. 4, a) as a result of adhesive processes in the abdominal cavity due to the transferred inflammatory process, due to infiltrates in the parauterine tissue, or due to tumors of the ovaries, fallopian tubes;
Its shift back (Fig. 4, b) due to prolonged forced horizontal position of the body, inflammatory processes, underdevelopment of internal genital organs, etc .;
Lateral displacement of the uterus to the right or left (Fig. 4, v) due to inflammatory processes in the genitals or adjacent loops of the intestines with the formation of adhesions in the peritoneum and scars in the pelvic tissue, pulling the uterus to the side;
"tilts" of the uterus, in which her body is pulled by scars and adhesions in one direction, and the neck in the other; bending of the uterus - a change in the angle between the cervix and the body of the uterus (backward bending of the uterus is often the cause of infertility) (Fig. 4, G).
Rice. 4. Wrong position of the uterus:
a - displacement of the uterus anteriorly; b - posterior displacement of the uterus; v - shift to the left (due to the development of an ovarian tumor); G - bending of the uterus
Therapy of abnormal positions of the uterus should be comprehensive. Along with measures that directly affect the restoration of the physiological position of the uterus, it is necessary to pay special attention to eliminating the causes that caused this disease.
Gymnastics occupies a special place in the treatment of this disease. In addition to the general strengthening effect on the body, specially selected exercises restore the normal physiological position of the uterus.
indication for medical gymnastics acquired forms violations of the position of the uterus, in contrast to congenital forms associated with malformations, the treatment of which has its own characteristics.
If the incorrect position of the uterus is aggravated by inflammation, neoplasm, etc., then gymnastics is indicated after the elimination of these complications.
Special physical exercises are selected in such a way as to displace the uterus anteriorly and fix it in a physiologically correct position. This is also achieved by choosing the most favorable starting positions when performing exercises, in this case, kneeling, sitting on the floor, lying on the stomach, when the uterus takes the correct position.
When doing most exercises, you need to monitor proper breathing. First of all, ensure that there are no breath holdings, so that the movement is always accompanied by a phase of inhalation or exhalation, no matter how difficult it may be to perform it. Usually, inhalation during physical exercises is done when a person unbends, exhalation - when he bends.
The control of a gynecologist is desirable in the first days of classes in order to take into account the response of the body to physical exercises, as well as at the end of the course of treatment (after 1.5–2 months of classes), when favorable changes in the position of the uterus can be noted during an internal study.
A set of special exercises for displacement of the uterus(Fig. 5)
A. Starting position (i.p. )- sitting on the floor with straight legs
1. Emphasis with hands behind, legs apart ( a). Connecting the legs, tilt the torso forward, bringing the arms forward ( b). Repeat 10-12 times. The pace is average, breathing is free.
2. I.p. - the same, hands to the sides. Exhale - turn to the left, bend over and reach with your right hand to your left toe; inhale - return to i.p. The same with the left hand to the right toe. Repeat 6-8 times.
3.I.p. - then same. Raise your hands up, leaning back - inhale; tilt your torso forward with a swinging motion, trying to reach your socks with your fingers - exhale. Repeat 6-8 times. The pace is average.
4. I.p. - the same, the legs are bent at the knees, arms clasped around the shins. Move forward and backward with support on the buttocks and heels. Repeat 6-8 times on each side.
5. I.p. - sitting on the floor, legs together, straightened, emphasis with hands behind ( a). Simultaneous bending ( b) and extension of the legs in the knee joints. Breathing is free, the pace is slow. Repeat 10-12 times.
B. Starting position (i.p. )- standing on all fours
Note that the arms and hips should be at right angles to the body.
6. Alternately lifting up the outstretched legs. Inhale - lift your right leg back and up; exhale - return to i.p. The same with the left foot. Repeat 6-8 times with each leg.
7. Alternate raising forward-upward outstretched arms. Inhale - raise your right hand; exhale - lower. The same with the left hand. Repeat 6-8 times with each hand.
8. Simultaneously raise the left arm up and forward and the right leg up and back while inhaling; as you exhale, return to i.p.
9. "Step over" with straight arms to the left until the maximum turn of the body to the left - when the uterus is shifted to the right. The same to the right - with the displacement of the uterus to the left. "Step" your hands back to the knee joints, and back when the uterus is bent. Repeat 6-10 times any option. The pace is average, breathing is free.
10. Leaning on your palms, “step over” with your knees and feet to the right, left side or straight (according to the method described in exercise 9). The pace is average, breathing is free. Repeat 6-8 times.
11. While inhaling, vigorously pulling in the perineum, lower your head, arching your back ( ab). Repeat 8-10 times.
12. On exhalation, without taking your hands off the floor, stretching as much as possible and arching your back, lower your pelvis between your heels; inhale - return to i.p. Repeat 8-12 times. The pace is slow.
13. Bend your arms at the elbow joints, take the knee-elbow position. Leaning on your forearms, lift your pelvis up as much as possible, rising on your toes and straightening your legs at the knee joints; go back to i.p.
14. From i.p. standing on all fours, lift the pelvis up as much as possible, straightening the legs at the knee joints, leaning on the feet and palms of straight arms; go back to i.p. Repeat 4-6 times. Breathing is free. The pace is slow.
15. On exhalation, without taking your hands off the floor, stretching as much as possible and arching your back, lower your pelvis between your heels (a); while inhaling, leaning on your hands, gradually straighten up, bending in the lower back, as if crawling under the fence (b
16. From the knee-elbow position while inhaling, lift the straight left leg up; as you exhale, return to i.p. The same with the right foot. Repeat 10-12 times with each leg. The pace is average.
B. Starting position lying on the stomach
17. Legs slightly apart, arms bent at the elbows (hands at shoulder level). Crawling in a plastunsky way for 30-60 seconds. The pace is average, breathing is free.
18. I.p. - also. At the same time, raise your head, shoulders, upper body and legs, arching sharply at the waist and raising your arms forward and upward. Repeat 4-6 times. The pace is slow, breathing is free.
Rice. 5. A set of special exercises for uterine displacements
19. Lie face down, palms at shoulder level. Exhale completely. Slowly inhaling, gently raise your head, tilting it as far back as possible. Straining your back muscles, raise your shoulders and torso, leaning on your hands. The lower abdomen and pelvis are on the floor. Breathing calmly, hold this position for 15-20 seconds. Exhaling slowly return to i.p. Repeat at least 3 times.
20. Raise your legs, and without lowering them to the floor, do short swings up and down, pulling your socks. Return to i.p. Repeat 8-10 times. The pace is average. Breathing is free.
21. While inhaling, clasp the ankle joints with your palms and swing 3–8 times back and forth, 3–8 times to the right and left. Tighten all muscles. Relax and lie down for 10-15 seconds without moving. Don't hold your breath.
D. Starting position standing
22. Feet shoulder width apart, arms to the sides. When the uterus is shifted to the left, tilt the torso to the right and touch the toes of the right leg with the fingers of the left hand (the right hand is laid aside). The same with the right hand to the toe of the left leg when the uterus is displaced to the right. When the uterus is bent, lower your hands to your toes (see Fig. 5). Repeat each option 6-8 times. The pace is slow, breathing is free.
23. Standing with the right side to the back of the chair, holding on to it with the right hand, the left hand is along the body. Perform swing movements with your right foot back and forth. Repeat 6-10 times. The same with the left foot, turning the left side to the back of the chair. The pace is average, breathing is free.
24. Hands on the belt. Walking with a cross step, when the left foot is placed in front of the right and vice versa. You can use walking in a semi-squat. Walking time 1-2 minutes.
Remember: The starting position lying on your back not only does not help to correct the incorrect position of the uterus, but moreover, it fixes this incorrect position. Therefore, it is recommended that all women suffering from this ailment rest and sleep in a prone position.
Therapeutic exercises for prolapse of the vagina
One of the most common diseases of the female genital organs is the prolapse and prolapse of the walls of the vagina, which can occur in young and old, in women who have given birth and who have not given birth. The main cause of the disease is a decrease in tone and (or) a violation of the integrity of the muscles of the pelvic floor. The muscles that make up the pelvic floor suffer from:
a) repeated stretching and overstretching in multiparous women, especially at the birth of large children;
b) birth trauma, especially surgical (imposition of obstetric forceps, extraction of the fetus by the pelvic end, vacuum extraction of the fetus, etc.);
c) age-related involution of the muscular apparatus, observed after 55–60 years, especially if a woman performs hard physical work;
d) a sharp and significant weight loss of young nulliparous women, either striving to achieve the modern ideal of beauty by observing strict diets, or as a result of illness.
Symptoms. At the initial stage, the disease may not manifest itself in any way, then there are pulling pains in the lower abdomen, in the lower back and sacrum, a feeling of the presence of a foreign body in the genital gap, impaired urination (often more frequent), difficulty in emptying the intestines, leading to chronic constipation.
Complications. The vagina is closely connected with the cervix, which, when lowered, is pulled down. Therefore, the prolapse of the vagina, if not properly treated, usually entails prolapse and sometimes prolapse of the uterus (Fig. 6), which requires surgical treatment.
Rice. 6. Complications of prolapsed vaginal walls
Treatment. At the initial stage of the disease, when the prolapse of the vagina is not accompanied by prolapse of the internal organs, in particular, the uterus, especially high treatment efficiency is achieved using therapeutic exercises. Special exercises can strengthen the muscles of the pelvic floor, and this will lead to the restoration of the normal physiological position of the vagina.
The most favorable starting points for the treatment of this disease are:
1) standing on all fours;
2) lying on your back.
A set of special exercises for vaginal prolapse(Fig. 7)
A. Starting position standing on all fours
1. Alternately lifting up the outstretched legs. Inhale - lift your left leg back and up; exhale - return to i.p. The same with the right foot. Repeat 6-8 times with each leg.
2. At the same time, while inhaling, lift your left arm up and forward and your right leg up and back; as you exhale, return to i.p. The same with the right hand and left foot. Repeat 4-6 times. The pace is slow.
3. While inhaling, vigorously pulling in the perineum, lower your head, arching your back ( a); as you exhale, just as energetically relax the muscles of the perineum and raise your head, bending in the lower back ( b). Repeat 8-10 times.
4. Bend your arms at the elbow joints, take the knee-elbow position. Leaning on your forearms, lift your pelvis up as much as possible, rising on your toes and straightening your legs at the knee joints; go back to i.p. Repeat 4-6 times. Breathing is free.
5. From the knee-elbow position while inhaling, lift the straight right leg up; as you exhale, return to i.p. The same with the left foot. Repeat 10-12 times with each leg. The pace is average.
6. From i.p. standing on all fours, lift the pelvis up as much as possible, straightening the legs at the knee joints, leaning on the feet and palms of straight arms; return to starting position. Repeat 4-6 times. Breathing is free. The pace is slow.
7. On exhalation, without taking your hands off the floor, stretching as much as possible and arching your back, lower your pelvis between your heels (a); while inhaling, leaning on your hands, gradually straighten up, bending in the lower back, as if crawling under the fence ( b). Repeat 6-8 times. The pace is slow.
B. Starting position lying on your back
8. Legs together, arms along the body. Alternate lifting on the exhale of straight legs. Repeat 8-10 times with each leg. The pace is average. Don't hold your breath.
9. Feet together, hands on the belt. Raise your legs as you exhale, spread them apart as you inhale; as you exhale, close your legs, as you inhale, return to i.p. When lifting your legs, do not bend them at the knees. Repeat 6-8 times. The pace is slow.
10. Feet together (or one lying on top of the other), hands under the head. Raise your pelvis by arching in the lumbar region and at the same time pulling the anus inward. Repeat 8-10 times. The pace is slow, breathing is free.
Rice. 7. A set of special exercises for vaginal prolapse
11. Legs together, arms along the body. Raise your legs, bending them at the knee joints, and perform movements, as when riding a bicycle. Repeat 16-20 times. The pace is average, breathing is free.
12. I.p. - also. Raise your legs and lower them behind your head, trying to touch the floor with your toes. Repeat 4-6 times. The pace is slow, breathing is free.
13. I.p. - also. While exhaling, simultaneously raise straight legs at an angle of 30–45 ° to the floor, while inhaling, return to i.p. Repeat 6-12 times. The pace is slow.
14. The legs are slightly apart and bent at the knee joints (with support on the entire foot), arms under the head. Raise your pelvis by spreading your knees wide and pulling your anus in. Repeat 8-10 times. The pace is slow, breathing is free.
Prevention of incorrect positions of the female genital organs is to eliminate the causes of these diseases.
Incorrect positions of the uterus can develop in childhood if the girl (as a result of parental negligence) the bladder and intestines are not emptied in time, which leads to posterior deviation of the uterus.
Parents of girls should also be aware of the dangers of increased intra-abdominal pressure as a result of physical overstrain: in everyday life, girls of 8–9 years old are often assigned to babysit and carry one-year-old brothers or sisters in their arms. And this negatively affects both the general development of the girl and the position of her internal organs, and the uterus in particular.
Spontaneous and artificial abortions with subsequent inflammatory diseases of the uterus; improperly conducted postpartum period with associated complications - all these points contribute to the development of incorrect positions of the female genital organs.
Physical education plays an important role in the prevention of these diseases. Thanks to gymnastics, a healthy, physically developed, functionally complete body is created, with good resistance to many harmful influences.
From the book The Art of Love author Michalina WislotskayaMUSCLES OF THE FEMALE GENITAL ORGANS The muscles of the female genital organs consist of three main muscles: the muscles of the perineum, the supporting muscles of the vagina and anus, as well as the muscles of the vagina, which have a circular direction. In the first group of muscles, the sphincter of the urethra
From the book Obstetrics and Gynecology: Lecture Notes author A. A. Ilyin1. Anatomy of the female genital organs The genital organs of a woman are usually divided into external and internal. The external genitalia are the pubis, the labia majora and minora, the clitoris, the vestibule of the vagina, and the hymen. Internal include the vagina, uterus, uterine
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Anomalies in the position of the genital organs- their persistent deviation from normal anatomical localization, which can lead to pathological manifestations.
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Etiological factors:
♦ tumors localized in the genitals (uterine fibroids, ovarian cystomas, etc.) or beyond (tumors of the rectum, bladder);
♦ inflammatory diseases, adhesive processes in the small pelvis, leading to fixation of the uterus to the parietal peritoneum;
♦ anomalies in the development of the genital organs;
♦ damage to the perineum, vagina, ligamentous apparatus;
♦ acquired diseases that reduce the tone of the tissues of the genital organs;
♦ postmenopausal hypoestrogenism.
Types of anomalies. There are several options for anomalies in the position of the genital organs:
1. Pathological position (positio) and inclination (versio) of the uterus.
2. Inflection of the body of the uterus (flexio).
3. Rotation (rotatio) and twisting (torsio) of the uterus.
4. Displacement of the uterus in the vertical plane: raising upward (elevatio), omission (descensus) and prolapse (prolapsus), eversion of the uterus (inversio).
pathological position(positio) - deviation of the longitudinal axis of the uterus from the midline of the pelvis. Among the incorrect positions of the uterus (displacement in the horizontal plane), the following types are distinguished:
Anteposition (antepositio)- displacement of the uterus forward. As a physiological phenomenon, it is observed when the rectum is full. It can be caused by a tumor of the recto-uterine space or the presence of exudate in it.
Retroposition (retropositio)- displacement of the uterus back while maintaining the correct direction of the axis of the uterus. Occurs when the bladder is overfilled, voluminous formations of the small pelvis located in front of the uterus.
Lateroposition (lateropositio)- displacement of the uterus to the side. Lateroposition can be observed with tumors of the small pelvis, inflammatory infiltrates of periuterine tissue, there are two types:
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2. Sinistroposition (sinistropositio) - displacement of the uterus to the left.
Pathological slope (versio) - displacement of the body of the uterus in one direction, and the cervix in the other. It occurs as a result of inflammatory processes in the cellulose of the pelvis and the ligamentous apparatus of the internal genital organs. There are such pathological inclinations of the uterus:
1. Anteversia (anteversio) - the body of the uterus is displaced anteriorly, and the cervix is posteriorly.
2. Retroversion (retroversio)- the body of the uterus is displaced backwards, and the cervix is anteriorly.
4. Sinistroversiya (sinistroversio) - the body of the uterus is tilted to the left, and the cervix is tilted to the right.
Bend (flexio) body of the uterus relative to the cervix. Types of uterine inflection:
1. Hyperanteflexia (hyperanteflexio)- pathological inflection of the uterus anteriorly, when an acute angle open anteriorly is formed between the body and the cervix (normally an obtuse angle open anteriorly).
Hyperanteflexia often accompanies sexual infantilism (the size of the cervix exceeds the length of the body of the uterus), less often - the result of inflammatory processes in the pelvic organs, sacro-uterine ligaments. With hyperanteflexia, the bladder does not cover the uterus, while the intestinal loops penetrate between the uterus and the bladder, putting pressure on the latter. With prolonged exposure, it is possible to shift the bladder and vagina downwards. Hypomenorrhea, algomenorrhea, constant pain in the pelvic area, dyspareunia, and infertility are observed. Structural and functional changes inherent in uterine hypoplasia are often found: the cervix has a conical shape, the body is small in size, the ratio between the body and the cervix corresponds to childhood, when the cervix approaches or exceeds the size of the uterine body in length. In addition, it is noted
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weakness of the ligamentous apparatus, which causes displacement of the uterus (acute-angled hyperanteflexia) posteriorly.
2. Retroflection (retroflexio) - inflection of the body of the uterus arched back with the formation between the body and the cervix of the angle, open backwards, while the body of the uterus is directed backwards, and the cervix - anteriorly. The bladder is not covered by the uterus, while the intestinal loops penetrate into the vesico-uterine space and put pressure on the wall of the bladder and on the anterior surface of the body of the uterus. During vaginal examination, the cervix is facing anteriorly, the body of the uterus is located posteriorly and is determined through the posterior fornix, between the body and the cervix there is an angle open posteriorly.
3. Retrodeviation (retrodeviatio) - it is a combination of retroflection and retroversion. There are two options for retrodeviation: mobile and fixed. The causes of this condition are anatomical and physiological disorders (decrease in the tone of the supporting, suspension and fixing apparatus of the genital organs), a sharp decrease in body weight, and improper management of the postpartum period. Fixed retrodeviation of the uterus develops as a result of past inflammatory diseases of the female genital organs, external endometriosis, tumors of the pelvic organs. With fixed retrodeviation, there are pains in the lower abdomen and in the sacrum, hyperpolymenorrhea, algo-dysmenorrhea, dysfunction of the pelvic organs, miscarriage.
Rotation of the uterus. When turning the uterus is rotated around the longitudinal axis. It occurs as a result of inflammation of the sacro-uterine ligaments, their shortening, as well as in the presence of tumors of the small pelvis, which are located behind and on the sides of the uterus.
Torsion (torsio) of the uterus - rotation of the body of the uterus in the region of the lower segment with a fixed cervix. The reasons for this condition are:
♦ unilateral volumetric formations of the uterine appendages;
♦ large subserous myomatous nodes on the uterus.
Displacement of the internal genital organs in a vertical plane
bones
Elevation (elevatio) of the uterus- upward displacement, while the bottom of the uterus is located above the entrance to the small pelvis, and the vaginal
Chapter P. Anomalies in the position of the genital organs 495
part of the cervix above the spinal plane. Among the reasons for the development of this pathology are:
1. Physiological causes (overflow of the bladder and rectum).
2. Pathological causes:
Accumulation of menstrual blood in the vagina due to atresia of the hymen or lower vagina;
Volumetric tumors of the vagina and rectum;
Encapsulated inflammatory effusions in the recto-uterine cavity;
Fusion of the uterus with the anterior abdominal wall after laparotomy (caesarean section, ventrofixation).
Omission (descensus) and prolapse (prolapse) uterus and vagina are detailed in section 11.3.
Clinical manifestations in patients with abnormal positions of the genital organs are determined by the main pathological process that caused this or that position anomaly. Treatment for all anomalies in the position of the genital organs should first of all be aimed at correcting the underlying disease.
