File:The diagnosis and treatment of diseases of women (1907) (14597662080).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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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 bony sides of the arch withbut little muscular resistance, the front part of the levator ani muscle and accom- TESTING THE PELVIC FLOOR 47 panying fascia, has been torn and there is decided loss of support in the pelvic floor.If now the patient be directed to bear down, the loss of support becomes still moreevident. Occasionally, even in cases of marked injury to the pelvic sling, the support willseem very good during the first part of the examination because of the musculartension. The strong fascial layer of the pelvic sling probably constitutes the principal fac-tor in continuous support, for the muscles cannot contract continuously.
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Fig. 59. Testing tlie pelvic floor by the two index fingers, intro-duced together and then separated. Now the facia may be so torn and stretched that it furnishes little or no contin-uous support and yet, as long as the muscles stay contracted, there seems to be afairly good pelvic floor. Any error in this respect may be avoided by watching forit, and securing entire relaxation before the examination is finished. Protrusion of Anterior or Posterior Vaginal Wall. To further test the loss of sup-port, separate the labia and instruct the patient to bear down. The resulting bulg-ing of the structures, gives some idea of how poorly the pelvic floor supports theorgans, provided the patient really bears down when she thinks she does. Thedownward displacement of the vaginal walls and pelvic diaphragm may be stillfurther shown by introducing the two examining fingers and pressing backward 48 THE PHYSICAL EXAMINATION and downward, at the same time separating the fingers widely, as mentioned in

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