The severest and most unmanageable forms of prolapseare found in elderly women who have borne many children. The repeated injuries and strains on the vaginal outlet not only destroy the supports of the uterus, but dislocate and disarrange the surrounding pelvic structures. This may occur to such an extent that the injury and prolapse of the adjacent structures is of greater practical importance than the descent of the uterus itself.
The problems connected with the treatment of severe prolapse are complicated. Not only are the mechanical difficulties great, but often the loss of tone and the atrophic condition of the tissues make them thin, friable, and difficult to operate on. On the other hand, after the menopause, the operator lias a certain advantage in that he is free to manipulate the tissues in any way he sees fit.He is no longer restricted by the need of providing for the possibilities
SOMERS GB. UTEROVAGINALNPROLAPSE IN ELDERLY WOMEN: THE OPERATION OF CHOICE. JAMA. 1911;LVII(24):1883–1885. doi:10.1001/jama.1911.04260120073002
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