home Endocrinology Anatomy of the female genital organs: details about the structure of the female organs. Incorrect (abnormal) position of the female genital organs Surgical methods of treatment

Anatomy of the female genital organs: details about the structure of the female organs. Incorrect (abnormal) position of the female genital organs Surgical methods of treatment

The normal (typical) position of the genital organs is considered to be their position in a healthy woman.
an adult woman in an upright position with the bladder emptied and erect
gut.

Normally, the fundus of the uterus is turned upward and does not protrude above the plane of the entrance to the pelvis, external
the opening of the cervical canal is at the level of the spinal plane, the vaginal part of the cervix
the uterus is facing posteriorly and downward. The body and cervix form an obtuse angle, open anteriorly. This situation is
Name anteflexion. The fundus of the bladder is adjacent to the anterior wall of the uterus in the area of the isthmus,
the urethra is in contact with the anterior wall of the vagina in its middle and lower third. Rectum
located behind the vagina and separated from it by loose fiber.

The normal position of the uterus and other female genital organs is maintained
check:

own tone of the genital organs;
supporting apparatus - pelvic floor muscles;
suspensory apparatus - round, wide and proper ligaments of the ovary;
anchoring apparatus - uterosacral ligaments, cardinal ligaments.

The uterus with tubes and ovaries has limited physiological mobility.

The reasons for the incorrect position of the female genital organs are usually varied.
The most common cause is damage to the pelvic floor muscles, vagina or ligaments,
most often due to birth trauma. The position of the internal genital organs can be disrupted
tumors of the abdominal organs or genitals, inflammatory processes in the pelvis with the formation
adhesions, endometriosis.

Less commonly, the cause of abnormal position of the genital organs is associated with severe somatic
diseases accompanied by exhaustion or myasthenia.

We can talk about the incorrect position of the genital organs if there are displacements coming out
beyond normal topographic boundaries and having a stable character. Among the anomalies
the position of the genital organs, the leading place is occupied by the displacement of the uterus and vagina. Ovarian displacement and
fallopian tubes, as a rule, is secondary in nature and depends on the displacement of the uterus.

The following forms of abnormal positions of the genital organs are distinguished:

Retroflexion of the uterus.

In this case, the body of the uterus is deflected posteriorly, there is an open angle between the uterus and the cervix
posteriorly Unlike the normal position - anteflexion, the body of the uterus is located in the posterior half
pelvis, and the neck is in the anterior. As a result, the topography of the location of intestinal loops changes,
ureters, which ultimately leads to prolapse of the uterus and vagina. The cause of retroflexion may be
serve endometriosis, complicated by adhesions, or inflammatory processes in the pelvis. At
Asymptomatic retroflexion does not require treatment. Treatment is resorted to when pain occurs,
menstrual irregularities, miscarriage. Among the methods of surgical treatment, the leading place is
Laparoscopy takes place.

Pathological anteflexion.

It differs from physiological anteflexion by its most acute angle. Occurs
very rarely and most often accompanies severe infantilism. As a rule, after restorative
treatment, the situation normalizes.

The normal position of the female genital organs is ensured by the suspensory, securing and supporting ligamentous apparatus, mutual support and pressure regulation by the diaphragm, abdominal press, and its own tone (hormonal influences). Disruption of these factors by inflammatory processes, traumatic injuries or tumors contributes to and determines their abnormal position.

Abnormalities in the position of the genital organs They are considered to be such permanent states that go beyond the limits of physiological norms and violate the normal relationships between them. All genital organs are interconnected in their position, therefore abnormal conditions are mostly complex (at the same time the position of the uterus, cervix, vagina, etc. changes).

Classification is determined by the nature of the abnormal position of the uterus: displacement along the horizontal plane (the entire uterus to the left, right, forward, backward; incorrect relationship between the body and the cervix in terms of inclination and severity of bending; twisting); displacement in the vertical plane (prolapse, prolapse, elevation and inversion of the uterus, prolapse and prolapse of the vagina).

Horizontal displacements. Displacement of the uterus and cervix to the right, left, forward, backward occurs more often due to compression by tumors or the formation of adhesions after inflammatory diseases of the genitals (Fig. 19). Diagnosis is achieved using gynecological examination, ultrasound and radiography. Symptoms are characteristic of the underlying disease. Treatment is aimed at eliminating the cause: surgery for tumors, physiotherapeutic procedures and gynecological massage for adhesions.

Pathological bending and bending between the body and the neck are considered simultaneously. Normally, in terms of bends and inclinations, there can be two options for the position of the uterus: inclination and bending anteriorly - anteversio-anteflexio, inclination and bending backwards - retroversio-retroflexio.

The angle between the cervix and the body of the uterus is open anteriorly or posteriorly and averages 90°. In the standing position of a woman, the body of the uterus is located almost horizontally, and the cervix at an angle to it is almost vertical. The fundus of the uterus is located at the level of the IV sacral vertebra, and the external os of the cervix is at the level of the spinal plane (spina ischii). In front of the vagina and uterus are the bladder and urethra, and behind is the rectum.

The position of the uterus is normal may vary depending on the filling of these organs. Pathological inclinations and bends of the uterus occur during infantilism at an early age (primary) and as a result of inflammatory and adhesive processes of the genitals (secondary). The uterus can be mobile or immobile (fixed).

Hyperanteversion and hyperanteflexia of the uterus- this is a position when the anterior inclination is more pronounced, the angle between the body and the cervix is sharp (<90°) и открыт кпереди.
Hyperretroversion and hyperretroflexion of the uterus is a sharp deviation of the uterus posteriorly, and the angle between the body and the cervix is acute (<90°) и открыт кзади.

Inclination and bending of the uterus to the side (to the right or left) is a rare pathology and determines the inclination of the uterus and the bend between its body and the cervix to one side.

Clinical picture All variants of horizontal displacement of the uterus have much in common and are characterized by painful sensations in the lower abdomen or in the sacral area, algodismenorrhea, and prolonged menstruation. Sometimes there are complaints of dysuria, pain during bowel movements, and increased leucorrhoea. Since this pathology is a consequence of inflammatory processes or endocrine pathology, it can be accompanied by symptoms of these diseases and cause infertility and pathological pregnancy.

Diagnostics based based on gynecological and ultrasound examination data, taking into account symptoms.

Treatment should be aimed at eliminating the causes- anti-inflammatory drugs, correction of endocrine disorders. FTL and gynecological massage are used. In case of severe pathology, surgical intervention may be indicated, with the help of which the uterus is removed from the adhesions and fixed in the anteversio-anteflexio position.

Uterine rotation and torsion are rare, are usually caused by tumors of the uterus or ovaries and are corrected simultaneously with removal of the tumors.

Displacement of the genital organs along the vertical axis. This pathology is especially common in women of the perimenopausal period, less often in young women.

Uterine prolapse is a condition when the uterus is below the normal level, the external os of the cervix is below the spinal plane, the fundus of the uterus is below the IV sacral vertebra, but the uterus does not come out of the genital slit even with straining. Simultaneously with the uterus, the anterior and posterior walls of the vagina descend, which are clearly visible from the genital slit.

Complete uterine prolapse- the cervix and body of the uterus are located below the genital slit, and at the same time the vaginal walls are everted. Vaginal prolapse and prolapse most often occur simultaneously with the uterus, which is due to the anatomical connection of these organs. When the vagina prolapses, its walls occupy a lower position than normal, protruding from the genital slit, but do not extend beyond it. Vaginal prolapse is characterized by complete or partial exit of its walls from the genital fissure located below the pelvic floor.

Vaginal prolapse and prolapse are usually accompanied by prolapse of the bladder (cystocele) and the walls of the rectum (retrocele). When the uterus prolapses, the tubes and ovaries simultaneously descend, and the location of the ureters changes.

The main factors for prolapse and prolapse of the genital organs: traumatic injuries to the perineum and pelvic floor, endocrine disorders (hypoestrogenism), heavy physical labor (lifting heavy objects for a long time), sprain of the uterine ligaments (multiple births).

Clinical picture characterized by a protracted course and steady progression of the process. Prolapse of the genital organs increases with walking, coughing, and lifting heavy objects. Nagging pain appears in the groin areas and sacrum. Possible disturbances of menstrual function (hyperpolymenorrhea), the function of the urinary organs (incontinence and non-inflammatory and antibacterial local therapy (levomekol, dimexide, antibiotics in ointments and suspensions), healing ointments (actovegin, solcoseryl), drugs with estrogens. Reduced position of the genital organs is desirable.

Methods of surgical treatment there are many, and they are determined by the degree of pathology, age, and the presence of concomitant extragenital and genital diseases. When treating young women, methods that do not interfere with sexual and reproductive functions should be preferred.

If there are old perineal tears, surgery is performed to restore the pelvic floor. Prolapse of the vaginal walls can be eliminated by plastic surgery of the anterior and posterior walls with strengthening of the levators. If necessary, the bladder sphincter is strengthened, an operation is performed to fix the uterus to the anterior abdominal wall, or lift it by shortening the round ligaments

In old age for uterine prolapse and prolapse, vaginal hysterectomy with vaginal and levator plastic surgery is used. If an elderly woman is not sexually active, then vaginal suturing surgery is recommended. After the operation, you cannot sit down for a week, then for a week you can only sit on a hard surface (chair), the first 4 days after the operation you must maintain general hygiene, diet (liquid food), take a laxative or a cleansing enema on the 5th day, treat the perineum 2 times a day day, sutures are removed on the 5-6th day.

Uterine inversion is an extremely rare pathology; it occurs in obstetrics at the birth of an unseparated placenta, in gynecology - at the birth of a submucous uterine myomatous node. In this case, the serous membrane of the uterus is located inside, and the mucous membrane is located outside.

Treatment consists of taking urgent measures to relieve pain and realign the inverted uterus. In case of complications (massive edema, infection, massive bleeding), surgical intervention to remove the uterus is indicated.

Elevated position of the uterus is secondary and can be caused by fixation of the uterus after surgical interventions, vaginal tumors, accumulation of blood in the vagina during atresia of the hymen.

Prevention of abnormalities in the position of the genital organs includes: elimination of etiological factors, correction of damage to the birth canal during childbirth (careful suturing of all ruptures), optimal management of childbirth, gymnastic exercises for a tendency to prolapse, compliance with occupational safety and health rules for women, timely surgical treatment for prolapse to prevent genital prolapse. To prevent prolapse of the genital organs, prompt surgical treatment of prolapsed organs should be carried out.

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

Anomalies in the position of the genital organs are considered to be such permanent conditions that go beyond physiological norms and violate the normal relationships between them. All genital organs are interconnected in their position, so abnormal conditions are mostly complex (at the same time the position of the uterus, cervix, vagina, etc. changes).

The classification is determined by the nature of the violations of the position of the uterus: displacement along the horizontal plane (the entire uterus to the left, right, forward, backward; incorrect relationship between the body and the cervix in terms of inclination and severity of bending; rotation and torsion); displacement in the vertical plane (prolapse, prolapse, elevation and inversion of the uterus, prolapse and prolapse of the vagina).

Displacements along the horizontal plane. Displacement of the uterus and cervix to the right, left, forward, backward occurs more often due to compression by tumors or the formation of adhesions after inflammatory diseases of the genitals (Fig. 19). Diagnosis is achieved using gynecological examination, ultrasound and radiography. Symptoms are characteristic of the underlying disease. Treatment is aimed at eliminating the cause: surgery for tumors, physiotherapeutic procedures and gynecological massage for adhesions.

Pathological inclinations and bends between the body and neck are considered simultaneously. Normally, in terms of bending and inclination, there can be two options for the position of the uterus: tilting and bending anteriorly - anteversio-anteflexio, tilting and bending backward - retroversio-retroflexio (Fig. 20). The angle between the cervix and the body of the uterus is open anteriorly or posteriorly and averages 90°. In the standing position of a woman, the body of the uterus is located almost horizontally, and the cervix at an angle to it is almost vertical. The fundus of the uterus is located at the level of the IV sacral vertebra, and the external os of the cervix is at the level of the spinal plane (spina ischii). In front of the vagina and uterus are the bladder and the urethra, and behind is the rectum. The position of the uterus can normally change depending on the filling of these organs. Pathological inclinations and bends of the uterus occur during infantilism at an early age (primary) and as a result of inflammatory and adhesive processes of the genitals (secondary). The uterus can be mobile or immobile (fixed).

Rice. 19.

: a - anteriorly by the myomatous node; b - to the left with a tumor of the right ovary; c - posteriorly with adhesions resulting from pelvioperitonitis.

Fig.20.

: a - anteflexio-anteversio; b - retroflexio-retroversio.

Rice. 22.

(a) and pathological bend of the uterus posteriorly (b).

Rice. 23.

to the left (a) and posterior displacement of the uterus (b).

Rice. 24.

: a - appearance; b - diagram.

Hyperanteversion and hyperanteflexion of the uterus is a position where the anterior inclination is more pronounced, and the angle between the body and the cervix is acute (
Hyperretroversion and hyperretroflexion of the uterus is a sharp deviation of the uterus posteriorly, and the angle between the body and the cervix is acute (
The inclination and bending of the uterus to the side (to the right or left) is a rare pathology and determines the inclination of the uterus and the bending between its body and the cervix to one side (Fig. 23).

The clinical picture of all variants of horizontal displacement of the uterus has much in common and is characterized by painful sensations in the lower abdomen or in the sacral area, algodismenorrhea, and prolonged menstruation. Sometimes there are complaints of dysuria, pain during bowel movements, and increased leucorrhoea. Since this pathology is a consequence of inflammatory processes or endocrine pathology, it can be accompanied by symptoms of these diseases and cause infertility and pathological pregnancy.

Diagnosis is based on data from gynecological and ultrasound examinations, taking into account symptoms.

Rice. 25.

: a - appearance; b - diagram.

Rice. 26.

: a - appearance; b - diagram.

Treatment should be aimed at eliminating the causes - anti-inflammatory drugs, correction of endocrine disorders. FTL and gynecological massage are used. In case of severe pathology, surgical intervention may be indicated, with the help of which the uterus is removed from the adhesions and fixed in the anteversio-anteflexio position.

Uterine rotation and torsion are rare, are usually caused by tumors of the uterus or ovaries and are corrected simultaneously with removal of the tumors.

Displacement of the genital organs along the vertical axis. This pathology is especially common in women of the perimenopausal period, less often in young women.

Uterine prolapse is a condition when the uterus is below the normal level, the external os of the cervix is below the spinal plane, the fundus of the uterus is below the IV sacral vertebra (Fig. 24), but the uterus does not come out of the genital slit even with straining. Simultaneously with the uterus, the anterior and posterior walls of the vagina descend, which are clearly visible from the genital slit.

Uterine prolapse - the uterus is sharply displaced downwards, partially or completely comes out of the genital slit when straining. Incomplete uterine prolapse - when only the vaginal part of the cervix emerges from the genital slit, and the body remains above the genital slit even with straining (Fig. 25). Complete uterine prolapse - the cervix and body of the uterus are located below the genital slit, and at the same time the vaginal walls are everted (Fig. 26). Vaginal prolapse and prolapse most often occur simultaneously with the uterus, which is due to the anatomical connection of these organs. When the vagina prolapses, its walls occupy a lower position than normal, protruding from the genital slit, but do not extend beyond it. Vaginal prolapse is characterized by complete or partial exit of its walls from the genital fissure located below the pelvic floor. Prolapse and prolapse of the vagina are usually accompanied by prolapse of the bladder (cystocele) and the walls of the rectum (retrocele) (Fig. 27). When the uterus prolapses, the tubes and ovaries simultaneously descend, and the location of the ureters changes.

The clinical picture is characterized by a protracted course and steady progression of the process. Prolapse of the genital organs increases with walking, coughing, and lifting heavy objects. Nagging pain appears in the groin areas and sacrum. Possible disturbances in menstrual function (hyperpolymenorrhea), the function of the urinary organs (urinary incontinence and incontinence, frequent urination). Sexual life and pregnancy are possible.

Diagnosis is carried out according to anamnesis, complaints, gynecological examination, and special research methods (ultrasound, colposcopy). When examining the mucous membrane of the vagina and cervix of a prolapsed uterus, trophic (decubital) ulcers are often noted due to injury and changes in flora (Fig. 28).

Fig.27.

1 - pubic bone; 2 - bladder, 3 - uterus; 4 - rectum, 5 - prolapsed intestinal loop, 6 - prolapsed posterior vaginal wall; 7 - vagina.

Treatment for prolapse and prolapse of the genital organs can be conservative and surgical. Conservative treatment boils down to the use of a set of gymnastic exercises aimed at strengthening the pelvic floor and abdominal muscles. It can be acceptable only with unexpressed prolapse of the uterus and vagina. It is very important to follow a work schedule (excluding heavy physical work, lifting weights), a diet rich in fiber, urinating “on the clock,” and avoiding constipation. These conditions must be observed during both conservative and surgical treatment. If there are contraindications to surgical treatment (old age, severe concomitant pathology), the introduction of pessaries or rings into the vagina is indicated, followed by training the woman in the rules of their processing and insertion. The patient should regularly visit a midwife or doctor to monitor the condition of the mucous membranes of the vagina and cervix (prevention of inflammation, bedsores, trophic ulcers). Treatment of trophic ulcers and bedsores involves the use of anti-inflammatory and antibacterial local therapy (levomekol, dimexide, antibiotics in ointments and suspensions), healing ointments (actovegin, solcoseryl), and preparations with estrogens. Reduced position of the genital organs is desirable.

There are many methods of surgical treatment, and they are determined by the degree of pathology, age, and the presence of concomitant extragenital and genital diseases. When treating young women, methods that do not interfere with sexual and reproductive functions should be preferred. If there are old perineal tears, surgery is performed to restore the pelvic floor. Prolapse of the vaginal walls can be eliminated by plastic surgery of the anterior and posterior walls with strengthening of the levators. If necessary, the bladder sphincter is strengthened, an operation is performed to fix the uterus to the anterior abdominal wall, or lift it by shortening the round ligaments.

In old age, with uterine prolapse and prolapse, vaginal hysterectomy with vaginal and levator plastic surgery is used. If an elderly woman is not sexually active, then vaginal suturing surgery is recommended. After the operation, you cannot sit down for a week, then for a week you can only sit on a hard surface (chair), the first 4 days after the operation you must maintain general hygiene, diet (liquid food), take a laxative or a cleansing enema on the 5th day, treat the perineum 2 times a day day, sutures are removed on the 5-6th day.

Uterine inversion is an extremely rare pathology, occurring in obstetrics at the birth of an unseparated placenta, and in gynecology at the birth of a submucosal myomatous uterine node. In this case, the serous membrane of the uterus is located inside, and the mucous membrane is located outside (Fig. 29).

Treatment consists of taking immediate measures to relieve pain and realign the inverted uterus. In case of complications (massive edema, infection, massive bleeding), surgical intervention to remove the uterus is indicated.

The elevated position of the uterus (Fig. 30) is secondary and can be caused by fixation of the uterus after surgery, vaginal tumors, and accumulation of blood in the vagina during atresia of the hymen.

Incorrect position of the genital organs is a persistent deviation from their normal position, usually accompanied by pathological phenomena. There are the following types of abnormal position of the uterus:

Displacement of the entire uterus (position anterior, posterior, right, left).

Anteposition - anterior displacement; occur as a physiological phenomenon with a crowded rectum, as well as with tumors and effusions located in the rectal-uterine space.

Retroposition is a posterior displacement of the entire uterus. This can be caused by a full bladder, inflammatory formations, cysts and tumors located in front of the uterus.

Lateroposition is a lateral displacement of the uterus. Caused mainly by inflammatory infiltrates of periuterine tissue.

Pathological inclination (version). The body of the uterus moves to one side, the cervix to the other.

Anteversion - the body of the uterus is tilted anteriorly, the cervix is tilted posteriorly.

Retroversion - the body of the uterus is tilted posteriorly, the cervix is tilted anteriorly.

Dextroversion - the body of the uterus is tilted to the right, the cervix is tilted to the left.

Sinisterversion - the body of the uterus is tilted to the left, the cervix is tilted to the right.

Pathological deviation of the uterus is caused by inflammatory processes in the peritoneum, fiber and related.

Bend of the body of the uterus relative to the cervix. Normally, between the body and the cervix there is an obtuse angle, open anteriorly.

Uterine hyperateflexion is a pathological bending of the uterine body anteriorly. There is an acute angle (70°) between the body and the neck. Often this is a congenital condition associated with general and sexual infantilism, less often it is the result of an inflammatory process in the area of the uterosacral ligaments.

Clinic. Painful menstruation, often infertility, pain in the sacrum and lower abdomen.

Diagnosis is based on general and gynecological examination. The uterus is small, sharply deviated anteriorly, the cervix is conical and often elongated. The vagina is narrow, the vaults are thickened.

Treatment is based on eliminating the cause that caused this pathology.

Retroflexion is a posterior bending of the body of the uterus. The angle between the body of the uterus and its cervix is open posteriorly.

Retrodeviation of the uterus. A common combination of retroflexion and retroversion. There are mobile and fixed retrodevnation. Mobile retrodevnation of the uterus can be a manifestation of anatomical and physiological disorders in a woman’s body. They are detected in young women and girls with an asthenic build. With infantilism and hypoplasmy of the genital organs. These women have reduced tone of the supporting and anchoring apparatus of the uterus. Such disorders can occur after childbirth, especially if the postpartum period is not managed correctly, and after a number of pathological processes (serious illnesses, sudden weight loss, etc.). fixed retrodeviation is usually a consequence of an inflammatory process in the pelvis.

Clinic. In many women, uterine retrodeviation does not cause any symptoms and is detected by chance. Some women complain of pain in the sacrum, algomenorrhea, heavy menstruation, leucorrhoea, heaviness in the lower abdomen, dysuria, and constipation.

The diagnosis is not difficult. This position of the uterus is recognized during a two-manual anterior abdominal wall vaginal examination. In some cases, this condition occurs from tumors of the uterus, ovaries, or tubal pregnancy. Additional research methods can clarify the diagnosis.

Treatment. Women who do not complain do not need treatment. During pregnancy, the enlarging uterus itself takes on the correct position. If the symptoms of the disease are pronounced, strengthening treatment is indicated (vitamin therapy, physical education, sports). In some cases, they resort to correcting the position of the uterus; it is produced after emptying the bladder and rectum. The body of the uterus is palpated deep in the rectouterine space. As during a gynecological examination, two fingers of the right hand are inserted into the vagina, the index finger pushes the cervix posteriorly, and the middle finger presses on the pelvic body. The outer hand grasps the fundus of the uterus and places it in the correct position. Since the cause causing retrodeviation is not established, lasting therapeutic success is usually not achieved. In some cases, pessaries are used to hold the uterus in the correct position. In case of fixed retrodeviation, it is necessary to check the therapy of the inflammatory process or its consequences.

Rotation of the uterus. The uterus is rotated around its longitudinal axis.

Etiology – inflammation in the area of the uterosacral ligaments, their shortening, the presence of a tumor located posteriorly and to the side of the uterus.

Treatment. Elimination of the reasons that caused the uterine rotation.

Torsion of the uterus. Rotation of the uterine body with a fixed cervix. The uterus may undergo torsion in the presence of a unilateral ovarian formation (cyst, languor) or a subserous fibromatous node.

Downward displacement of the uterus and vagina (prolapse and prolapse). Has little practical significance.

Uterine prolapse - the cervix is located below the interspinal plane of the pelvis. When the uterus prolapses, it extends beyond the genital slit completely (complete prolapse) or partially; sometimes only the neck comes out (incomplete prolapse).

Etiology. Increased intra-abdominal pressure, insufficiency of the pelvic floor muscles, prolonged increase in intra-abdominal pressure due to heavy physical work and constipation, insufficiency of the pelvic floor muscles as a result of trauma to the perineum during childbirth. Predisposing factors: early physical labor in the postpartum period, frequent childbirth, uterine retroversion, sudden weight loss, infantilism, tissue atrophy in old age.

Clinic. Patients complain of a feeling of heaviness and pain in the lower abdomen, difficulty urinating, and the presence of a “foreign body” in the genital opening.

Prolapse of the uterus is usually accompanied by prolapse of the vaginal walls. With complete prolapse of the uterus, the vaginal walls become inverted. Used prolapse of the vaginal walls is noted in the absence of the uterus (after exterthetion). In rare cases, an underdeveloped vagina may prolapse in the absence of a uterus. Prolapse of the walls of the vagina and uterus entails prolapse and prolapse of the bladder (cystocoel) and rectum (rectocoel). With prolapse of the genital organs, bedsores often develop on the cervix and vaginal walls, the vaginal walls become rough and inelastic, swollen, and cracks easily appear. The presence of bedsores leads to the development of infection, which often spreads to the urinary tract. A prolapsed uterus is usually swollen and cyanotic due to impaired lymphatic drainage and blood stagnation.

When the diseased uterus is in a horizontal position, it is reduced. Prolapse of the rectal walls is often accompanied by constipation. There is often incontinence of urine and gases when coughing and sneezing. Prolapse and prolapse of the uterus develop slowly, but are progressive, especially if the woman does hard work.

The diagnosis is established based on the patient’s complaints and gynecological examination data. When the walls of the vagina and uterus prolapse with the hips apart, the genital gap gapes, and there is a divergence of the levator ani muscle; The posterior wall of the vagina will be applied directly to the wall of the rectum. Decubital ulcer should be differentiated from tumor cancer.

Prevention. Correct management of childbirth and the postpartum period, anatomically correct suturing of perineal tears, elimination of excessive physical activity, especially in the postpartum period.

Treatment. With slight prolapse of the uterus, exercise therapy is indicated to strengthen the pelvic floor muscles, general strengthening therapy, and transfer from heavy to lighter physical work. In women with severe prolapse or prolapse of the genital organs, surgery is indicated. There are numerous types of surgical interventions, but all operations must be accompanied by plastic surgery of the pelvic floor muscles. In case of complete or partial prolapse of the uterus, extirtation should be resorted to if there is cervical erosion, fibroids, etc. In other cases, more conservative operations are indicated. If there are contraindications to surgery, vaginal pessaries are used.

Elevation of the uterus. Upward displacement of the uterus. Occurs with ovarian tumors, hematoma and other pathological processes. Under physiological conditions, uterine elevation can be caused by overfilling of the bladder and rectum.

DISORDERS MENSTRUAL CYCLE.

NORMAL MENSTRUAL CYCLE AND ITS REGULATION. AMENORRHEA.

I. The menstrual cycle is a complex biological process that occurs in a woman’s body, repeating at regular intervals and externally manifested by regular uterine bleeding.

Signs of the physiological menstrual cycle:

Biphasicity;

Duration 21-35 days;

Cyclicality;

Bleeding time 2-7 days;

Blood loss 50-150 ml;

No painful phenomena.

The regulation of the menstrual cycle involves 5 links:

Cerebral cortex – center not established.

Hypothalamus;

Pituitary;

Ovaries;

In animals, removal of the bark does not affect ovulation and pregnancy. In a person with mental trauma, the menstrual cycle is disrupted.

Castration – weakens the function of the cortex.

The subcutaneous region - the hypothalamus - releases releasing hormones RG (resolving factors) - neurohormones.

RG – FSH RG – follicle-stimulating hormones.

RG – LH – luteinizing

RG LTG – luteotropic (prolactin)

RG - enter through the vessels into the anterior pituitary gland, where they contribute to the formation of gonodotropic hormones.

FSH LH LTG

Blockade of the hypothalamus-pituitary gland connection leads to the cessation of menstruation. The pituitary gland produces FSH and LH, which stimulate the growth and maturation of the follicle in which estrogens are formed.

1. Ovarian estrogens increase the sensitivity of the pituitary gland to the effects of RG - FSH.

2. Estrogens inhibit the production of FSH and LH and stimulate the release of LTG.

At certain ratios of FSH and LH, ovulation occurs, the corpus luteum is formed, and the hormone progesterone is produced.

Progesterone inhibits the production of LH and LTG. The corpus luteum exists for a week. In response to a decline in hormones, FSH begins to be released. A new cycle begins.

In the pituitary gland, phase 2 - follicular FSH LH

luteal LH and LTG

LH – promotes: secretion of estrogen in the ovary, ovulation.

The ovaries secrete estrogens, progesterone, androgens that act on the pituitary gland, uterus, metabolism, and endocrine glands. Under the influence of estrogen, the functional layer in the uterus grows - the proliferation phase; under the influence of progesterone - the glands of the functional layer of the uterus expand and begin to produce secretion - the secretion phase.

When the corpus luteum atrophies in the ovary, and the new follicle has still begun to function, in response to a decline in hormones, desquamation and regeneration (bleeding) occur.

II. Causes of menstrual irregularities.

Organic and functional diseases of the central nervous system;

Disorders and diseases of the hypothalamic-pituitary region;

Eating disorders;

Occupational hazards;

Infectious diseases;

Diseases of the cardiovascular system, hematopoietic system, liver;

Gynecological diseases;

Surgeries on the genital organs, injuries, fistulas.

III. Classification of violations.

1) Amenorrhea – absence of menstruation for more than 6 months.

2) Dysfunctional uterine bleeding.

3) Algomenorrhea - painful menstruation.

4) Hypomenstrual syndrome.

5) Hypermenstrual syndrome.

6) Premenstrual and menopausal syndromes.

7) Metrorrgia - bleeding not associated with the menstrual cycle.