In the 1800s,Hugh Lenox Hodge designed the lever pessary to treat uterine retroversion thought to be a cause of pelvic pain.1 As modifications of the lever pessary were made, other indications were proposed for its use. In 1961,Vitsky2
suggested that cervical incompetence was attributable to a lack of central uterine support. Uterine retroversion has also been associated with infertility and pelvic pain. Placing a lever pessary would displace the cervix posteriorly, thus lifting the weight of the uterus off of the incompetent cervix. Women diagnosed with an incompetent cervix were treated during pregnancy with a Hodge pessary from 14 to 38 weeks' gestation, with an 83% success rate.3 Currently, cervical cerclage is the treatment of choice for women with cervical incompetence. There is great controversy regarding the possible causative role of uterine retroversion in many gynecologic conditions including pelvic pain, infertility, and sexual dysfunction.
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