Incorrect positions of the genital organs. Incorrect position of the female genital organs Treatment of uterine curvature
Incorrect positions of the female genital organs
Disturbances in the normal location of the genital organs in women are quite common and can be a manifestation of a wide variety of pathological processes. Main reasons their occurrences are:
Inflammatory processes in the genital organs;
Adhesive processes 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 rectum;
Weakness of the ligamentous apparatus of the uterus.
When determining the correct or incorrect location of the female genital organs, the main attention is paid to the position of the uterus and somewhat less to 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 of the bladder and intestines. Significant displacement of the uterus occurs during pregnancy. It is characteristic that after the cessation of the action of these factors, the uterus relatively quickly returns to its original position. In childhood, the uterus is located significantly higher, and in old age (due to the developing atrophy of the pelvic floor muscles and ligaments) - lower than in the reproductive period of a woman’s life.
In the treatment of incorrect positions of the female genital organs, therapeutic exercises play an important role. When performing it, you need to remember a few rules.
Rules for performing therapeutic exercises
1. There should be no unpleasant sensations, much less pain, during exercises. At the end of the gymnastics, you should only feel pleasant muscle fatigue.
2. You should exercise 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 meals.
3. Start with fewer repetitions of the exercise, gradually working up to more. Make sure you are breathing correctly. Focusing on your well-being, include pauses for rest in your routine.
4. If pain or other unpleasant phenomena occur, be sure to consult your doctor.
5. Monitoring by a gynecologist is desirable in the first days of classes in order to take into account the body’s responses to stress, as well as at the end of the course of treatment (after 1–1.5 months), when internal examination can indicate favorable changes.
Therapeutic exercises for abnormal 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:
Shifting it forward (Fig. 4, A) as a result of adhesions in the abdominal cavity due to an inflammatory process, due to infiltrates in the periuterine tissue, or due to tumors of the ovaries and fallopian tubes;
Shifting it back (Fig. 4, b) due to prolonged forced horizontal position of the body, inflammatory processes, underdevelopment of the 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 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 its body is pulled by scars and adhesions in one direction, and the cervix in the other; bending of the uterus - a change in the angle between the cervix and the body of the uterus (bending the uterus back is often the cause of infertility) (Fig. 4, G).
Rice. 4. Incorrect position of the uterus:
A – anterior displacement of the uterus; b – posterior displacement of the uterus; V – shift to the left (due to the development of an ovarian tumor); G – bend of the uterus
Treatment for abnormal uterine positions 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 serve for therapeutic exercises acquired forms violations of the position of the uterus, in contrast to congenital forms associated with developmental defects, 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 eliminating these complications.
Special physical exercises are selected in such a way as to shift 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 - standing on your knees, sitting on the floor, lying on your stomach, when the uterus takes the correct position.
When performing most exercises, you need to ensure proper breathing. First of all, ensure that there is no holding your breath, so that the movement is always accompanied by an inhalation or exhalation phase, no matter how difficult it may be to perform. Typically, when performing physical exercises, inhalation is done when a person extends, and exhalation is done when he bends.
Monitoring by a gynecologist is desirable in the first days of classes in order to take into account the body’s responses to physical exercise, as well as at the end of the course of treatment (after 1.5–2 months of classes), when internal examination can indicate favorable changes in the position of the uterus.
A set of special exercises for uterine displacement(Fig. 5)
A. Starting position (i.p. )– sitting on the floor with legs straight
1. Support with your hands behind you, legs apart ( A). Connecting your legs, tilt your torso forward, bringing your arms forward ( b). Repeat 10-12 times. The pace is average, breathing is free.
2. I.p. – the same, arms to the sides. Exhale - turn to the left, bend over and reach your left toe with your right hand; inhale - return to i.p. Do the same with your left hand to your right toe. Repeat 6-8 times.
3.I.p. - That same. Raise your arms up, leaning back - inhale; with a swinging motion, tilt your torso forward, trying to reach your toes with your fingers - exhale. Repeat 6-8 times. The pace is average.
4. I.p. – the same, legs bent at the knees, hands clasped around the shins. Move forward and backward using your buttocks and heels. Repeat 6-8 times in each direction.
5. I.p. – sitting on the floor, legs together, straightened, hands behind ( A). Simultaneous flexion ( b) and extension of the legs at the knee joints. Breathing is free, pace is slow. Repeat 10–12 times.
B. Starting position (i.p. )- standing on all fours
Please note that your arms and hips should be at right angles to your body.
6. Alternately raising the outstretched legs up. Inhale – lift your right leg back and up; exhale - return to i.p. Same with the left foot. Repeat 6-8 times with each leg.
7. Alternately raising the outstretched arms forward and upward. Inhale – raise your right hand; exhale - lower. The same with the left hand. Repeat 6-8 times with each hand.
8. At the same time, while inhaling, raise your left arm up and forward and your right leg up and back; as you exhale, return to i.p.
9. “Step over” with straight arms to the left until the torso turns to the left as much as possible - when the uterus shifts to the right. The same to the right - when the uterus is displaced to the left. “Step over” your hands back to the knee joints, and back when the uterus is bent. Repeat any option 6-10 times. The pace is average, breathing is free.
10. Leaning on your palms, “step over” your knees and feet to the right, left 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 drawing in the perineum, lower your head, arching your back ( Ab). Repeat 8-10 times.
12. As you exhale, without lifting your hands from the floor, stretching out as much as possible and arching your back, lower your pelvis between your heels; on inhalation - return to i.p. Repeat 8-12 times. The pace is slow.
13. Bend your arms at the elbow joints, take a knee-elbow position. Leaning on your forearms, lift your pelvis up as much as possible, rising onto your toes and straightening your legs at the knee joints; come back to i.p.
14. From i.p. standing on all fours, lift your pelvis up as much as possible, straightening your legs at the knee joints, resting on your feet and palms of your straight arms; come back to i.p. Repeat 4-6 times. Breathing is free. The pace is slow.
15. As you exhale, without lifting your hands from the floor, stretching out 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 at the lower back, as if crawling under a fence (b
16. From the knee-elbow position, while inhaling, lift your straight left leg up; as you exhale, return to i.p. Same with the right foot. Repeat 10-12 times with each leg. The pace is average.
B. Starting position lying on your stomach
17. Legs slightly apart, arms bent at elbows (hands at shoulder level). Crawling on your belly for 30–60 seconds. The pace is average, breathing is free.
18. I.p. – Same. At the same time, raise your head, shoulders, upper torso and legs, sharply bending at the waist and raising your arms forward and up. 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. Inhaling slowly, smoothly raise your head, tilting it as far back as possible. Tightening 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. Slowly exhaling return to i.p. Repeat at least 3 times.
20. Raise your legs, and without lowering them to the floor, make short swings up and down, pulling your toes. Return to i.p. Repeat 8-10 times. The pace is average. Breathing is free.
21. While inhaling, clasp your ankle joints with your palms and rock 3–8 times back and forth, 3–8 times left and right. Tighten all muscles. Relax and lie motionless for 10–15 seconds. Do not hold your breath.
D. Starting position standing
22. Feet shoulder-width apart, arms to the sides. When the uterus shifts to the left, tilt your torso to the right and touch the toes of your right foot with the fingers of your left hand (your right arm is moved to the side). Do the same with the right hand to the toe of the left foot when the uterus shifts 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 your right side to the back of a chair, holding it with your right hand, your left hand along your body. Swing your right leg back and forth. Repeat 6-10 times. Do the same with your left foot, turning your 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 also use walking in a half-squat. Walking time is 1–2 minutes.
Remember: The initial position lying on your back not only does not help correct the incorrect position of the uterus, but, moreover, fixes this incorrect position. Therefore, it is recommended that all women suffering from this disease rest and sleep in a prone position on their stomach.
Therapeutic exercises for vaginal prolapse
One of the most common diseases of the female genital organs is prolapse and prolapse of the vaginal walls, which can occur in young and old, in parous and nulliparous women. The main cause of the disease is a decrease in tone and (or) disruption of the integrity of the pelvic floor muscles. The muscles that make up the pelvic floor suffer due to:
a) repeated sprains and hyperextensions in multiparous women, especially when giving birth to large children;
b) birth trauma, especially surgical (application of obstetric forceps, extraction of the fetus by the pelvic end, vacuum extraction of the fetus, etc.);
c) age-related involution of the muscular system, observed after 55–60 years, especially if a woman performs heavy physical work;
d) sudden and significant weight loss of young nulliparous women, either seeking to achieve the modern ideal of beauty by following strict diets, or as a result of illness.
Symptoms At the initial stage, the disease may not manifest itself in any way, then nagging pain appears in the lower abdomen, in the lower back and sacrum, a feeling of the presence of a foreign body in the genital fissure, impaired urination (usually increased frequency), difficulty in bowel movements, leading in the future to chronic constipation.
Complications. The vagina is closely connected to the cervix, which is pulled down when prolapsed. Therefore, vaginal prolapse in the absence of proper treatment usually entails prolapse and sometimes prolapse of the uterus (Fig. 6), which requires surgical treatment.
Rice. 6. Complications of vaginal wall prolapse
Treatment. At the initial stage of the disease, when vaginal prolapse is not accompanied by prolapse of internal organs, in particular the uterus, particularly high treatment effectiveness is achieved using therapeutic exercises. Special exercises can strengthen the pelvic floor muscles, and this will lead to the restoration of the normal physiological position of the vagina.
The most advantageous 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 raising the outstretched legs up. Inhale – lift your left leg back and up; exhale - return to i.p. Same with the right foot. Repeat 6-8 times with each leg.
2. At the same time, while inhaling, raise 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 leg. Repeat 4-6 times. The pace is slow.
3. While inhaling, vigorously drawing 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, arching at the lower back ( b). Repeat 8-10 times.
4. Bend your arms at the elbow joints, take a knee-elbow position. Leaning on your forearms, lift your pelvis up as much as possible, rising onto your toes and straightening your legs at the knee joints; come back to i.p. Repeat 4-6 times. Breathing is free.
5. From the knee-elbow position, while inhaling, lift your straight right leg up; as you exhale, return to i.p. 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 your pelvis up as much as possible, straightening your legs at the knee joints, resting on your feet and palms of your straight arms; return to the starting position. Repeat 4-6 times. Breathing is free. The pace is slow.
7. As you exhale, without lifting your hands from the floor, stretching out 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 at the lower back, as if crawling under a fence ( b). Repeat 6–8 times. The pace is slow.
B. Starting position lying on your back
8. Feet together, arms along the body. Alternately lifting straight legs while exhaling. Repeat 8-10 times with each leg. The pace is average. Do not hold your breath.
9. Feet together, hands on the belt. As you exhale, lift your legs, while inhaling, spread them apart; As you exhale, close your legs, while inhaling, 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, arching in the lumbar region and at the same time pulling your anus inward. Repeat 8-10 times. The pace is slow, breathing is free.
Rice. 7. A set of special exercises for vaginal prolapse
11. Feet together, arms along the body. Raise your legs, bending them at the knee joints, and perform movements as if 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. As you exhale, simultaneously raise your 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. Legs slightly spread and bent at the knee joints (with support on the entire foot), hands under the head. Lift your pelvis, spreading your knees wide and pulling your anus inward. 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 that cause these diseases.
Abnormal positions of the uterus can develop in childhood if a girl (as a result of parental negligence) the bladder and bowels are not emptied in a timely manner, which leads to posterior deviation of the uterus.
Parents of girls should also be aware of the dangers of increasing intra-abdominal pressure as a result of physical overexertion: in everyday life, very often girls 8–9 years old are tasked with nursing and carrying one-year-old brothers or sisters. 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 induced 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 woman’s genital organs.
Physical culture plays an important role in the prevention of these diseases. Thanks to gymnastics, a healthy, physically developed, functionally complete organism is created, with good resistance to many harmful influences.
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From the book Obstetrics and Gynecology: Lecture Notes author A. A. Ilyin1. Anatomy of the female genital organs A woman’s genital organs 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. The internal ones include the vagina, uterus, uterine
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From the author's bookDiseases of the female genital organs Objectives of massage Reducing pain, improving blood circulation in the pelvic organs, reducing congestion in the circulatory and lymphatic systems of the pelvic organs, increasing the tone of the uterus and its contractile function,
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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 pelvis, the area of the external uterine pharynx is at the level of the spinal spines, and 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 provokes / Causes of Incorrect positions of the genital organs:
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 position of the genital organs:
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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Other diseases from the group Diseases of the genitourinary system:
| "Acute abdomen" in gynecology |
| Algodismenorrhea (dysmenorrhea) |
| Algodismenorrhea secondary |
| Amenorrhea |
| Amenorrhea of pituitary origin |
| Kidney amyloidosis |
| Ovarian apoplexy |
| Bacterial vaginosis |
| Infertility |
| Vaginal candidiasis |
| Ectopic pregnancy |
| Intrauterine septum |
| Intrauterine synechiae (fusions) |
| Inflammatory diseases of the genital organs in women |
| Secondary renal amyloidosis |
| Secondary acute pyelonephritis |
| Genital fistulas |
| Genital herpes |
| Genital tuberculosis |
| Hepatorenal syndrome |
| Germ cell tumors |
| Hyperplastic processes of the endometrium |
| Gonorrhea |
| Diabetic glomerulosclerosis |
| Dysfunctional uterine bleeding |
| Dysfunctional uterine bleeding of the perimenopausal period |
| Cervical diseases |
| Delayed puberty in girls |
| Foreign bodies in the uterus |
| Interstitial nephritis |
| Vaginal candidiasis |
| Corpus luteum cyst |
| Intestinal-genital fistulas of inflammatory origin |
| Colpitis |
| Myeloma nephropathy |
| Uterine fibroids |
| Genitourinary fistulas |
| Disorders of sexual development in girls |
| Hereditary nephropathies |
| Urinary incontinence in women |
| Necrosis of myomatous node |
| Nephrocalcinosis |
| Nephropathy in pregnancy |
| Nephrotic syndrome |
| Nephrotic syndrome primary and secondary |
| Acute urological diseases |
| Oliguria and anuria |
| Tumor-like formations of the uterine appendages |
| Tumors and tumor-like formations of the ovaries |
| Sex cord stromal tumors (hormonally active) |
| Prolapse and prolapse of the uterus and vagina |
| Acute renal failure |
| Acute glomerulonephritis |
| Acute glomerulonephritis (AGN) |
| Acute diffuse glomerulonephritis |
| Acute nephritic syndrome |
| Acute pyelonephritis |
| Acute pyelonephritis |
| Lack of sexual development in girls |
| Focal nephritis |
| Paraovarian cysts |
| Torsion of the pedicle of adnexal tumors |
| Testicular torsion |
| Pyelonephritis |
| Pyelonephritis |
| subacute glomerulonephritis |
| Subacute diffuse glomerulocephritis |
| Submucosal (submucosal) uterine fibroids |
| Polycystic kidney disease |
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 pelvis, the area of the external uterine pharynx is at the level of the spinal spines, and 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 provokes / Causes of Incorrect positions of the genital organs:
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 position of the genital organs:
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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Other diseases from the group Diseases of the genitourinary system:
| "Acute abdomen" in gynecology |
| Algodismenorrhea (dysmenorrhea) |
| Algodismenorrhea secondary |
| Amenorrhea |
| Amenorrhea of pituitary origin |
| Kidney amyloidosis |
| Ovarian apoplexy |
| Bacterial vaginosis |
| Infertility |
| Vaginal candidiasis |
| Ectopic pregnancy |
| Intrauterine septum |
| Intrauterine synechiae (fusions) |
| Inflammatory diseases of the genital organs in women |
| Secondary renal amyloidosis |
| Secondary acute pyelonephritis |
| Genital fistulas |
| Genital herpes |
| Genital tuberculosis |
| Hepatorenal syndrome |
| Germ cell tumors |
| Hyperplastic processes of the endometrium |
| Gonorrhea |
| Diabetic glomerulosclerosis |
| Dysfunctional uterine bleeding |
| Dysfunctional uterine bleeding of the perimenopausal period |
| Cervical diseases |
| Delayed puberty in girls |
| Foreign bodies in the uterus |
| Interstitial nephritis |
| Vaginal candidiasis |
| Corpus luteum cyst |
| Intestinal-genital fistulas of inflammatory origin |
| Colpitis |
| Myeloma nephropathy |
| Uterine fibroids |
| Genitourinary fistulas |
| Disorders of sexual development in girls |
| Hereditary nephropathies |
| Urinary incontinence in women |
| Necrosis of myomatous node |
| Nephrocalcinosis |
| Nephropathy in pregnancy |
| Nephrotic syndrome |
| Nephrotic syndrome primary and secondary |
| Acute urological diseases |
| Oliguria and anuria |
| Tumor-like formations of the uterine appendages |
| Tumors and tumor-like formations of the ovaries |
| Sex cord stromal tumors (hormonally active) |
| Prolapse and prolapse of the uterus and vagina |
| Acute renal failure |
| Acute glomerulonephritis |
| Acute glomerulonephritis (AGN) |
| Acute diffuse glomerulonephritis |
| Acute nephritic syndrome |
| Acute pyelonephritis |
| Acute pyelonephritis |
| Lack of sexual development in girls |
| Focal nephritis |
| Paraovarian cysts |
| Torsion of the pedicle of adnexal tumors |
| Testicular torsion |
| Pyelonephritis |
| Pyelonephritis |
| subacute glomerulonephritis |
| Subacute diffuse glomerulocephritis |
| Submucosal (submucosal) uterine fibroids |
| Polycystic kidney disease |
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 pelvis, the area of the external uterine pharynx is at the level of the spinal spines, and 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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Slide 2
Incorrect position of 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 plane.
Slide 3
hyperanteflexia
The uterus is bent anteriorly, when an angle of less than 70 degrees is created between the body and the cervix. May be due to sexual infantilism or inflammatory processes in the pelvis.
Slide 4
Clinic: menstrual dysfunction such as hypomenstrual syndrome, algomenorrhea, infertility. Diagnosis: vaginal examination - the uterus is small in size, 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)
Slide 5
Retroflexion
Deviation of the uterine body posteriorly and the cervix anteriorly. In this case, the bladder remains uncovered by the uterus. And the intestinal loops constantly put pressure on the surface of the uterus. This may contribute to prolapse of the genitals. There are mobile (due to decreased tone of the uterus and its ligaments during birth trauma) and fixed (due to inflammatory processes)
Slide 6
Clinic: nagging pain 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 causing retroflection.
Slide 7
Prolapse and prolapse of the uterus and vagina
Prolapse of the anterior wall of the vagina. - prolapse of the posterior wall of the vagina. - incomplete prolapse of the uterus (the cervix reaches the genital slit or extends beyond it. - complete prolapse of the uterus (the entire uterus extends beyond the genital slit)
Slide 8
The basis of prolapse and prolapse of the genital organs is the incompetence of the pelvic floor muscles and the ligamentous apparatus of the uterus, and increased intra-abdominal pressure.
Slide 9
clinic
Sensation of a foreign body in the vagina. A feeling of heaviness and pain in the lower abdomen, lower back, intensifying during or after walking, when lifting heavy objects, or coughing. A decubital ulcer often forms on the surface of the prolapsed neck. Cyanosis of the mucous membranes and their swelling. Difficulty urinating. Constipation.
Slide 10
diagnostics
Inspection with reduction of prolapsed genital organs. Bimanual examination. (to assess the condition of the pelvic floor muscles) Rectal examination (to identify rectocele, the condition of the rectal sphincter) For severe urination disorders, cystoscopy and excretory urography are indicated. Ultrasound
Slide 11
Incomplete uterine prolapse Complete uterine prolapse
Slide 12
slide 13
treatment
Treatment is determined by the degree of genital prolapse. For small prolapses 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
Slide 15
For more severe prolapses, 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.
Slide 16
1 group. Strengthening the pelvic floor - colpoperineolevatoplasty. 2nd group. Shortening and strengthening of the uterine suspensory apparatus. 3rd group. Strengthening the fixing apparatus of the uterus. 4th group. Rigid fixation of prolapsed organs to the pelvic walls. 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.
View all slides
