. Clinical gyncology, medical and surgical. rawn down by the prolapsing vaginal walls. This, however, is by nomeans the usual mode of formation of prolapse of the uterus and should be stated that these rare forms of prolapse of the normal retro-flexed or antefiexed uterus occurred in virgins of advanced years, in whom 512 DISPLACEMENTS OF THE UTERUS. the natural relaxation of the pelvic connective tissue permitted a vaginaland uterine prolapse. To recapitulate: complete prolapse of the uterus is usually associatedwith complete prolapse of the anterior and posterior vaginal walls, tog
. Clinical gyncology, medical and surgical. rawn down by the prolapsing vaginal walls. This, however, is by nomeans the usual mode of formation of prolapse of the uterus and should be stated that these rare forms of prolapse of the normal retro-flexed or antefiexed uterus occurred in virgins of advanced years, in whom 512 DISPLACEMENTS OF THE UTERUS. the natural relaxation of the pelvic connective tissue permitted a vaginaland uterine prolapse. To recapitulate: complete prolapse of the uterus is usually associatedwith complete prolapse of the anterior and posterior vaginal walls, togetherwith the corresponding portions of the bladder and rectum. When onlyone vaginal wall is prolapsed, it is usually the anterior with the corre-sponding portion of the rectum, and in the large majority of cases this isthe way in which a uterine prolapse first begins,—namely, prolapse of theanterior vaginal wall and bladder; second, dragging down of the heavyuterus; and, third, prolapse of the posterior vaginal wall and rectum. Fig. Section of prolapse of anterior vaginal wall and bladder. Slight rectocele. Causes.—The causes of prolapse of the uterus are twofold: 1. Aheavy uterus dragging down the suspensory ligaments, chiefly the broadligaments, and gradually sinking deeper and deeper into the pelvic cavityuntil it finally draws down with it the anterior vaginal wall with thebladder and then the posterior vaginal wall with the rectum. 2. Prolapseof the anterior vaginal wall with the bladder, dragging down of the uterus,probably also more or less enlarged, and, finally, prolapse of the posteriorvaginal wall with the rectum. In the first instance it is the heavy uteruswhich primarily causes the prolapsus; in the second, it is the relaxed anddescending vaginal walls which drag down after them the heavy uterus. As indirect causes of prolapsus uteri must be mentioned the lacerationor equivalent relaxation of the perineum and the pelvic floor, whereby DISPLACEMENTS OF THE
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