. The Principles and practice of gynecology : for students and practitioners. ve—that is,the pessary should be bent away from the irritated part. The pubiccurve may, however, be so great that the lower part of the jiessaryoccupies the centre of the vulva, where it is apt to create this condition lessening of the pubic curve is the remedy. Thepessary should not be so wide as to distend the vagina. The lengthshould be measured by the distance from the lower extremity of thesymphysis pubis to the posterior vaginal cul-de-sac, less the thickness 668 D IS PL A CEMENTS. of the finger.
. The Principles and practice of gynecology : for students and practitioners. ve—that is,the pessary should be bent away from the irritated part. The pubiccurve may, however, be so great that the lower part of the jiessaryoccupies the centre of the vulva, where it is apt to create this condition lessening of the pubic curve is the remedy. Thepessary should not be so wide as to distend the vagina. The lengthshould be measured by the distance from the lower extremity of thesymphysis pubis to the posterior vaginal cul-de-sac, less the thickness 668 D IS PL A CEMENTS. of the finger. If properly adjusted in a suitable case, it should sus-tain the pelvic floor in its normal relations and the uterus in stableequilibrium. Thomas retroflexion pessary, with its bulbous upper extremity, isa long-, narrow instrument of extreme uterine curve. It lifts theuterus very high, and is specially applicable in cases of great relaxa-tion of the pelvic floor and of complicating prolapse of the ovaries :sometimes the bulbous portion is made of soft rubber. Figure Thomas retroflexion pessary. In retroversion and retroflexion always replace the uterus beforeadjusting the pessary, otherwise the instrument will press upon thesensitive uterus, and one of three unfortunate results may occur: (a)the pessary may not be tolerated on account of pain; (6) it may beforced down by pressure from above so near to the vulva that it willfail to do the least good; (c) the uterus, finding it impossible to holdits position against the pessary, instead of taking its proper position,may be bent over it in exaggerated retroflexion, ^yith the cervix be-tween the pessary and the pubes, or the whole organ may slip off toone side of the instrument into a malposition more serious than theone for which relief is sought. A properly adjusted pessary gives to the patient no consciousnessof its presence. If the instrument causes pain, it should be removed,and search made for the tender places ; it t
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