. Atlas and epitome of gynecology . the vaginal vault, bimanual examina-tion causes marked pain, especially on moving the uterus. The adhesions are recognized from the fact that theuterus has lost its range of motion, being bound down insome pathologic position. (See Displacements of theUterus and accompanying plates.) Exudates never exist without peritoneal pain, fever, are usually found in the pouch of Douglas, and maybe palpated from the rectum or from the posterior vaginalvault. The adnexa are embedded in the exudate. (SeeEetro-uterine Tumors under Ovarian Cystomata.) If thepouch
. Atlas and epitome of gynecology . the vaginal vault, bimanual examina-tion causes marked pain, especially on moving the uterus. The adhesions are recognized from the fact that theuterus has lost its range of motion, being bound down insome pathologic position. (See Displacements of theUterus and accompanying plates.) Exudates never exist without peritoneal pain, fever, are usually found in the pouch of Douglas, and maybe palpated from the rectum or from the posterior vaginalvault. The adnexa are embedded in the exudate. (SeeEetro-uterine Tumors under Ovarian Cystomata.) If thepouch of Douglas is obliterated, the exudate occurs abovethe pelvic inlet—in the iliac fossae. In other cases themass may reach as high as the umbilicus. Treatment.—The acute form is discussed in § 16. Inthe chronic form every therapeutic manipulation of thegenitalia is contraindicated. This includes the introduc-tion of pessaries and of the mtra-uterine sound, scarifica-tion of the cervix, prolonged bimanual examination, etc. COOS. § \
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