File:The diagnosis and treatment of diseases of women (1907) (14597857007).jpg

Identifier: diagnosistreatmecros (find matches)
Title: The diagnosis and treatment of diseases of women
Year: 1907 (1900s)
Authors: Crossen, Harry Sturgeon, 1869-
Subjects: Genital Diseases, Female Gynecology Gynecology Women Generative organs, Female
Publisher: St. Louis : Mosby
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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is not, however, an important factor in the real supporting power ofthe pelvic floor. Hence a relaxed vaginal opening does not necessarily mean a re-laxed pelvic sling, though it usually accompanies the same. Resistance to Downward and Backward Pressure on the Pelvic Floor. Usually inthe woman who has borne children, there is not the firm support back of the pos-terior vaginal wall and extending well up toward the cervix, that is found in nulli-para. There is not, however, the marked difference one would naturally expectfrom the enormous stretching that necessarily takes place in child-birth. 46 THE PHYSICAL EXAMINATION The provisions of nature for the restoration of the parts to near their former con-dition, are wonderfully effective when not interfered with by tears or over-stretch-ing or subinvolution. The resistance in each sulcus may be tested with one finger, as shown in Fig. 56,to determine if there has been a tear in the levator ani in that region, with conse-quent relaxation.
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Fig. 57. Testing the pelvic floor. The vaginal fingersare separated widely, as explained in Fig. 58, andpressed downward. Fi?. 58. Showing the relative position of thefingers when in the vagina, while testing the pel-vic floor. A much more satisfactory method of testing the integrity of the pelvic floor is tointroduce the two examining fingers and turn them so that their palmar sur-faces are directed backward. Then press backward and downward on the pelvicfloor, at the same time separating the fingers as widely as possible (Fig. 57). The fingers in the vagina are separated as shown in Fig. 58. This maneuver willgive a very good idea of the amount of support furnished by the pelvic sling and ofthe downward displacement of the pelvic organs that is permitted when the patientis standing. Another useful method is to introduce the two index fingers, side byside, into the vagina and then separate them widely in a direction downward andoutward (Fig. 59). If the fingers can be carried to the

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