TUMORS OF THE VULVA AND VAGINA 313 



stump returned to the vagina. The vagina should be cleansed 

 daily with antiseptics until the discharge has ceased. 



RUPTURE OF THE VAGINA. 



During dystocia from rough manipulation, or from sharp 

 instruments the vagina may be torn or ruptured making at 

 once an opening into the abdominal cavity. This will allow 

 septic material to gain entrance which usually produces peri- 

 tonitis. In some cases after rupture of the vagina, and when 

 straining is induced, or still present from the dystocia, there 

 may be a prolapsus of the bladder through the rent. When 

 this occurs the bladder becomes displaced and projects from 

 the vulva. It will be recognized as a fluctuating enlargement 

 appearing suddenly between the labia of the vulva. An 

 exploring trocar may be used to determine its contents if the 

 diagnosis is in doubt. Laparotomy should be performed at 

 once (see Laparotomy) and the displaced organs returned to 

 their normal position. If possible close the opening in the 

 vagina. If septic infection has developed little can be done. 



TUMORS OF THE VULVA AND VAGINA. 



The majority of the neoplasms found in the vulva and 

 vagina are benign growths consisting in most instances of 

 fibromata, papillomata, or a mixture of fibromata with 

 myxomatous, myomatous, or lipomatous elements. Malig- 

 nant tumors are uncommon in the vagina, but do occur 

 occasionally as secondary growths, or in the form of venereal 

 granulomata. 



Fibromata. These are found in most instances projecting 

 from the walls of the vagina, or from the cervix. They 

 appear as hard, firm enlargements, usually smooth on the 

 surface, show no tendency to degeneration or necrosis, except 

 when they project through the vulva and become irritated 

 from exposure. 



Diagnosis. Made by the character of the enlargement, its 

 slow growth and finally by a microscopic examination. 



Prognosis. Favorable in most cases. 



