aoao HUMAN ANATOMY. 



nearly horizon,! than vertical 

 , it will be seen that the lower surfac of the cerv p * ^ 



** -^' ll three and a half inches long ; and 



ended w ?h air, permitting a more thorough visual examination of its walls. The 

 riorly and th* base of the bladder and the urethra anteriorly, are within 

 oTSc finger in the vagina. Calculi, either in the lower ends of the ureters 

 supra) or in the bladder, can be removed through the anterior vaginal wall 



The intr'avaginal portion of the cervix uteri can, with little or no pain, be grasped 

 bv a tenaculum and drawn down towards the vaginal orifice so that local applications 

 can be made. It is so insensitive that such applications, even when strong and irri- 

 tating do not necessitate the use of an anaesthetic. Since it is the part of the cervix 

 most exposed to traumatism and infection, it is the most frequent seat of pathological 

 lesions such as the so-called "erosions." Persistent*.*, unhealed lacerations 

 are often sources of irritation, of reflex pains, and of some forms of dysmenorrhcea. 

 Much of the pelvic pain, associated with them, is probably due to pelvic lymphangitis 

 or lymphadenitis (Penrose). These lacerations seem to invite the development of 

 cancer. Primary involvement of the body of the uterus is . comparatively rare, the 

 great majority of cancers of the uterus beginning in the cervix. As a result of the 

 relations and contiguity of the cervix to surrounding important structures, such as the 

 bladder, ureters, and rectum, the prognosis of cancer of the cervix is less favorable 

 than that of the body of the uterus, where infiltration of neighboring structures does 

 not occur so early. As a rule, dissemination by lymphatic channels from carcinoma 

 of the cervix, affects first the sacral or the iliac glands ; carcinoma of the body of the 

 uterus is more likely to involve the lumbar glands surrounding the common iliacs, 

 the aorta, and the vena cava. Pressure on the last-named vessel may result in 

 oedematous swelling of the lower extremities or in ascites. 



An hypertrophied cervix shows as an increased projection into the vagina and a 

 deepening of the vaginal fornices. This condition may be a cause of sterility. 



The vagina is most roomy in its upper portion, and is narrowest at its lower 

 end, where it passes through the triangular ligament and is surrounded by the con- 

 strictor vaginae muscle. This favors the retention of blood-clots within the vagina 

 during the menstrual period and after labor. Spasmodic contraction of this muscle 

 (vaginismus) is described as being sometimes strong enough to prevent coitus and 

 to call for surgical treatment, though such cases, if they exist at all, are due to reflex 

 irritation, such as from urethral caruncle. The dilatation of the vagina seems to be 

 limited only by the pelvic wall. In nullipara the rugosity of its mucous membrane 

 necessitated by its great changes in diameter is marked. The transverse folds 

 favor retention of secretions and of discharges resulting from infection and render 

 sterilization of the vagina difficult. Vaginitis may be followed by endometritis, as 

 the uterine and vaginal imicos.-p are directly continuous. 



The hymen rarely may have no opening, when it will require incision to relieve 



the obstructed first menstrual flow. The exact importance to be attached to the 



presence or absence of the hymen in medical jurisprudence is still undetermined. 



Wh lly broken at th<- first coitus, it may remain intact until the first 



Therefore its presence does not prove virginity. Its original perfora- 



te been large enough to leave little or no evidence of the membrane, 



9 absence does not prove that coitus has taken place. 



tul* between tin- Madder and va-ina i vrsk-o-vaoinal), between the urethra 

 Lro-vaginal), between tin- rectum and vagina (recto-vaginal), and 

 etwecn the cervical canal and the bladder (utero-vesical), may occur. 



