Incorrect Positions of the Genitals

What is Incorrect Positions of the Genitals?

Normal (typical) is considered to be the position of the genitals in a healthy sexually mature non-pregnant and non-nursing woman in an upright position with an empty bladder and rectum. Normally, the bottom of the uterus is turned up and does not protrude above the entrance to the pelvis, the area of ​​the external uterine pharynx is at the level of the spinal awns, the vaginal part of the cervix is ​​down and back. The body and cervix form an obtuse angle that is open anteriorly (anteversio and anteflexio position). The vagina is located obliquely in the pelvic cavity, heading from the top and back down and anteriorly. The bottom of the bladder is adjacent to the anterior wall of the uterus in the area of ​​the isthmus, the urethra is in contact with the anterior wall of the vagina in its middle and lower thirds. The rectum is located behind the vagina and is associated with loose fiber. The upper part of the posterior wall of the vagina – the posterior arch is covered with the peritoneum of the rectum-uterine space.

The normal position of the female genital organs is ensured by their own tone of the genital organs, the relationship of the internal organs and the coordinated activity of the diaphragm, abdominal wall and pelvic floor and the ligamentous apparatus of the uterus (suspending, fixing and supporting).

The proper tone of the genitals depends on the proper functioning of all body systems. A decrease in tone may be associated with a decrease in the level of sex hormones, a violation of the functional state of the nervous system, and age-related changes.

The interrelations of internal organs (intestines, omentum, parenchymal and genital organs) form their single complex. Intra-abdominal pressure is regulated by the friendly function of the diaphragm, anterior abdominal wall and pelvic floor.

The hanging ligamentous apparatus of the uterus is made up of round and wide ligaments of the uterus, its own ligament and the suspensory ligament of the ovary. These ligaments provide the middle position of the fundus of the uterus and its physiological inclination anteriorly.

The fixative ligamentous apparatus of the uterus includes the sacro-uterine, main, uterine-cystic and cystic-pubic ligaments. The locking device ensures the central position of the uterus and makes it virtually impossible to move it to the sides, back and anterior. Since the ligamentous apparatus departs from the lower part of the uterus, its physiological inclinations in various directions are possible (the woman is lying down, her bladder is full, etc.).

The supporting ligamentous apparatus of the uterus is represented mainly by the muscles of the pelvic floor (lower, middle and upper layers), as well as the vesicovaginal, rectal-vaginal septa and dense connective tissue located at the side walls of the vagina. The lower layer of the pelvic floor muscles is the external sphincter of the rectum, bulbous-cavernous, sciatic-cavernous and superficial transverse muscles of the perineum. The middle layer of muscles is represented by the urogenital diaphragm, the external sphincter of the urethra and the deep transverse muscle of the perineum. The upper layer of the muscles of the pelvic floor forms a paired muscle that raises the anus.

Causes of Incorrect Positions of the Genitals

Wrong positions of the genitals arise under the influence of inflammatory processes, tumors, injuries and other factors. The uterus can be displaced both in the vertical plane (up and down), and around the longitudinal axis and in the horizontal plane. The most important clinical significance is the displacement of the uterus down (prolapse), posterior displacement (retroflexion) and pathological anteflexia (hyperanteflexia).

Symptoms of Incorrect Positions of the Genitals

Hyperanteflexia is a pathological excess of the uterus anteriorly, when an acute angle is created between the body and the cervix (less than 70 °). Pathological anteflexia may be the result of sexual infantilism and, less commonly, the inflammatory process in the pelvis.

The clinical picture of hyperanteflexia corresponds to that of the underlying disease that caused the abnormality of the uterus. The most typical complaints of menstrual dysfunction by type of hypomenstrual syndrome, algomenorrhea. Often there is infertility (usually primary) due to decreased ovarian function.

The diagnosis is made on the basis of characteristic complaints and vaginal examination data. As a rule, the uterus of small sizes is sharply deflected anteriorly, with an elongated conical neck, the vagina is narrow, the vaginal arches are flattened.

The treatment of hyperanteflexia is based on the elimination of the causes that caused this pathology (treatment of infantilism, the inflammatory process). With severe algomenorrhea, various painkillers are used. Antispasmodics (no-shpa, baralgin, etc.) are widely used, as well as antiprostaglandins: indomethacin, butadion, etc. 2-3 days before the onset of menstruation.

Uterus retroflexion is an open posterior angle between the body and cervix. In this position, the body of the uterus is deflected posteriorly, and the cervix is ​​anteriorly. In retroflexion, the bladder is not covered by the uterus, and intestinal loops exert constant pressure on the anterior surface of the uterus and the posterior wall of the bladder. As a result of this, prolonged retroflexion leads to prolapse or prolapse of the genitals.

Distinguish between mobile and fixed uterine retroflexion. Mobile retroflexion is a consequence of a decrease in the tone of the uterus and its ligaments with infantilism, birth injury, tumors of the uterus and ovaries. Mobile retroflexion is often found in women of asthenic physique and after general severe illness with severe weight loss. Fixed uterine retroflexion is a consequence of inflammatory processes in the pelvis and endometriosis.

The clinic of uterine retroflexion is determined by the symptoms of the underlying disease: pain, impaired function of neighboring organs and menstrual function. In many women, uterine retroflexion is not accompanied by any complaints and is detected by chance during a gynecological examination.

Diagnosis of uterine retroflexion usually does not present any difficulties. In a bimanual examination, a uterus deflected posteriorly is palpated through the posterior vaginal fornix. With mobile retroflexion, the uterus is quite easily brought to a normal position; with fixed retroflexion, the uterus is usually unable to withdraw.

Treatment. In asymptomatic uterine retroflexion, treatment is not indicated. Clinical symptom retroflexion requires treatment of the underlying disease (inflammatory processes, endometriosis). Pessaries for keeping the uterus in the correct position are not currently used, as well as surgical correction of uterine retroflexion. Gynecological massage is also not recommended.