INFLUENCE OF OVAKY ON GENEKATIVE TKACT 631 



been able to find, was only six years old when pregnancy occurred. This 

 case was reported by Mandeslo (quoted by Lenz). 



Primary Dysmenorrhea 



Introductory. Endocrinologic Rela- 

 tionship. At first sight there would 

 seem to be little connection between 

 primary dysmenorrhea and the endo- 

 crine system, and yet I believe that an 

 important relation of this sort does exist. 

 By primary dysmenorrhea we mean that 

 form of menstrual pain which occurs in 

 the entire absence of discoverable dis- 

 ease in the pelvis. It is observed with 

 great frequency in young nulliparous 

 women, either single or married, and is 

 the cause of a great deal of suffering. 

 The factors which have been considered 

 instrumental in the causation of this 

 form of dysmenorrhea are as follows: 

 (1) Mechanical obstruction of the cerv- 

 ical canal; (2) the neurotic factor; (3) 

 hypoplasia of the uterus. 



Importance of Hypoplasia of the 

 Uterus. Etiology. --There is little 

 doubt that by far the most important of 

 these factors is a defective development 

 ipf the uterus. It is extremely com- 

 mon to find a greater or less degree of 

 genital hypoplasia in women whose de- 

 velopment otherwise is quite normal. 

 This cause of uterine hypoplasia may be 

 classified under three heads, according 

 to the degree of hypoplasia: a. The fetal type (Fig. 6), in which the 

 arrested development occurs at a very early stage, so that the uterus 

 is of the fetal type. The special characteristics of the latter are its 

 small size and the fact that it is made up almost entirely of cervix, 

 the corpus uteri being exceedingly rudimentary, b. The infantile type 

 (Fig. 7), in which the uterus resembles that normally found in infants 

 and young children. Here again the cervix predominates over the 

 corpus, although the latter is not as rudimentary as in the fetal type. 

 The uterus as a whole is larger and there is often an associated ante- 



Fig. 5. Precocious development in 

 a girl of six. 



