DIAGNOSIS AND PROGNOSIS.--The symptoms outlined in the preceding paragraph indicate the probability of displacement, but the diagnosis depends upon direct examination of the uterus. Conjoined manipulation and the probe will usually show the retroverted organ with the cervix displaced toward the pubes and with the corpus in the hollow of the sacrum. The introduction of the probe is contraindicated by cellulitis and peritonitis. In certain cases of anteflexion, as represented in Fig. 23, the cervix is bent forward in the vaginal axis as in retroversion. The condition is in reality one of retroversion of the cervix with high anteflexion of the corpus, which may usually be detected by careful conjoined examination. The prognosis with treatment is generally favorable both for speedy relief and ultimate recovery. TREATMENT.--As in descent, the treatment consists in removing cellulitis, peritonitis, and other complications, in the use of pessaries, and in operations on the anterior and posterior vaginal walls if needed. Inasmuch as the treatment corresponds to that of retroflexion, it will be presented under that subject. Retroflexion. ETIOLOGY AND PATHOLOGY.--Retroflexion is that displacement in which the organ is bent backward upon itself. It usually results from, {167} and is associated with, retroversion, but for convenience the double displacement will be termed retroflexion. It may be caused by the great weight of the corpus, the soft flexible state of the uterine walls during and after involution, intra-abdominal forces, downward pressure during defecation, tight clothing, and not commonly by the obstetric bandage. The ovaries, unless fixed elsewhere by adhesions, are displaced with, and held down on either side of, the corpus, sometimes enlarged from inflammation, often adherent, and always extremely sensitive. Chronic metritis, cellulitis, and peritonitis, with adhesions more or less firm, are usually present, and not infrequently as the result of gonorrhoea, abortion, or injudicious treatment. Peritoneal adhesions between the corpus and the cul-de-sac of Douglas sometimes make replacement impossible. In rare cases the displacement is congenital. [Illustration: FIG. 15. Extreme Retroflexion, with Hypertrophy of the Corpus, which impinges upon the rectum and compresses the recto-vaginal wall.]