US2763265A - Gynecological instrument - Google Patents

Description

Sept. 18, 1956 E. G. WATERS GYNECOLOGICAL INSTRUMENT Filed Dec. 14, 1954 m w m m EDWARD G. MTEES BY #1144, 7101/1901;

ATTORNEYS;

United States Patent GYNECOLOGICAL INSTRUMENT Edward G. Waters, Jersey City, N. J.

Application December 14, 1954, Serial No. 475,147

7 Claims. (Cl. 128-343) This invention relates to a gynecological instrument for use as a vaginal dilator and exerciser for levator ani muscle development.

An object of the invention is to provide an instrument scientifically proportioned, constructed, and arranged to engage and operate upon the several muscles in proper sequence and degree.

A further object of the invention is to provide an instrument which not only meets the requirements of a gynecologist in the treatment of overstretched, weak, or damaged muscle structures or in the corrective treatment of the muscles; but is also adapted to be beneficially employed by a patient under his directions.

Further objects will more fully appear from the following description taken in connection with the accompanying drawings illustrating the preferred embodiment of the invention.

Referring to the drawings illustrating, by way of example, the preferred embodiment of the invention:

Fig. 1 is an elevational view of a preferred form of the instrument;

Fig. 2 is an end view of the device shown in Fig. 1;

Fig. 3 is a cross-sectional view taken at the line 3-3 of Fig. 1; and

Fig. 4 is a similar cross-sectional view of a modification showing a solid body.

Referring to the drawings: it will be seen that the instrument is in the form of an elongated body provided at one end with a tip 1, preferably in the form of a somewhat blunt or rounded end, and provided at the other end with a hand engageable end 2, preferably in the form of a knob comprising a head of rounded configuration and a neck of a substantially smaller diameter designated 2'. Intermediate the neck 2' and the tip 1 the body is provided with three peripherally disposed protuberant zones 3, 4, and 5 which are spaced apart axially and whose surfaces are preferably smoothly continuous peripherally. In the spaces intermediate the bulges or prominences provided by said protuberant zones 3, 4, and 5 the body is provided with two alternate peripherally disposed concave zones 6 and 7 which smoothly merge with said bulges so as to provide a surface undulatory in the axial direction of said body. The protuberance 3 tapers gradually to the tip 1 to thus provide a penetrating portion which terminates in the concave zone 6. By way of illustrating the relative proportions of the instrument, comparative dimensions will be be given for two sizes which have been proven to be properly proportional.

In each size the axial distance from the tip 1 to the ,major diameter of zone 3 is 1 inch; from the major diwe lC ameter of zone 3 to the major diameter of zone 4 is 1% inches; from the major diameter of zone 4 to the minor concavity of zone 7 is one inch; and from the minor concavity of zone 7 to the major diameter of zone 5 is one inch. The minor diameter of neck 2 is preferably /2 inch at a distance of about one inch from the outer extremity of the knob 2 whose major diameter is conveniently 1% inches. The concavity 6 is located intermediate the protuberant zones 3 and 4 generally midway, but its exact location is believed not to be as important as is the position of the cavity 7 relative to the zones 4 and 5.

Early use of rigid materials (glass, wood and rigid plastic), while satisfactory, suggested that some degree of compressibility of the instrument would give to the patient more positive indication of developing muscle function, or in the case of its use as a dilator, less spasm producing or traumatic vaginal penetration. Experience, derived from repeated trials has shown the advantages of a hollow instrument of plastic composition, with a resilience factor of compressibility between 20 and 30 mm. of mercury pressure. The construction of the instrument makes it clear that while this is not the factor of greatest importance, it has been shown to lessen the time needed for patient-appreciation of muscle tone improvement. This resilience factor of compressibility or impression factor may be measured by means of a manometer placed in communication with the interior of the hollow body; the manometer reading being taken while the hollow body is subjected to normal compressive forces to which the instrument is subjected in the uses above described. When made in solid form the instrument is preferably made of a soft wood, such for example as balsa wood, suitable coated with a material such as a resinous finish.

Operation The penetrator, comprising the region from the tip 1 to cavity 6 is designed to be insinuated painlessly into the introitus between the labia minora, entering at 1, dilating the orifice at zone 3 and then coming to lie within the orifice, at which time the depression 6 will be encompassed by the constrictor muscles of the vaginal outlet. When so engaged at this time, the point 1 is beginning to enter the hiatus in the levator muscular diaphragm. The latter encompasses the vagina and is attached to it approximately one inch above the introital and orificial muscle.

Zone 4 represents a secondary bulge in the instrument and zone 7 the secondary depression. When the instrument is carried further into the vagina, point 1 slips beyond the levator muscular diaphragm which is first dilated by zone 3 and then comes to rest in the depression 6. At the same moment the orificial muscles which have encompassed 6, are dilated by the bulge 4 as the instrument passes further upward and rests at depression 7. At this time both sets of constrictor'inuscles of the vagina, those of the mid-vagina, the levator muscles, and those of the orifice, the introital group, are engaged respectively at zones 6 and 7 while point 1 rests in the upper vaginal cavity. Projection of the instrument higher into the vagina results in further dilatation of the orificial muscles by the prominence 5 and eifects a further dilatation of the levator muscle ring by the prominence 4. The entire introduction is brought about by pressing the instrument firmly into the vagina with the fingers grasping the manual knob 2.

The orificial muscular systems which control the capacity of the vagina are located at the introitus and at approximately one inch Within the introitus. The integrity of the normal fascis and rehabilitation of fascia which has been damaged is dependent largely upon their relationship to the adjacent muscles and the blood supply received therefrom. Stretched and damaged structures can be markedly rehabilitated by voluntary exercise, n some instances in an unbelievable manner, by systematic and intelligent exercise of these sphincteric structures, and developing conscious and purposeful use of these muscles.

The major uses of the instrument are two-fold. First, as a developer of the levator muscles and introital muscles with rehabilitation of the fasciae of the superior and inferior pelvic diaphragms. This is brought about by educating the patient in the use of the muscles of the introitus and the levator ani. Deliberate constriction of the introitus and mid-vaginal section of the vagina is obtained through exercise of muscles which have been attenuated or weakened, or Whose function is at the moment unknown to the patient. The instrument serves to acquaint the patient with the two separate constrictor areas in the vagina and to permit her to develop these structures intelligently through regular exercises. Varying degrees of pelvic relaxation including cystocele, rectocele and perineal relaxation may be overcome to a marked extent by such physician-directed treatment.

Second: Use of the instrument as a vaginal dilator. When the vagina is excessively reduced in size through reflex or involuntary spasm, inadequate marital dilatation, postpartum overcorrection after perineotomy, vaginal stricture following vaginal hysterectomy or vaginal plastic procedures, similar intelligent instruction of the patient in the use of the instrument is begun. The small size will first be accepted by the vagina Without spasm inducing pain and subsequent dilatation obtained through successively larger sizes graduated up to such physiologic accommodation as determined by marital needs.

The method of introduction is simple. The'penetrator portion is well lubricated, the labia spread apart with the second and third fingers of one hand and with the knob 2 grasped by the other, the penetrator end is introduced through the vaginal introitus. It is then carried deliberately and slowly upward and forward and the patient instructed so that she Will recognize by sensation the structures encountered and passed, until the instrument is fully introduced to point zone 5. With the middle and index fingers of the right hand forming an inverted V, knob 2 is then encompassed and the instrument slowly withdrawn, concomitantly teaching the patientappreciation of the passage of the instrument over the various structures which have been described.

The instrument is preferably made in two or more sizes, the various parts of which have been accurately proportioned and arranged by experience and experimentation, as generally suitable for the intended use: If dilatation is the requirement, the smallest size #1 is used first, with supervised progression to the larger sizes. When rehabilitation of over-stretched and weak supporting structures is desired, the largest size is first used. The patient is instructed in attaining recognizable contractions of the pelvic sphincter muscles. This is followed by vaginal introduction of the instrument, and then its gradual withdrawal while musculofascial contraction is attained and maintained. She is thus made aware of contractions, at first weak, which tend to check withdrawal of the instrument. One size is continued in use until progress is definite and warrants change to a smaller size.

Having thus described my invention in detail in its present preferred embodiment, it will be obvious to those skilled in the art, after understanding my invention, that various changes and'modifications may be made therein Without departing from the spirit and scope thereof, and

,I aim in the appended claims to cover all such modifications and changes.

What I claim is:

1. An instrument of the character described comprising an elongated body of substantially circular cross-section 'havinga eripheral surface undulatory in the direction of its length and providing three axially spaced peripherally disposed protuberant zones alternating with two intermediate peripherally disposed concave zones, one end of said body being provided with a penetrating portion and the opposite end of said body being provided with a hand engageable portion, one of said protuberant zones being disposed adjacent an end of said body and forming the maximum diameter of said penetrating portion which tapers graduallyto an entering end, the next succeeding protuberant zone having a maximum diameter slightly larger than the maximum diameter of said first protuberant zone and the third protuberant zone having substantively the same maximum diameter as the maximum diameter of the first protuberant zone.

' 2. An instrument of the character described comprising an elongated body of substantially circular cross-section having a peripheral surface undulatory in the direction of its length and providing three axially spaced'peripherally continuous protuberant zones alternating with two intermediate peripherally continuous concave zones, one end of said body being provided With a penetrating portion and the opposite end of said body being provided with a hand engageable portion, one of said protuberant zones being disposed adjacent an end of said body and forming the maximum diameter of said penetrating portion which tapers gradually to a rounded point, the next succeeding protuberant zone having a maximum diameter slightly larger than the maximum diameter of said first protuberant zone and the third protuberant zone having a maximum diameter substantively the same as the maximum diameter of the first protuberant zone, said hand engageable portion being in the form of a knob comprising a head of rounded configuration and a neck of a diameter substantially less than the diameter of said knob and the maximum diameter of said third protuberant zone.

3. An instrument as set forth in claim 1 in which the major diameter of the protuberant zone is approximately 1 inch from the penetrating end of said body and approximately 3% inches from the major diameter of the third protuberant zone, the second protuberant zone having a major diameter of the order of 1 /zl% inches and being spaced nearer to the major diameter of the first protuberant zone than to the major diameter of the third protuberant zone, and the first and third protuberant zones each being approximately %%1 inch less in major diameter than the major diameter of the second protuberantzone.

4. An instrument as set forth in claim 1 in which the major diameter of each said first and third protuberant zones is of the order of 1% inches, the major diameter of said intermediate protuberant zone is of the 'order of 1 /2 inches and the minor diameter of each of said intervening concave zones is of the order of 1% inches, and the axial distance between the major diameters of the first and second protuberant zones is of the order of 1% inches and the corresponding distance between the second and third protuberant zones is of fhe order of 2 inches.

5. An instrument as set forth in claim 1 in which the major diameter of each said first and third protuberant zone is of the order of 1 /2 inches, the major diameter of said second protuberant zone is of the order of 1% inches, and the minor diameter of each of said intervening concave zones is of the order of 1% inches, and the axial distance between the major diameters of the first and second protuberant zones is of the order of 1% inches, and the corresponding distance between the second and 'third prlotuberances is of the order of 2 inches.

6. An instrument of the character described comprising an elongated, slightly resilient body having an impression factor of the order of 30 mm. of mercury pressure, said body being of substantially circular cross-section having a peripheral surface undulatory in the direction of its length and providing three axially spaced peripherally disposed protuberant zones alternating with two intermediate peripherally disposed concave zones, one end of said body being provided with a penetrating portion and the opposite end of said body being provided with a hand engageable portion, one of said protuberant zones being disposed adjacent an end of said body and forming the maximum diameter of said penetrating portion which tapers gradually to a rounded point, the next succeeding protuberant zone having a maximum diameter slightly larger than the maximum diameter of said first protuberant zone and the third protuberant zone having a maximum diameter substantively the same as the maximum diameter of the first protuberant zone.

7. An instrument of the character described comprising a slightly resilient hollow plastic body of substantially circular cross-section having a peripheral surface undula- 15 tory in the direction of its length and providing three axially spaced peripherally disposed protuberant zones alternating with two intermediate peripherally disposed concave zones, one end of said body being provided with a penetrating portion and the opposite end of said body being provided with a hand engageable portion, one of said protuberant zones being disposed adjacent an end of said body and forming the maximum diameter of said penetrating portion which tapers gradually to a rounded point, the next succeeding protuberant zone having a maximum diameter slightly larger than the maximum diameter of said first protuberant zone and the third protuberant zone having a maximum diameter substantively the same as the maximum diameter of the first protuberant zone.

References Cited in the file of this patent UNITED STATES PATENTS 826,091 Dorman July 17, 1906 1,537,992 Gearon May 19, 1925 1,928,893 Hoard Oct. 3, 1933 2,63 8,093 Kulick May 12, 1953

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