Because of the mobility of the pelvic organs, and the fact that they are subjected to pressure from above during such actions as sneezing, coughing, straining, or even breathing, certain mechanical results can take place that are peculiar to this particular area. This is accentuated by the presence of the vaginal canal, which really represents an opening in the pelvic floor.
Some doctors liken this situation to other parts of the body where apertures exist and internal contents can be forced through the lightly covered orifices. This is the basic pathology of hernias, whether they be about the navel region (as in babies), or lower down in the inguinal (groin) region in adults.
The more common uterine displacements will be discussed. After this, a short word will be given over to the urinary tract that forms part of the pelvic cavity, for this is very significant, and is a well-known cause of trouble to many women.
The uterus is normally positioned pointing upwards and forwards. The cervical (neck) portion forms the upper part of the vaginal canal. From here, the body of the womb wells up into the pelvic cavity, tilting toward the front of the body. This is referred to as the normal anteverted position.
It is held in this position by a variety of anatomical bands and ligaments. It tends to remain in this position throughout life.
It is often believed that this position is significant. Under conditions of normal copulation, with the female partner lying on her back, and with the male uppermost. the seminal pool following ejaculation will be placed automatically in such a way that the cervix is bathed in it while the female remains in this position. It is essential that the sperms have ready and prompt access to the cervical canal. The entire mechanics of a uterus located in the way described will ensure maximum possibility for a pregnancy to result, provided the timing of the menstrual cycle is correct.
In some cases of infertility, the uterus is in the opposite position. It tilts backwards, and is described as being retroverted. At this time, if a similar position is used during intercourse, the cervical canal could be some distance away from the vital seminal pool. Fertilisation may thus become difficult or even impossible.
This of course assumes that the male uppermost position is being used. If other positions are utilised at a time when pregnancy is desired, then other mechanical problems may arise.
In recent times, many gynaecologists have studied the problem of retroversion. Once it was claimed to play a significant part not only in infertility, but was blamed for many other gynaecological symptoms. These ranged from backache, and pelvic pain, to abortion.
Many now believe that the uterus is a very mobile organ, and rarely plays much part in producing symptoms. However, fairly simple tests can be carried out to see if the apparent misplacement is really producing the symptoms claimed. It may be necessary to make further investigations.
In years past, innumerable surgical operations were carried out to correct retroversion. Many complex arrangements were entered into. The uterus was dragged from its backward tilt and forced to point forwards. In retrospect, it is not known just how much good these operations accomplished. Undoubtedly they had their part and assisted many women. But, some modern-thinking gynaecologists now claim that the effect was probably more in their minds (both the patients’ as well as the doctors’) than in the pelvis.
Be that as it may, it still holds a place in gynaecological practice. Often when there is not much else to do, it seems to be a potent factor in assisting couples with infertility problems.