Mechanical supports of this kind are only indicated in women in whom operation is contraindicated on account of old age or for some other reason. Perhaps the best instrument for supporting the uterus in such cases is Braun’s colpeurynter (Fig. 79). The uterus should be reduced, and the colpeurynter, well greased and containing about an ounce of water, should be introduced in the vagina and then distended with air. This instrument takes its support evenly from all parts of the vaginal outlet, and is therefore less apt to produce ulceration from pressure than the various pessaries. It should be removed at night. CHAPTER X. ANTEFLEXION OF THE UTERUS. As has already been said, the uterus normally lies with its anterior surface in contact with the posterior surface of the bladder, and with its long axis approximately perpendicular to the long axis of the vagina. The forward inclination of the uterus varies with the degree of distention of the bladder; it is greatest when the bladder is collapsed. In the normal woman the long axis of the body of the uterus is inclined forward at an obtuse angle with the long axis of the cervix. In other words, the uterus is normally anteflexed. This angle is subject to rather wide variations within the limits of health. It is greater in the multiparous than in the nulliparous woman. It varies with the distention of the bladder, the position of the woman, and the intensity of intra-abdominal pressure. The axis of the uterus when removed from the body is usually straight. The anteflexion found in the organ when _in situ_ in the living woman rarely persists. The normal or physiological anteflexion is maintained during life by the utero-sacral ligaments, which hold the cervix back, and the intra-abdominal pressure, which, acting upon the posterior aspect of the fundus, pushes the body of the uterus forward. In the fetus and in early infancy the cervix is relatively much more developed than the body of the uterus, and there is a very marked angle of flexion between them. Anteflexion of the uterus becomes pathological when the bend in the cervical canal is sufficient to impede the escape of menstrual blood or other uterine discharges. Obstruction of this kind depends upon two factors--the degree of the flexion, and the rigidity of the uterus, which diminishes the mobility that normally exists at the angle of flexion. No matter how sharp the angle of flexion, it should not be considered a pathological condition unless obstruction in the cervical canal is present--unless the woman presents the symptoms of dysmenorrhea and sterility. Three varieties of anteflexion have been described: I. _Corporeal anteflexion_, in which the cervix has the normal backward direction, and the body of the uterus is bent forward upon it (Fig. 80). [Illustration: FIG. 80.--Corporeal anteflexion.]