. Gynecology : . g accelerated by the physiologic weakening of thepelvic supports that occurs at and after the menopause. Rarely it may beseen in young women a few months after labor. The change from prolapse to procidentia—i. e., the protrusion of the cervicalorifice beyond the vaginal introitus—sometimes gives the patient the impression 476 GYNECOLOGY that the condition has developed suddenly, especially if the prolapse has notbeen noticed or if the perineum has been sufficiently small to obstruct tempo-rarily the onward progress of the down-coming cervix. It should be remem-bered, however,
. Gynecology : . g accelerated by the physiologic weakening of thepelvic supports that occurs at and after the menopause. Rarely it may beseen in young women a few months after labor. The change from prolapse to procidentia—i. e., the protrusion of the cervicalorifice beyond the vaginal introitus—sometimes gives the patient the impression 476 GYNECOLOGY that the condition has developed suddenly, especially if the prolapse has notbeen noticed or if the perineum has been sufficiently small to obstruct tempo-rarily the onward progress of the down-coming cervix. It should be remem-bered, however, that the presence of a procidentia indicates a gradual andusually slow progress. It is not brought on suddenly from a normal conditionby falls, jars, and other forms of traumatism. The existence and extent of procidentia are not necessarily dependent onthe number of labors through which the patient has passed, but rather on theindividual character of the pelvic supporting tissues. It is a noticeable fact that. Fig. 197.—Procidentia. Typical Case. the mothers of very large families often suffer very little damage from theirrepeated labors, while other women, with a very limited number of childbirths,may exhibit extreme relaxation. Congenital procidentia is a term somewhat improperly applied to nulliparouswomen who develop the condition. It is implied that there exists a congenital-tissue deficiency in the pelvic supports, but not that the procidentia appearsin infancy. It may come to notice in comparatively young women, often notuntil the approach of or even after the menopause. In the congenital type thedescent represents chiefly a continued elongation of the cervix. As there have MALPOSITIONS OF THE UTERUS 477 been no previous lacerations, cystocele, rectocele, and hypertrophy of the cervixare less marked than in the ordinary procidentia that results from childbirth. The extrusion of the cervix in procidentia is in most cases primarily due to itselongation. This lengthen
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