THE REPRODUCTIVE ORGANS OF THE FEMALE. 661 



that of an apple, and have a cauliflower appearance. Lipomata, fibro- 

 myomata, and fibro-sarcomata are of occasional occurrence in the vulva. 

 A few cases of melano-sarcoma are recorded. Chondroma of the clitoris 

 has been described. Carcinoma of the vulva may be primary, usually in 

 the form of epithelioma of the clitoris or labia, or it may be secondary to 

 cancer of the uterus, vagina, etc. 



Cysts are found in the connective tissue of the labia majora and 

 minora. They are from the size of a pea to that of a child's head. 

 They may contain serum, colloid material, purulent or bloody fluid, or 

 they may have the characters of dermoid cysts or atheroma cysts. Their 

 origin is in many cases obscure. In some cases they are doubtless due 

 to dilatation of lymph -vessels. Cysts may be formed by a stoppage and 

 filling with fluid of the canal of Nuck, or by a dilatation of the ducts or 

 acini of the vulvo-vaginal glands. 



The Vagina. 



Malformations. 



The vagina may be entirely absent, and the internal organs of generation also ab- 

 sent or imperfectly developed. Either the upper or the lower portion of the canal may 

 be absent while the remaining portion is present. 



The vagina may be closed ~by an imperforate hymen or by fibrous septa at any part 

 of its canal. The canal may be abnormally small without being occluded. 



The vagina may be double, in connection with a double uterus : or, while the uterus 

 is normal, the vagina may be incompletely divided by a longitudinal septum. 



Changes in Size and Position. 



DILATATION of the vagina is produced by tumors, by the prolapsed uterus, and by 

 the accumulation of blood and mucus behind constrictions or obliterations of the canal. 



LENGTHENING of the vagina is produced by any cause which draws the uterus up- 

 ward. NARROWING occurs as a senile change; is produced by the pressure of tumors or 

 may follow ulceration of the wall of the canal through cicatricial contraction. 



PROLAPSE of the vagina occurs independently, usually as a result of thickening 

 or laxity of its walls, or in connection with prolapse of the uterus. It may occur soon 

 after parturition. A larger or smaller portion of the canal is inverted and projects 

 through the vulva. The entire circumference of the canal may be inverted and pro- 

 lapsed, or only the anterior or posterior w r all. The prolapse, at first small, may after- 

 ward gradually increase in size and drag down the uterus with it. In other cases pro- 

 lapse of the uterus is primary, and the vagina is inverted by the descent of that organ ; 

 or the body of the uterus may retain its normal position, while an hypertrophy and 

 lengthening of the cervix alone drags down the vagina. 



HERNIA VESICO-VAGINALIS CYSTOCELE may be either the cause or effect of a 

 prolapse of the vagina and uterus. If the cystocele be the primary lesion, it begins as 

 a small projection of the wall of the bladder into the anterior part of the vagina. As 

 the urine accumulates in this sac it increases in size, projects through the vulva, draws 

 down the vagina and the anterior lip of the cervix, and finally the entire uterus. If 

 the cystocele be the secondary lesion, it is produced by the dragging down of the pos- 

 terior wall of the bladder by the inverted vagina. 



HERNIA INTESTINO-VAGINALIS. A portion of the intestines may become fixed in 

 Douglas' cul-de-sac between the rectum and the uterus. This portion of intestine grad- 



