Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . uched by the pessary during the second step of backward ro-tation. The difficulties which I have seen beginners encounter consistedin pain during the passage through the vaginal orifice, and failure to seizethe proper portion of the instrument with the finger in the second pain at the orifice depended entirely upon the omission to pushback the perineum, and the consequent pressure by the right bar of thepessa
Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner . uched by the pessary during the second step of backward ro-tation. The difficulties which I have seen beginners encounter consistedin pain during the passage through the vaginal orifice, and failure to seizethe proper portion of the instrument with the finger in the second pain at the orifice depended entirely upon the omission to pushback the perineum, and the consequent pressure by the right bar of thepessary on the sensitive vestibule. The failure to grasp the right curve,RP, with the finger was due to non-comprehension of the principle of themethod, and omission to rotate the pessary with the left hand at the beak,so as to have RP within easy reach. The usual fault was that the pessarywas introduced too far, and the arch RP could not be easily reached bythe finger. The result of not securing a firm grasp on the arch at RP, wasthat the traction was always exerted nearer the other curve of the arch LP(see Fig. 264), and the operator was astonished to find that he had placed. Fig. 966.—Introduction of lever pessary (Albert Smiths). Third step. (P. F. M.) the pessary behind the cervix, with the arch P pointing toward the rectum,that is to say, wrong side forward. Of course, a pessary so placed couldbut give pain and do harm. Occasionally, if the parts are too thoroughlylubricated, the finger may slip from the posterior arch, and the maneuvrefail for the moment, even in experienced hands. The double lever pessaries, like Hodges, Smiths, Thomas, Sims, arebest introduced in this manner, but thesingle levers, like Noeggeraths,are also easily applied as described. The usual method consists in inserting the pessary with the posteriorarch and larger concavity pointing upward, passing it in front of the cer-vix, and then, with the index finger pressed against the cross-bar under thepessa
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