As you know, during gynecological examinations in women, not only infectious and inflammatory diseases of the reproductive system are detected. After examining the patient, the doctor may also detect an abnormal location of the genital organs. One of these is the bend of the cervix.

What is cervical flexion?

Cervical flexion is a common disease of the female reproductive system. Characterized by deviation of an organ from its normal location. The doctor can detect the pathology when examining a woman in a chair.

Normally, in the small pelvis, the uterus occupies a mid-position, and its body and cervix are at an obtuse angle relative to each other. The uterine fundus is directed anteriorly and upward, and the cervical part (vaginal) is directed downward and posteriorly.

For certain reasons, an organ can change its position. This is not always a pathology. If a girl has such signs from birth (especially when her mother and grandmother had the same thing), we can assume that this is an individual genetic feature.

Classification: bending of the organ posteriorly, anteriorly, to the sides

Bends can be observed:

• with lateral displacement of the uterus;
• its inclinations (versions);
• bends (flexions).

Variants of the norm are considered:

1. Anteversion: the uterus is located in the center of the small pelvis, the body and the cervix are on the same axis.
2. Anteflexion: the uterus is located in the center of the small pelvis, the cervix is ​​located down and posteriorly, the bottom of the organ is directed upward and anteriorly.
3. Retroversion: the body and neck are on the same axis so that the organ occupies a posteriorly deflected position in the small pelvis.

The pathologies are:

1. Hyperanteflexia: bending of the uterine body forward, with the fundus strongly inclined towards the bladder.
2. Retroflexion: the body of the uterus is bent backwards, the fundus is shifted towards the rectum.
3. Sinistroflexia: bending of the uterine body to the left.
4. Dextrumflexion: bending of the uterine body to the right.

In addition to classification according to the position of the uterus in the pelvis, there are:

• fixed deviations (occur due to adhesions in the pelvis or tumor formations);
• unfixed deviations (they do not cause any particular concern, they are a consequence of sudden weight loss, delivery of a large fetus and some gynecological diseases).

Options for the location of the uterus in the pelvis - photo gallery

Position of the uterus anteversio Position of the uterus anteflexio Position of the uterus retroversio Retroflexio position of the uterus Hyperanteflexio position of the uterus

Causes and development factors

In approximately one in ten women with a similar diagnosis, an anomaly in the position of the uterus is considered a variant of the norm (anatomical feature of the body). Basically, organ displacement is a pathology and can be caused by a number of reasons:

• anatomical features of the structure of the reproductive organs;
• early drop-off of girls;
• adhesions in the pelvis;
• tumor process;
• ovarian cysts;
• inflammatory processes in the pelvic organs;
• weakening of the muscle tone of the uterus;
• weakening of the ligamentous apparatus that holds the uterus in its normal position in the pelvis;
• intrauterine surgical interventions (abortions, curettage, etc.);
• pregnancy pathologies;
• difficult childbirth;
• improper obstetric care;
• uterine subinvolution (poor contraction after childbirth);
• chronic constipation;
• untimely emptying of the bladder (overflow);
• hard physical labor.

If a woman has a history (information about the course of the disease) of any of the above, then she should be classified as a risk group.

Symptoms of a bent uterus

Clinical symptoms with a changed position of the uterus are associated not so much with the anomaly itself, but with the reasons that caused this displacement.

What to pay attention to:

• painful menstruation. When blood and blood clots leave the cavity of the curved uterus, hypertonicity of its muscles occurs, which leads to quite painful sensations;
• constipation or increased frequency of urination due to squeezing of the intestines or bladder by the bent uterus;
• miscarriage due to impaired stretching of the uterine walls;
• infertility, which is associated with the inability of sperm to pass into the uterine cavity at the point of its inflection.
• pain during sexual intercourse (mostly occurs with fixed bends due to tissue overstretching);
• profuse leucorrhoea.

Diagnosis and differential diagnosis

Determining the abnormal location of the uterus is not difficult. The diagnosis is made on the basis of a gynecological examination and diagnostic methods.

Already during a bimanual (two-handed) examination of a woman in a chair, the doctor can detect a deviation of the uterus from its normal location. After this, he will give directions for additional research (depending on complaints and manifestations) to establish the exact causes of uterine inflexion, as well as to differentiate the pathology from other conditions:

• Ultrasound examination of the pelvic organs will help determine the size, position, location of the uterus and the condition of the appendages (the presence of tumors and cystic formations);
• magnetic resonance imaging (MRI) and computed tomography (CT) allow you to more accurately see in several projections the location of the uterus in the pelvis and the position of the bend, the condition of the appendages, determine the presence of tumors and cysts, and adhesions;
• hysterosalpingography allows you to study the structure of the uterus and fallopian tubes, and also serves as a way to check tubal patency;

Treatment of uterine curvature

Treatment comes down primarily to eliminating the causes that caused the displacement of the organ. As a rule, this process is long. In some cases, the anomaly can only be eliminated through surgery. If nothing bothers the woman and no other pathologies have been identified, then she is put under dispensary observation to monitor her condition.

Drug therapy

Drug therapy is aimed at eliminating inflammatory and infectious processes in the pelvic organs and alleviating the symptoms of the pathology. For these purposes the following is used:

• antibacterial/antiseptic therapy. Used in the presence of bacterial infections (for example, Hexicon vaginal suppositories, Chlorhexidine solution);
• antiprotozoal drugs. Necessary if a fungal infection is present (for example, drugs Metronidazole, Trichopolum);
• non-steroidal anti-inflammatory drugs. Prescribed to relieve pain and relieve inflammation (Ibuprofen, Paracetamol);
• analgesics. Used for pain relief (Analgin, Tempalgin);
• enzyme proteolytic preparations. Used to improve nutrition and tissue permeability, resorption and elimination of adhesions (Longidaza drug).
• m-anticholinergics. Necessary to relieve pain during menstruation (they reduce the tone of the uterine muscles, thereby promoting the normal outflow of blood and blood clots from the uterine cavity). Such remedies include Buscopan rectal suppositories.

Medicines for the treatment of cervical flexion - photo gallery

Buscopan relaxes the uterine muscles, relieving pain Tempalgin is an excellent pain reliever Ibuprofen relieves pain and relieves inflammation in the pelvis Metronidazole is a broad-spectrum drug with antibacterial and antiprotozoal activity Longidaza promotes resorption of adhesions Hexicon belongs to the group of antiseptics; it is used for sexually transmitted diseases, as well as for infectious and inflammatory pathologies

Gymnastic exercises

If the cause of the pathology is weakening of the pelvic floor muscles, then Kegel gymnastics will help. Quite effective exercises are:

The gynecologist should draw up a set of necessary exercises and explain the exact technique of execution.

Gymnastics is performed in different positions: sitting, lying, standing, on all fours and squatting.

Physiotherapeutic methods

Physiotherapeutic methods are not the only method of treatment and should only be used in combination. Very often, when the uterus is bent, gynecological massage is used. It helps with muscle weakness, adhesions and ovarian dysfunction. As a result of its implementation, blood circulation in the uterus and pelvic cavity improves, the tone of both the pelvic and uterine muscles increases, the adhesive process decreases (and in some cases is completely eliminated), which helps return the uterus to its normal position.

The course of treatment is individual and varies from 4 to 20 procedures.

It is also advisable to use:

• electro- and phonophoresis with drugs;
• acupuncture;
• hirudotherapy;
• mud therapy.

Surgical treatment

Surgical treatment is used extremely rarely and in extremely advanced cases. Using laparoscopy with minimal trauma, adhesions are dissected, tumor and cystic formations that have led to a change in the position of the uterus are removed, and its normal position is restored.

It should be noted that the surgical treatment method is not a 100% guarantee that relapse will not occur.

Folk remedies

Folk remedies cannot be regarded as a panacea. They are only additional aids in treatment.

Here are some recipes that can be used for this pathology:

Treatment prognosis and possible complications

Many women are concerned about the possibility of conceiving with an abnormal position of the uterus. In general, the prognosis is favorable, but difficulties may arise. After the treatment, the question of pregnancy and pregnancy disappears by itself, since fertility is completely restored. After childbirth, the uterus, as a rule, takes its proper position in the pelvis.

In severe cases and if a woman does not want to be treated (especially if there are complications), infertility may occur.

Prevention

Prevention comes down to normalizing lifestyle and eliminating provoking factors.

What is needed:

• eliminate heavy physical labor;
• carry out proper rehabilitation after childbirth;
• empty your bladder and bowels regularly (don’t tolerate it);
• regularly visit a gynecologist (at least 2 times a year) for timely detection and treatment of inflammatory processes (they provoke the formation of adhesions);
• girls in infancy should not be dropped off prematurely;
• sleep on your stomach;
• exclude physical inactivity;
• To prevent constipation, eat regularly, consume at least two liters of fluid per day, food should contain a large amount of fiber.
• strictly observe intimate hygiene.

Bend of the cervix-video

Deflection of the uterus is a completely curable pathology. Most often, conservative therapy is sufficient to relieve unpleasant symptoms. The main thing is not to neglect the problem and start treatment on time to avoid complications.

What are genital malpositions?

The normal (typical) position of the genital organs in a healthy, sexually mature, non-pregnant and non-lactating woman is in an upright position with the bladder and rectum emptied. Normally, the fundus of the uterus is turned upward and does not protrude above the entrance to the small pelvis, the area of ​​the external uterine pharynx is at the level of the spinal spines, the vaginal part of the cervix is ​​downward and posterior. The body and cervix form an obtuse angle, open anteriorly (anteversio and anteflexio position). The vagina is located obliquely in the pelvic cavity, running from above and behind, down and anteriorly. The bottom of the bladder is adjacent to the anterior wall of the uterus in the isthmus region, the urethra is in contact with the anterior wall of the vagina in its middle and lower thirds. The rectum is located behind the vagina and is connected to it by loose fiber. The upper part of the posterior wall of the vagina - the posterior fornix - is covered with the peritoneum of the rectal-uterine space.

The normal position of the female genital organs is ensured by the own tone of the genital organs, the relationships of the internal organs and the coordinated activity of the diaphragm, abdominal wall and pelvic floor and the ligamentous apparatus of the uterus (suspensory, fixing and supporting).

The proper tone of the genital organs depends on the proper functioning of all body systems. A decrease in tone may be associated with a decrease in the level of sex hormones, disruption of the functional state of the nervous system, and age-related changes.

The relationships between the internal organs (intestines, omentum, parenchymal and genital organs) form their single complex. Intra-abdominal pressure is regulated by the cooperative function of the diaphragm, anterior abdominal wall and pelvic floor.

The suspensory ligament apparatus of the uterus consists of the round and broad ligaments of the uterus, the ligament proper and the suspensory ligament of the ovary. These ligaments ensure the midline position of the uterine fundus and its physiological anterior tilt.

The fixing ligamentous apparatus of the uterus includes the uterosacral, main, uterovesical and vesico-pubic ligaments. The fixation device ensures the central position of the uterus and makes it almost impossible to move it to the sides, back and front. Since the ligamentous apparatus extends from the lower part of the uterus, its physiological inclinations in different directions are possible (the woman is lying down, the bladder is full, etc.).

The supporting ligamentous apparatus of the uterus is represented mainly by the pelvic floor muscles (lower, middle and upper layers), as well as the vesicovaginal, rectovaginal septa and dense connective tissue located at the lateral walls of the vagina. The lower layer of the pelvic floor muscles consists of the external rectal sphincter, bulbocavernosus, ischiocavernosus and superficial transverse perineal muscles. The middle layer of muscles is represented by the urogenital diaphragm, the external sphincter of the urethra and the deep transverse perineal muscle. The upper layer of the pelvic floor muscles is formed by the paired levator ani muscle.

What Causes Incorrect Position of the Genitals?

Incorrect positions of the genital organs occur under the influence of inflammatory processes, tumors, injuries and other factors. The uterus can move both in the vertical plane (up and down), and around the longitudinal axis and in the horizontal plane. The most important clinical significance is downward displacement of the uterus (prolapse), posterior displacement (retroflexion) and pathological anteflexion (hyperanteflexia).

Symptoms of Incorrect Genital Positions

Hyperanteflexia is a pathological bend of the uterus anteriorly, when an acute angle (less than 70°) is created between the body and the cervix. Pathological anteflexion can be a consequence of sexual infantilism and, less commonly, an inflammatory process in the pelvis.

The clinical picture of hyperanteflexia corresponds to that of the underlying disease that caused the abnormal position of the uterus. The most typical complaints are about menstrual dysfunction such as hypomenstrual syndrome and algomenorrhea. Infertility (usually primary) often occurs due to decreased ovarian function.

The diagnosis is established on the basis of characteristic complaints and vaginal examination data. As a rule, the small uterus is sharply deviated anteriorly, with an elongated conical neck, the vagina is narrow, and the vaginal vaults are flattened.

Treatment of hyperanteflexia is based on eliminating the causes that caused this pathology (treatment of infantilism, inflammatory process). For severe algomenorrhea, various painkillers are used. Antispasmodics (no-spa, baralgin, etc.), as well as antiprostaglandins: indomethacin, butadione, etc., are widely used 2-3 days before the onset of menstruation.

Retroflexion of the uterus is an open posterior angle between the body and the cervix. In this position, the body of the uterus is tilted posteriorly, and the cervix is ​​tilted anteriorly. With retroflexion, the bladder is not covered by the uterus, and intestinal loops exert constant pressure on the anterior surface of the uterus and the posterior wall of the bladder. As a result, prolonged retroflexion leads to prolapse or prolapse of the genital organs.

There are mobile and fixed retroflexion of the uterus. Mobile retroflexion is a consequence of decreased tone of the uterus and its ligaments during infantilism, birth trauma, tumors of the uterus and ovaries. Mobile retroflexion often occurs in women of asthenic physique and after general severe illnesses with severe weight loss. Fixed retroflexion of the uterus is a consequence of inflammatory processes in the pelvis and endometriosis.

The clinical picture of uterine retroflexion is determined by the symptoms of the underlying disease: pain, dysfunction of adjacent organs and menstrual function. In many women, uterine retroflexion is not accompanied by any complaints and is discovered by chance during a gynecological examination.

Diagnosis of uterine retroflexion usually does not present any difficulties. Bimanual examination reveals a posteriorly deviated uterus, palpated through the posterior vaginal fornix. With mobile retroflexion, the uterus is quite easily brought back to its normal position; with fixed retroflexion, it is usually not possible to bring the uterus out.

Treatment. For asymptomatic uterine retroflexion, treatment is not indicated. Retroflexion with clinical symptoms requires treatment of the underlying disease (inflammatory processes, endometriosis). Pessaries to keep the uterus in the correct position are not currently used, nor is surgical correction of uterine retroflexion. Gynecological massage is also not recommended.

Which doctors should you contact if you have genital abnormalities?

Gynecologist

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Under normal conditions, the uterus is located in the center of the pelvis and has a certain physiological mobility. When the bladder is empty, the fundus and body of the uterus are directed forward; the front surface looks forward and down; the body of the uterus forms an angle with the cervix, open anteriorly. The position of the uterus changes during pregnancy, with a full bladder or rectum.

The causes of incorrect position of the uterus (bends, displacements - posteriorly or to the side (left, right), prolapse, torsion and kinks) are most often inflammatory processes in the pelvic tissue, which occur in diseases not only of the internal genital organs, but also of the intestines. Incorrect position of the uterus can also occur with: anomalies of its development; neoplasms localized in various parts of the reproductive system; multiple pregnancies and childbirths; birth injuries of the muscles and ligaments of the perineum; physical inactivity, leading to weakening of the muscles and ligaments of the abdomen and pelvis.

Prolapse and prolapse of the uterus. Prolapse of the uterus is a condition in which the uterus or vaginal walls drop down without extending beyond the genital opening. Uterine prolapse characterized by its partial or complete protrusion from the labia majora. The causes of these conditions are: violation of the integrity of the pelvic floor (unsutured perineal ruptures after childbirth); weakness of the abdominal muscles (especially in women who have given birth many times or in multiple pregnancies).

With prolapse and prolapse of the uterus, changes are noted in the vaginal mucosa, which are expressed by dryness, smoothing of folds, the formation of trophic ulcers in the cervical area, and pseudo-erosion. In addition, the genitourinary system is involved in the pathological process: prolapse of the posterior wall of the bladder is noted; the structure of the rectum is disrupted - there is a prolapse of its anterior wall, which is accompanied by insufficiency of the anal sphincter: hemorrhoids develop.

There are three degrees of this disease: I degree – the uterus is displaced downwards, the cervix is ​​located in the vagina; II degree - the body of the uterus in the vagina, the external os of the cervix in the vestibule of the vagina or below it - “partial prolapse”; III degree - prolapse of the entire uterus and, to a large extent, the vaginal wall outside the genital slit - “complete prolapse”.

Clinical picture. Characterized by nagging pain in the lower abdomen, lumbar region and sacrum; urinary disorders - complete or partial urinary incontinence during coughing, during physical exertion, lifting weights; development of constipation. In grade III, urination is difficult. The general condition worsens and the ability to work is lost for a long time.

The “risk group” consists of: primigravida women with second-degree postpartum perineal injuries; primiparous women who had a large fetus, especially with a breech presentation; women who completed childbirth surgically.

Treatment. Can be conservative or operative. As a rule, conservative treatment is effective in grade I. General strengthening procedures are used to improve the tone of the uterus, pelvic floor muscles and abdominal muscles. The leading place is occupied by physical exercises performed using traditional and non-traditional methods, and massage (especially gynecological). For grades II and III, surgical treatment is used.

Bends of the uterus posteriorly or anteriorly. Retrodeviation is associated with a violation of the tone of the uterus and a change in the angle between its neck and body, overstretching of the ligamentous apparatus, and weakness of the pelvic floor muscles. The cause of the development of this disease may be the consequences of inflammatory diseases of the female genital organs, which cause the formation of adhesions. The mobility of the uterus decreases, which can cause spontaneous abortions and strangulation of the pregnant uterus. Posterior bending of the uterus often causes infertility.

For posterior bends of the uterus, fixed with adhesions, therapeutic exercises are used in combination with physio‑ and balneo‑procedures, and gynecological massage.

– violations of the shape, size, localization, number, symmetry and proportions of the internal and external genital organs. The cause is unfavorable heredity, intoxication, infectious diseases, early and late gestosis, hormonal disorders, occupational hazards, stress, poor nutrition, poor environment, etc. The diagnosis is established on the basis of complaints, anamnesis, external examination, gynecological examination and instrumental results research. Therapeutic tactics are determined by the characteristics of the developmental defect.

General information

Anomalies of the female genital organs are disorders of the anatomical structure of the genital organs that arose during the period of intrauterine development. Usually accompanied by functional disorders. They account for 2-4% of the total number of birth defects. In more than 40% of cases they are combined with anomalies of the urinary system. Patients may also have lower gastrointestinal malformations, congenital heart defects, and musculoskeletal abnormalities.

The frequent combination of anomalies of the female genital organs with other congenital defects necessitates a thorough comprehensive examination of patients with this pathology. Congenital defects of the external genitalia are usually detected at birth. Anomalies of the internal genital organs can be detected during menarche, during a routine gynecological examination, when visiting a gynecologist with complaints about dysfunction of the reproductive system (for example, infertility) or during gestation. Treatment is carried out by specialists in the field of gynecology.

Classification of anomalies of female genital organs

Taking into account anatomical features, the following types of birth defects of the female reproductive system are distinguished:

• Absence of an organ: complete – agenesis, partial – aplasia.
• Violation of the lumen: complete fusion or underdevelopment - atresia, narrowing - stenosis.
• Change in size: decrease - hypoplasia, increase - hyperplasia.

An increase in the number of entire organs or their parts is called multiplication. Doubling is usually observed. Anomalies of the female genitalia, in which individual organs form an integral anatomical structure, are called fusion. If the organ is located in an unusual location, it is called ectopia. Depending on the severity, there are three types of anomalies of the female genital organs. The first is the lungs, which do not affect the functions of the genitals. The second is of moderate severity, having a certain effect on the functions of the reproductive system, but not excluding childbearing. The third is severe, accompanied by gross disorders and incurable infertility.

Causes of abnormalities of the female genital organs

This pathology occurs under the influence of internal and external teratogenic factors. Internal factors include genetic disorders and pathological conditions of the mother’s body. Such factors include all kinds of mutations and burdened heredity of unknown etiology. The patient's relatives may have developmental defects, infertile marriages, multiple miscarriages and high infant mortality.

The list of internal factors that cause abnormalities of the female genital organs also includes somatic diseases and endocrine disorders. Some experts in their studies mention the age of parents over 35 years. Among the external factors contributing to the development of abnormalities of the female genital organs are drug addiction, alcoholism, taking a number of medications, poor nutrition, bacterial and viral infections (especially in the first trimester of gestation), occupational hazards, household poisoning, unfavorable environmental conditions, ionizing radiation , being in a war zone, etc.

The immediate cause of abnormalities of the female genital organs is disorders of organogenesis. The most severe defects occur due to adverse effects in the early stages of gestation. The formation of paired Müllerian ducts occurs in the first month of gestation. At first they look like cords, but in the second month they transform into canals. Subsequently, the lower and middle parts of these canals merge, the uterine rudiment is formed from the middle part, and the vaginal rudiment is formed from the lower part. At 4-5 months, the body and cervix are differentiated.

The fallopian tubes, originating from the upper, unfused part of the Müllerian ducts, are formed at 8-10 weeks. The formation of the tubes is completed by week 16. The hymen comes from the lower part of the fused ducts. The external genitalia are formed from the skin and the urogenital sinus (anterior part of the cloaca). Their differentiation occurs at 17-18 weeks of gestation. The formation of the vagina begins at 8 weeks, its increased growth occurs at 19 weeks.

Variants of anomalies of female genital organs

Abnormalities of the external genitalia

Malformations of the clitoris can manifest themselves in the form of agenesis, hypoplasia and hypertrophy. The first two defects are extremely rare anomalies of the female genital organs. Clitoral hypertrophy is found in congenital adrenogenital syndrome (congenital adrenal hyperplasia). Severe hypertrophy is considered an indication for surgical correction.

Anomalies of the vulva, as a rule, are detected as part of multiple malformations, combined with congenital defects of the rectum and lower parts of the urinary system, which is due to the formation of these organs from the common cloaca. Anomalies of the female genital organs, such as hypoplasia of the labia majora or fusion of the vagina, may or may not be combined with fusion of the anus. Rectovestibular and rectovaginal fistulas are common. Surgical treatment – ​​labiaplasty, vaginalplasty, excision of the fistula.

Anomalies of the hymen and vagina

Abnormalities of the ovaries and fallopian tubes

Quite common anomalies of the fallopian tubes are congenital obstruction and various variants of tube underdevelopment, usually combined with other signs of infantilism. Anomalies of the female genital organs that increase the risk of developing an ectopic pregnancy include asymmetrical fallopian tubes. Malformations such as aplasia, complete duplication of tubes, splitting of tubes, blind passages and additional holes in tubes are rarely detected.

Ovarian abnormalities usually occur due to chromosomal abnormalities, combined with birth defects or disruption of the functioning of other organs and systems. Ovarian dysgenesis is observed in Klinefelter syndrome. Agenesis of one or both gonads and complete duplication of the ovaries are among the extremely rare anomalies of the female genital organs. Ovarian hypoplasia is possible, usually combined with underdevelopment of other parts of the reproductive system. Cases of ovarian ectopia and the formation of additional gonads adjacent to the main organ have been described.

The development of pregnancy in an abnormal fallopian tube is an indication for emergency tubectomy. With normally functioning ovaries and abnormal tubes, pregnancy is possible through in vitro fertilization of an egg taken during follicle puncture. In cases of ovarian anomaly, it is possible to use reproductive technologies with fertilization

Abnormalities in the position of the genital organs.

The normal (typical) position of the genital organs is considered position in a healthy, sexually mature, non-pregnant, non-lactating woman, in an upright position, with the bladder and rectum emptied. Under these conditions, the uterus is located in the center of the small pelvis, at the same distance from the symphysis, sacrum and side walls of the small pelvis. The fundus of the uterus does not extend beyond the plane of the entrance to the pelvis, and the external os is located on the line connecting the ischial spines (interspinal plane). The uterus is tilted slightly anteriorly, due to which the fundus is directed towards the anterior abdominal wall (anteversio) and has a bend between the cervix and the body, forming an obtuse angle anteriorly (anteflexio). The vagina is located in the pelvic cavity, directed from the outside and front obliquely upward and backward to the cervix. The appendages are located on the side and somewhat behind the uterus.

The normal position of the female genital organs is ensured by the following factors:

Own tone of the genital organs, depending on the level of sex hormones

Coordinated activity of the diaphragm, abdominal muscles and pelvic muscles ensuring normal intra-abdominal pressure

Suspensory apparatus of the uterus (round, broad ligaments of the uterus, own ligaments of the ovary)

Anchoring apparatus of the uterus (sacrouterine, cardinal, uterovesical ligaments)

Supportive apparatus (three layers of pelvic floor muscles)

In childhood, the uterus is located much higher, and in old age (due to atrophy of the pelvic floor muscles) - lower than in the reproductive period of a woman’s life.

The position of the uterus and appendages can be affected by:

Changes in intra-abdominal pressure

Filling or emptying the bladder and bowels

Pregnancy

Incorrect positions of the genitals deviations from the normal position in the pelvis that are persistent in nature, as well as violations of the normal relationships between the sections and layers of the female genital organs, are considered.

Reasons:

Inflammatory processes

Tumors

Hard physical labor

Pathological birth

Infantilism, asthenia

Classification of incorrect positions of the female genital organs.

1. Displacement of the entire uterus in the pelvic cavity (disposition):

A. On the horizontal plane:

Anterior displacement (anteposition)

Posterior displacement (retroposition)

Shift to the left (synistroposition)

Shift to the right (dextroposition)

B. On the vertical plane:

Elevation of the uterus

Uterine prolapse

Uterine prolapse (prolapsed)

2. Displacement of the sections and layers of the uterus in relation to each other:

Pathological inclination of the uterus anteriorly (anteversio)

Posteriorly (retroversio)

Right or left

3. Bend of the uterus:

Anteriorly (hyperanteflexio)

Posteriorly (retroflexio)

Right or left

4. Rotation of the uterus

5. Torsion of the uterus

6. Inversion of the uterus

Changing position- displacement of the entire uterus along a horizontal plane, in which the normal obtuse angle between the cervix and the body is maintained. Displacement of the uterus is distinguished anteriorly, posteriorly and to the sides (to the right and to the left).

Anteposition - anterior displacement of the uterus - is observed as a physiological phenomenon when the rectum is full. Occurs with tumors or effusion (blood, pus) located in the rectouterine cavity.

Retroposition - posterior displacement of the uterus - occurs with a full bladder, inflammatory processes, tumors located anterior to the uterus, occurs as a result of severe inflammatory processes that lead to the pulling of the uterus to the posterior wall of the pelvis.

Lateroposition - lateral displacement of the uterus - to the right or left. These displacements of the uterus are most often caused by the presence of inflammatory infiltrates in the periuterine tissue (the uterus is located in the opposite direction), tumors of the appendages, and adhesions (the uterus is displaced towards the adhesions).

The diagnosis is made by bimanual examination.

Treatment consists of eliminating the cause that caused the disposition of the uterus.

Displacement of the entire uterus along a vertical plane

Elevation of the uterus(elevation) - an upward displacement of the uterus, in which its bottom is located above the plane of the entrance to the pelvis, the external os of the cervix is ​​above the interspinal line, during vaginal examination - the cervix is ​​reached with difficulty or is not reached at all. There are physiological and pathological elevation of the uterus. Physiological elevation includes elevation of the uterus in childhood, as well as with simultaneous fullness of the bladder and rectum. Pathological elevation is caused by tumors of the uterus, vagina, rectum, and the presence of effusion in the rectal-uterine cavity.

The diagnosis is made by bimanual examination. Treatment is aimed at eliminating the causes of this pathology.

Pathological inclination (version)- a condition when the body of the uterus moves to one side, and the cervix moves to the other.

Anteversion - the body of the uterus is inclined anteriorly, and the cervix is ​​inclined posteriorly. In a normal position, there is always a slight anterior inclination of the uterus. A sharper inclination of the body of the uterus anteriorly, when the cervix with its external pharynx faces backward and upward, indicates pathological anteversion.

Retroversion - the body of the uterus is tilted posteriorly and downward, and the cervix is ​​tilted anteriorly and upward.

Dextroversion - the body of the uterus is tilted to the right and upward, and the cervix is ​​tilted to the left and downward.

Sinistrosia - the body of the uterus is tilted to the left and upward, and the cervix is ​​tilted to the right and downward.

Bend of the body of the uterus relative to the cervix.

Pathological anteflexion of the uterus- hyperanteflexia - pathological bending of the uterus anteriorly, when an acute angle (less than 70°) is created between the body and the cervix. This position of the uterus may be a consequence of sexual infantilism, an inflammatory process in the pelvis. The clinical picture of pathological anteflexion is determined not so much by the uterine anomaly itself, but rather depends on the main cause that caused this pathology. The most typical complaints are pain in the lower abdomen and in the sacral area, menstrual dysfunction such as hypomenstrual syndrome, and painful menstruation. The diagnosis is made on the basis of complaints and gynecological examination data.

Treatment consists of eliminating the causes that caused this pathology. Therapeutic gymnastics, gynecological massage, physiotherapy and spa treatment in some cases help correct the abnormal position of the uterus.

Posterior bending of the uterine body- uterine retroflexion is characterized by the presence of an angle between the body and the cervix, open posteriorly. With this position of the uterus, its body deviates posteriorly, and the cervix is ​​located anteriorly. There are mobile and fixed retroflexion of the uterus. If, during a bimanual examination, the uterus can be given the correct position, then they speak of mobile retroflexion. When adhesions with the parietal peritoneum, the uterus, which is in retroflexion, loses its mobility and cannot be removed using manual techniques. This retroflexion is called fixed.

Causes of mobile retroflexion:

Decreased tone of the uterus and its ligaments with underdevelopment of the genital organs

Asthenic physique

Marked weight loss

Atrophic changes in old age

Prolonged bed rest

Fixed retroflexion of the uterus is a consequence of inflammatory processes in the pelvis and endometriosis.

In many women, uterine retroflexion (especially mobile) is not accompanied by any complaints and is discovered by chance during a gynecological examination. With fixed retroflexion, pain appears in the

lower abdomen and sacral area, menstrual dysfunction (hyperpolymenorrhea, dysmenorrhea), constipation, urination disorders, leucorrhoea. Possible infertility or miscarriage.

The combination of retroversion and retroflexion is called retrodeviation. When the uterus retrodeviates, there is an inflection of the vessels supplying it, located along the lateral surfaces of the organ. This causes hyperpolymenorrhea. When an acute angle forms between the body of the uterus and the cervix, the outflow of menstrual blood is disrupted and dysmenorrhea develops. Pain syndrome is associated with adhesions in the abdominal cavity. Pain may occur during sexual intercourse. Increased secretory function (increased amount of leucorrhoea), caused by congestion in the pelvis. Frequent urination and constipation are noted.

The diagnosis is made by bimanual examination and is not difficult.

Treatment. With mobile retroflexion of the uterus, which is asymptomatic, treatment is not carried out.

With fixed retroflexion, treatment is aimed at eliminating the underlying cause of the disease.

Surgical correction is advisable in the presence of diseases requiring surgical intervention

Displacements of the uterus include rotation of the uterus and its torsion.

Rotation of the uterine body together with the neck around the longitudinal axis from left to right and vice versa, it is observed with inflammation of the uterosacral ligaments, their shortening, the presence of a tumor located posteriorly and to the side of the uterus, and the adhesive process.

Rotation of the uterus with a stationary cervix is ​​called uterine torsion. This pathology can occur in the presence of a unilateral adnexal tumor or subserous fibromatous node. Treatment for displacement of the uterus around its longitudinal axis involves eliminating the causes.

Inversion of the uterus- the mucous membrane of the uterus faces outward, and the serous covering inward.

Eversion forms:

Puerperal form of eversion. WITH associated with improper management of the placenta (pulling the umbilical cord and squeezing the placenta). Spontaneous inversion of the uterus is possible with severe atony.

Sharp pain in the lower abdomen

State of shock

Pale skin

Bleeding from the placental site

The prolapsed uterus can be pinched, and then swelling develops, and then tissue necrosis

The diagnosis is made upon examination.

Treatment is repositioning of the uterus followed by the introduction of uterine contractions, anti-shock measures, and antibacterial therapy.

The oncogenetic form of eversion occurs when a submucosal tumor of the uterus is expelled from the uterus. Treatment is only surgical, hysterectomy.

Downward displacement of the uterus and vagina.

Among various gynecological diseases, prolapse and prolapse of the internal genital organs occupy one of the leading places. The frequency of this pathology ranges from 5 to 30%.

Classification:

1st degree - uterine prolapse

2nd degree - incomplete uterine prolapse

3rd degree - complete prolapse of the uterus

Uterine prolapse is a position of the organ in which the cervix is ​​located below the interspinal line, but does not extend beyond the genital fissure.

Incomplete uterine prolapse is characterized by the fact that the downward displacement of the uterus increases, the cervix emerges from the genital fissure, but the body of the uterus is in the pelvis (II degree).

With complete prolapse, the entire uterus extends beyond the genital slit along with the walls of the vagina (III degree).

Predisposing factors:

Number of births in history (three or more)

The nature of labor (weakness of labor, rapid labor)

Large fruit

Perineal lacerations

Surgical delivery (application of obstetric forceps, extraction of the fetus by the pelvic end)

Hard physical labor

Constitutional factors

Infantilism

Heredity

Prolapse, and subsequently prolapse of the uterus, is a dynamic process and develops gradually, progresses slowly and adversely affects the general condition of the patient.

Typically, prolapse of the vaginal walls begins from the anterior wall, since it is attached to the urogenital diaphragm, which is much weaker than the pelvic diaphragm. Losing natural support as a result of a rupture of the perineum, the anterior wall of the vagina descends and carries with it the wall of the bladder, forming a hernial protrusion (cystocele). The prolapse and prolapse of the posterior wall of the vagina often entails prolapse of the anterior wall of the rectum, resulting in the formation of a hernial protrusion (rectocele).

Clinical picture:

Frequent, painful urination

Stress incontinence

Acute urinary retention caused by kinking and compression of the urethra

Ascending urinary tract infection

Nagging pain in the lower abdomen, lumbar region and sacrum

Presence of a “foreign body” in the genital opening

Difficulty in defecation

Incontinence of urine and gases when coughing and sneezing

Menstrual dysfunction type hyperpolymenorrhea

When prolapsed, the walls of the vagina become dry, inelastic, rough, cracks, bedsores, and trophic ulcers appear in them.

The prolapsed uterus is edematous and cyanotic

Sexual function is impaired

Fertility is reduced due to the rapid evacuation of sperm, but pregnancy is possible. Clinically, there are 5 degrees of prolapse of the walls of the vagina, uterus and their prolapse.

I degree - the initial stage of prolapse, associated with partial weakening of the muscles of the pelvic floor and urogenital diaphragm, in which the genital fissure gapes, and the anterior and posterior walls of the vagina are slightly lowered.

II degree - more significant weakening of the pelvic floor muscles; prolapse of the vaginal walls

III degree - the uterus is prolapsed, the cervix reaches the entrance to the vagina.

IV degree - incomplete uterine prolapse, in which the cervix protrudes beyond the entrance to the vagina.

V degree - complete prolapse of the uterus with eversion of the vaginal walls.

Diagnosis is based on history, examination and palpation with mandatory bimanual and rectal examinations, during which the condition of the pelvic floor muscles is assessed.

When initial forms of genital prolapse are detected, patients should be registered at a dispensary.

Treatment of the first degree is conservative:

Diet that regulates bowel function

Water procedures

Therapeutic exercise

Wearing a special belt-bandage.

Orthopedic method of treating uterine prolapse using pessaries (used only if there are absolute contraindications to surgical treatment)

Disadvantages of using pessaries:

The occurrence of colpitis, bedsores

Pelvic floor muscle stretch

Wearing pessaries requires daily douching

To correct genital prolapse and prolapse, surgical treatment is most widely used.

When choosing a surgical method, the patient’s age, general state of health, features of menstrual function, the possibility of future pregnancy and childbirth, and the degree of prolapse of the walls of the vagina and uterus are taken into account.

1. Surgeries aimed at strengthening the pelvic floor - colpoperineoplasty.

2. Operations with shortening and strengthening of the round ligaments and fixation of the uterus.

3. Operations aimed at strengthening the cardinal and uterosacral ligaments by stitching them together

4. The radical method is vaginal extirpation.

Work ability examination. Temporary disability is established during surgery for the duration of the hospital stay and then on an outpatient basis until recovery. In the next 6 months after surgery, it is necessary to exclude those types of work activities that are associated with physical activity, heavy lifting, long walking, prolonged standing, and business trips.

In exceptional cases, when surgical treatment is impossible, disability is established.