312 DISEASES OF THE VAGINA AND VULVA 



Symptoms. The condition is characterized by an enlarge- 

 ment appearing at the vulvar opening. At first the prolapsus 

 is a red, congested mass, which later, on exposure, becomes 

 dark in color and gangrenous. In hypertrophy of the mucosa 

 it appears as a rounded enlargement of rather firm consist- 

 ency projecting through the vulvar opening and coming from 

 one side of the vaginal wall. In some cases it will remain 

 outside of the vulva, becoming dark in color and gangrenous 

 on the surface; or it may not protrude beyond the vulvar 

 opening and appear only at intervals. Usually there are no 

 general symptoms. There may be some interference with 

 micturition. 



Diagnosis. This is not difficult in most cases. A thorough 

 manual examination should be made to determine the exact 

 conditions present. 



Prognosis. Favorable. 



Treatment. In prolapsus of the vagina an attempt should 

 be made to replace it. The parts should be cleansed, disin- 

 fected and if there is much congestion, astringents (alum, 2 

 per cent.) may be used. In some cases this will be sufficient, 

 in others when there is a recurrence of the condition without 

 necrosis or gangrene, it should be returned and if necessary 

 held in place by temporary sutures through the labia of the 

 vulva. They should be placed so that the urine can be 

 voided. Remove them in twenty-four to forty-eight hours. 

 When gangrene sets in, amputation of the prolapsed portion 

 becomes necessary. This is done by grasping the mass and 

 withdrawing it until the normal mucosa appears. If the 

 prolapsus involves only a portion of the circumference of the 

 vagina it may be ligated. The ligature should be inserted 

 through the base of the mass and drawn securely to control 

 hemorrhage and stop absorption. In case the vagina is 

 prolapsed, throughout its whole circumference sectional 

 suturing will be necessary. Care must be taken in all cases 

 to avoid injuring the urethra. In hypertrophy of the mucosa 

 amputation of the mass is necessary. This is done by thor- 

 ough cleansing and disinfecting the parts, withdrawing the 

 mass from the vulva, and ligating through its base. The 

 mass should be removed with the knife or scissors and the 



