CHAPTER IV.. The Female Generative Organs.

THE FEMALE GENERATIVE ORGANS.

Section I. THE PUDENDA AND VAGINA.

1. The Pudenda.

=Congenital Anomalies.= In rare cases the external organs are entirely absent, more frequently but partially developed.

The nymphæ may be found abnormally enlarged.

The clitoris may be abnormally long, perforated, or cleft.

Many of the cases of so-called hermaphroditism are instances of an undue congenital development of the clitoris, with an irregular development of the other organs of generation, either external or internal, or both.

=Hypertrophy.= We may find an hypertrophy of the labia, due to a kind of solid œdema, perhaps originally dependent upon a fissure or ulcer of the part. The nymphæ are often abnormally enlarged, not necessarily as the result of an abuse of sexual indulgence. In new-born infants, they normally project beyond the labia majora. The clitoris occasionally is enlarged, elongated and pendulous, and, in some cases, attains an enormous size. A specimen preserved in the Museum of the University of Bonn, is fourteen inches in circumference and weighs eight pounds. There is no necessary connection between an habitual sexual indulgence and an enlarged clitoris.

Varicose swellings of the labia may reach a considerable size, and, although not generally interfering with parturition, have been known to be lacerated at that time with fatal issue.

As the result of external violence, or during parturition, suggillations often occur in the labia, and may give rise to considerable swelling. The tumor presents a tense, smooth surface, of a livid color, thus distinguished from a varicose swelling, with the peculiar vermicular character of its contents.

=Inflammation.= The cutaneous covering, the mucous lining, the cellular tissue, and the sebaceous and mucous follicles, may be the seat of inflammation, resulting from external or internal causes.

Eczematous and apthous inflammations may result from derangement of the digestive organs, from pregnancy, from a want of cleanliness, or from excessive sexual indulgence, and are of frequent occurrence.

The loose cellular tissue is especially favorable to œdematous swelling, and when the inflammation has a phlegmonous character, extensive sloughing may result. It occasionally occurs as an epidemic among those in early life.

The vulvo-vaginal glands are also liable to inflammation of a catarrhal, herpetic or syphilitic character, resulting in chronic ulceration, or tedious discharges. Young children are frequently liable to a benignant inflammatory affection of these parts, giving rise to much irritation and a muco-purulent secretion.

Morbid Growths.

Warty excrescences, arising from a syphilitic taint, may affect the labia, the entrance of the vagina, and the clitoris. They consist of groups of small pedunculated tumors, producing a sort of mushroom appearance.

Syphilitic mucous tubercles are described as round, flattened tubercles, raised above the surrounding tissues, sometimes becoming elongated, of a reddish-blue color, and frequently ulcerated on the surface.

Cystic tumors are also met with in the labia. They consist of a membranous envelope, containing a transparent, glairy fluid, and often attain a large size.

The mucous membrane surrounding the orifice of the urethra, is liable to an hypertrophy of development, giving rise to small vascular, generally pedunculated tumors, extremely sensitive during life, and liable to become abraded.

Elephantiasis may attack the labia majora, the nymphæ, or the clitoris, and may attain to a great size. It consists of the loose connective tissue of the part, infiltrated with serum, and covered either with the smooth skin, or one which has become roughened by hypertrophy of the papillæ. It may appear as a diffused hypertrophy, or be furnished with a pedicle, and resemble a polypus.

Fibrous, fatty and scirrhus tumors are also met with in this part of the system.

2. The Vagina.

=Congenital Anomalies.= The valvular fold of membrane which protects the virgin vagina, the hymen, may be imperforate or much indurated, and of a cartilaginous consistency. It may thus entirely close the vagina. Besides this, we may find the vagina terminating in a cul-de-sac, either with the uterus present or absent, and the ovaries normal or abnormal. The vagina may also be duplicated, by a septum extending the entire length of the canal, or only partially dividing it. There may be at the same time a double uterus. Entire absence of the vagina is also met with, the internal organs of generation being also absent, or but imperfectly developed.

=Morbid States.= Occlusion or stricture of the vagina sometimes occurs as the result of external injury, or of cicatrization of ulcers.

Dilatation, or lengthening of the vagina, also occurs.

The rigidity or laxness of the walls of the vagina, varies much in different individuals, according to constitution, age, and the effects of cohabitation and child-birth. Prolonged uterine or vesical disease, often produces a very lax condition of the mucous membrane of the vagina. In old women we often meet with this relaxed state, which may amount to a complete prolapsus. The anterior wall is particularly liable to be thus affected.

=Laceration and Rupture.= External mechanical injuries may produce laceration of the vagina. During parturition, either from unusual rigidity, or from want of care on the part of the attendant, the lower portion of the canal is apt to give way when the labor pains are at their height. The lesion may vary from a mere laceration of the fourchette, to a rupture of the entire perineum, from the vagina to the anus. Lacerations of the upper portions of the vagina also occur with rupture of the uterus, or even independently of it.

Lacerations of the vagina are not necessarily fatal, but may result in vesico-vaginal fistula, where a communication is established between the bladder or urethra, and the vagina; or in recto-vaginal fistula, where the fistula opens into the rectum.

=Inflammation.= The mucous membrane of the vagina is frequently the seat of inflammation. The commonest form is the catarrhal, which may be acute or chronic. In the first stage, the passage is reddened, heated and dry. This is followed by an abundant secretion of white, creamy mucus; or of a more purulent discharge, if the inflammation has anything of a specific character.

Croupous inflammations, in connection with general disease, or a similar disease of the uterus, may occur. They produce a solution of the mucous membrane and the submucous tissue, varying in shape and depth, and not unfrequently resembling gangrenous destruction. (Rokitansky.)

A chronic thickening of the mucous membrane, as the result of inflammation, is occasionally met with.

The follicular, syphilitic and carcinomatous ulcer also affect this part.

Suppurative inflammation may result from injuries, ending in the formation of an abscess in the fibrous structures, which may burrow within the pelvic areolar tissue, or extend into the labia.

Gangrene sometimes results from injuries received during parturition, or from a degeneration of croupous inflammation in a vagina affected with blenorrhœa of a gonorrhœal or syphilitic origin.

Morbid Growths.

Polypi and cysts are the varieties most frequently met with in this situation. The polypi may be either fibro-vesicular, or cellulo-vascular, varying greatly in size. The encysted tumors, originate in an obstruction of the follicles of the part, and contain a glairy, transparent, greenish, or dirty-brown albuminous fluid.

Myomatous tumors may be found developed within the muscular coat of the vagina, the posterior wall being their usual position.

Carcinoma may occur primarily, or by an extension of the disease from the cervix uteri.

The form in which it appears is the encephaloid kind, the appearance of which is described in connection with the uterus.

Malignant epithelial growths are not met with in the vagina.