Anomalies of the female genital organs. Bend of the cervix: types, diagnosis, treatment Anomalies of the hymen and vagina

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The incorrect position of the internal organs occurs under the influence of inflammatory processes, tumors, injuries and other factors. The uterus can move in the vertical (up and down) and horizontal planes.

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hyperanteflexia

Inflection of the uterus anteriorly, when an angle of less than 70 degrees is created between the body and the cervix. It may be due to sexual infantilism or inflammatory processes in the small pelvis.

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Clinic: violation of menstrual function according to the type of hypomenstrual syndrome, algomenorrhea, infertility. Diagnosis: vaginal examination - the uterus is small, sharply deviated anteriorly, with an elongated conical neck. The vagina is narrow. Treatment: elimination of the causes that caused this pathology (treatment of the inflammatory process)

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Retroflection

Deviation of the body of the uterus posteriorly, and the cervix anteriorly. In this case, the bladder remains uncovered by the uterus. And loops of intestines constantly put pressure on the surface of the uterus. This can contribute to the prolapse of the genitals. There are mobile (due to a decrease in the tone of the uterus and its ligaments during birth trauma) and fixed (due to inflammatory processes)

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Clinic: pulling pains in the lower abdomen before and during menstruation, dysfunction of neighboring organs. Diagnosis: bimanual examination determines the posterior deviation of the uterus. Treatment: treatment of the underlying disease that caused retroflection.

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Prolapse and prolapse of the uterus and vagina

Omission of the anterior wall of the vagina. - Omission of the posterior wall of the vagina. - Incomplete prolapse of the uterus (the cervix reaches the genital gap or goes beyond it. - Complete prolapse of the uterus (the entire uterus goes beyond the genital gap)

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The basis of the prolapse and prolapse of the genital organs is the failure of the muscles of the pelvic floor and the ligamentous apparatus of the uterus, increased intra-abdominal pressure.

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clinic

Sensation of a foreign body in the vagina. Feeling of heaviness and pain in the lower abdomen, lower back aggravated during or after walking, when lifting weights, coughing. On the surface of the prolapsed neck, a decubital ulcer is often formed. Cyanosis of mucous membranes and their edema. Difficulty urinating. Constipation.

Slide 10

diagnostics

Inspection with reduction of prolapsed genitals. Bimanual research. (to assess the condition of the muscles of the pelvic floor) Rectal examination (to detect rectocele, the condition of the sphincter of the rectum) In case of severe urination disorders, cystoscopy and excretory urography are indicated. ultrasound

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Incomplete uterine prolapse Complete uterine prolapse

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treatment

Treatment is determined by the degree of prolapse of the genital organs. With small omissions of the internal genital organs, when they do not reach the vagina and in the absence of dysfunction of neighboring organs, conservative treatment is prescribed - a set of physical exercises.

Slide 14

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With more pronounced omissions, surgical treatment is indicated. Surgical operations were divided into 7 groups according to the anatomical formation used and strengthened to correct the position of the internal genital organs.

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1 group. Strengthening the pelvic floor - colpoperineolevathoroplasty. 2 group. Shortening and strengthening of the suspensory apparatus of the uterus. 3rd group. Strengthening the fixing apparatus of the uterus. 4 group. Rigid fixation of prolapsed organs to the walls of the pelvis. 5 group. The use of alloplastic materials to strengthen the ligamentous apparatus of the uterus. 6 group. Obliteration of the vagina excluding the possibility of sexual activity. 7 group. Vaginal hysterectomy.

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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, in) 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; in - 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. - Same. 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. - Same. 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. - Same. 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 accompanying 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.

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Incorrect position of the genital organs of women are such deviations from the norm, in which they are persistent, accompanied by a violation of the relationship between the various parts of the reproductive system.

The reasons for the change in the normal location of the female genital organs can be inflammatory diseases, tumors, trauma, hard work, pathological childbirth, obesity. A particularly important factor is excess weight after pregnancy - in a woman who did not suffer from this disease before childbirth, after them, excess weight and displacement of the uterus appear. Therefore, the question of how to lose weight after childbirth quickly is important not only for beauty, but also for health.

The following can lead to the formation of an incorrect location of the female genital organs: factors:

Propensity factors due to:

  • heredity;
  • race;
  • socio-cultural characteristics;
  • neurological status,
  • anatomical features;
  • the state of the connective tissue (collagen status);

Initiating factors:

  • childbirth (number, complications, fetal body weight, obstetric care and);
  • surgical interventions;
  • damage to the pelvic organs and muscles;
  • radiation damage;

Influencing factors:

  • bowel dysfunction;
  • increased physical activity;
  • excess body weight;
  • obstructive lung disease;

Decompensation factors:

  • advanced and senile age;
  • mental status.

The function of the supporting apparatus of the small pelvis is to counteract gravity, intra-abdominal pressure.

The active component of counteracting the earth's gravity is provided by the tone of the pelvic floor muscles, their reflex contraction during coughing, tension, laughter. The passive component is provided by connective tissue structures - derivatives of the pelvic fascia. In the supporting apparatus of the small pelvis, three levels can be distinguished.

Classification of the incorrect position of the female genital organs.

Displacement of the uterus in the pelvis:

  • horizontally - displacement anteriorly, posteriorly, left, right:
  • vertically - rise, omission or prolapse (full or partial) of the uterus.

Violation of interactions between different parts of the uterus:

  • pathological tilt of the uterus - forward, backward, right, left;
  • inflection of the uterus - anterior, posterior, right, left. The combination of uterine tilt back and inflection is called retrodeviation of the uterus;
  • uterine rotation;
  • twisting of the uterus;
  • inversion of the uterus.
The article was prepared and edited by: surgeon

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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 relationship 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.
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