A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
=Treatment.=--The treatment of ovarian prolapse depends upon the cause
of the condition. Prolapse of the ovary caused by uterine displacement
is usually cured by the treatment that restores the uterus to its
normal position.
Prolapse of the ovary accompanying tubal disease and prolapse caused
by small ovarian tumors demand operation and removal of the tube and
ovary.
When the ovary is not adherent, it may sometimes be restored to its
normal position, or at least be considerably elevated, so that the
suffering is much relieved, by placing the woman in the knee-chest
position and opening the vagina. In this position all the pelvic
structures are carried upward.
A pledget of cotton or wool placed back of the cervix, in the posterior
vaginal fornix, will often give great temporary relief. The cotton may
stay in the vagina for twenty-four to forty-eight hours.
The woman should be advised to assume the knee-chest position, allowing
air to enter the vagina by introducing the nozzle-piece of the vaginal
syringe, once or twice daily. The best time is immediately before
retiring at night, and she should afterwards sleep as much as possible
on the side, in the Sims position. She should remain in the knee-chest
position for several minutes--until tired.
In addition to this treatment, the pelvic congestion should be relieved
by continuous use of saline laxatives, by hot-water vaginal douches,
and by occasional applications of Churchill’s tincture of iodine to the
vaginal vault, and the use of the glycerine tampon. If the prolapse has
been caused by subinvolution of the ovary and its attachments, such
treatment may ultimately result in cure. The enlarged ovary diminishes
in size and weight, and its ligaments contract and regain tonicity.
Subinvolution of the uterus is often also present. This condition
should be treated as has already been advised.
In many cases of ovarian prolapse there have taken place in the
ovary secondary changes that resist such treatment even when most
conscientiously applied. The physician is then driven to the operation
of oöphorectomy as the only method of relieving the intolerable
suffering. This operation should never be performed, however, until
other milder treatment has been carefully tried, and unless the
suffering of the woman incapacitates her for the duties of life.
In some cases in which the ovary is not itself grossly diseased it may
be possible to avoid oöphorectomy, and to correct the displacement
by attaching the ovary by suture to the upper margin of the broad
ligament, or by shortening the infundibulo-pelvic ligament by suture.
If the ovary has become adherent in Douglas’s pouch, the condition can
be relieved only by operation--celiotomy, and usually oöphorectomy.
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