. Gynecology : . bance of the nervous and digestive functions leads to headaches. Adherentmasses in the posterior culdesac, or the backward dislocation of the uterus, maycause sacral backache. Most women with this disease are sterile, and thismay be a source of mental worry. Leukorrhea from an associated endocervici- 14 210 GYNECOLOGY tis is usually present and aggravates the nervous and mental distress. Bladdersymptoms are sometimes present, but are not common, because the disease doesnot usually extend to the anterior half of the pelvis. Disturbances of menstruation are common and are of imp
. Gynecology : . bance of the nervous and digestive functions leads to headaches. Adherentmasses in the posterior culdesac, or the backward dislocation of the uterus, maycause sacral backache. Most women with this disease are sterile, and thismay be a source of mental worry. Leukorrhea from an associated endocervici- 14 210 GYNECOLOGY tis is usually present and aggravates the nervous and mental distress. Bladdersymptoms are sometimes present, but are not common, because the disease doesnot usually extend to the anterior half of the pelvis. Disturbances of menstruation are common and are of importance. Someof the menstrual abnormalities of chronic pelvic inflammation cannot easily beexplained. Some think them due to a disturbance in the ovarian secretion, whichis believed to preside over the function of menstruation. This, however, is notproved. There is usualty dysmenorrhea, in the sense that the pelvic pains areexaggerated during catamenia. As will be seen (see page 516), this must be SevY^\)\Xv$. Fig. 42.—Cheonic tubes are closed and implicated in adhesions. Salpingitis isthmica nodosa is seen at the bases of both tubes. regarded not as an essential, but as a secondary, dysmenorrhea. It is doubtlessdue to the increased congestion of adherent and immobilized organs. It occasionally happens that there is a temporary amenorrhea. Patientsin this condition sometimes think themselves pregnant and attempt abortion,with very disastrous results. Menorrhagia and metrorrhagia are not uncommon, and may lead to muchconfusion in diagnosis. For example, a period of menorrhagia may follow aperiod of amenorrhea. This sequence, in connection with pelvic pain and apalpable mass, may cause a very excusable diagnosis of extra-uterine pregnancy. INFLAMMATIONS . 211 The abnormal uterine bleeding sometimes leads the attending physician to curetthe uterus, a dangerous procedure, which too often results in lighting up thechronic process into dangerous activity. • A
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