VAGINA (ABNORMAL ANATOMY). 



the vesical, and haemorrhoidal, and uterine 

 plexuses ; the blood being finally collected by 

 large veins which empty themselves into the 

 internal iliacs. Figs. 482. and 483. 



The Lympatics are those which are common 

 to the bladder, cervix uteri, and lower part of 

 the rectum. They terminate in the pelvic 

 glands. 



The Nerves are derived from the pelvic 

 plexus, which contains a large proportion of 

 tubular fibres, derived from the fourth and 

 fifth sacral nerves. 



Uses of the vagina. The vagina, during 

 copulation, serves for the reception of the 

 male intromittent organ, and for the lodge- 

 ment of the seminal fluid in such a posi- 

 tion as to facilitate the introduction of that 

 fluid into the uterus.* During menstruation 

 the vagina gives passage to the catamenia. 

 In labour it transmits the foetus and secun- 

 dines, and subsequently the lochia. 



ABNORMAL ANATOMY OF THE VAGINA. 



Anomalies. Congenital absence of the 

 vagina is not very rare. The entire vagina 

 may be wanting ; so that on separating the 

 labia no trace appears of a canal leading to 

 the uterus ; or the canal may be so narrow as 

 only to admit a probe or quill ; it may be very 

 .short, terminating in a cul de sac, or it may 

 open into the urethra or rectum. The latter 

 malformation has not always prevented preg- 

 nancy, even when combined with an entire 

 absence of the external organs. 



A vertical septum occasionally divides the 

 vagina through a greater or less portion of its 

 course. This, when complete, produces the 

 double vagina with double hymen (^g.461.). 

 The septum may cease at a variable distance 

 from the vaginal orifice, the fornix and upper 

 part remaining single ; or, contrarily, the for- 

 nix may show signs of division, while the 

 lower part of the tube remains single. The 

 septum is almost invariably in the median 

 line, but the more frequent use of one or 

 other channel in parturition or sexual con- 

 junction may give to them an appearance of 

 unequal development. 



Transverse membranous septa sometimes 

 pass across and obstruct the vagina more or 

 less completely. These, though they do not 

 necessarily prevent impregnation, for they 

 are seldom absolutely imperforate, may so far 

 impede labour as to require division. They 

 occur at various points within the canal ; at 

 a short distance from the orifice, or as high 

 up as the level of the utero-sacral ligaments. 

 They consist, for the most part, of natural 

 folds unusually developed, or they result from 

 accident, as inflammation or injury consequent 

 on difficult labours. Some of those constric- 

 tions which occur near the orifice are doubt- 

 less the consequence of inflammation of the 

 vulva and vagina in infancy.-f- Atresia of the 

 vagina may thus be acquired, or it may be 



* See IXSEMINATION, p. 671. 

 f These cases are sometimes recorded as examples 

 of imperforate hymen. 



707 



congenital. When the obstruction is com- 

 plete, retention of the menstrual fluid results. 



Displacements. The vagina may be alto- 

 gether displaced from the pelvis, or it may 

 simply have its normal direction altered within 

 that cavity. Prolapsus of the vagina occurs 

 sometimes alone, but it is more often com- 

 bined with procidentia or inversion of the 

 uterus (Jig. 469.). In any of these cases, if 

 the prolapse is permanent, the vaginal surface 

 loses altogether the character and appearance 

 of a mucous membrane, acquiring a thick 

 cuticular covering, and assuming the condition 

 of ordinary integument. In retroversion of the 

 uterus, the vagina is drawn upwards and for- 

 wards, its extremity lying behind the pubic 

 symphysis. (FigAGS.) "in hernia of the uterus, 

 the vagina is diverted from the median line to- 

 wards one or other side of the pelvis, and may 

 be partly included in the hernial sac. 



Solutions of continuity. Laceration of the 

 vaginal walls may occur during obstructed la- 

 bour, and is then frequently associated with 

 rupture of the uterine cervix. Fistulous 

 openings into the bladder, and sometimes into 

 the rectum, are occasioned by sloughs con- 

 sequent on protracted labour. Fistulous 

 cloacae are also commonly formed in advanced 

 stages of cancer (fig. 479.). 



Inflammation of the vagina. Vaginitis. 

 This occurs both in the acute and chronic 

 form. It may present the character of be- 

 nignant catarrh, or of a specific blenorrhoea 

 (gonorrhoea}. In the more acute form the 

 mucous membrane is highly vascular, and is 

 sometimes excoriated, from excessive shed- 

 ding of epithelium. The discharge presents 

 variable characters, from the viscid yellow 

 puriform mucus, to the creamy, milk-hke, or 

 thin, nearly watery, fluid (leucorrhcea). 



Croupous exudations occasionally form upon 

 the vaginal mucous membrane, chiefly in con- 

 nexion with typhoid exanthematous or puer- 

 peral processes. 



Epithelial desquamaiion. Occasionally 

 the entire epithelial coat of the vagina is 

 thrown off, forming a membranous cast of 

 that canal. Several of these casts may be 

 found, one contained within another. Their 

 discharge may be accompanied by symptoms 

 resembling those of dysmenorrhoea ; but more 

 particularly by an intolerable itching or sensa- 

 tion of crawling in the vagina. They are 

 composed entirely of dense vaginal tessel- 

 lated epithelium.* 



Serous and sanguineous infiltration into the 

 mucous and fibrous coats of the vagina takes 

 place occasionally during protracted labour, 

 producing considerable tumefaction, and con- 

 sequent narrowing of the canal. In this state 



* 1 have given a description, with several illus- 

 trative figures, of these epithelial casts of the vagina, 

 some of which include also the epithelium of the 

 vaginal portion of the cervix uteri, in Beale's Ar- 

 chives of Medicine, for April, 1858. I suspect that 

 the nature of these has been overlooked, and that 

 they, have been confounded with the true dysmenor- 

 rhoeal membranes which consist of the lining mem- 

 brane of the uterus. See^fy. 443. 

 z z 2 



