708 



UTERUS AND ITS APPENDAGES. 



the vaginal walls are easily lacerable, or if 

 subjected to continued pressure pass readily 

 into gangrene. 



Abscess forms occasionally in the vaginal 

 walls, but many of the abscesses which burst 

 into that canal have their origin in pelvic 

 cellulitis, or in inflammation of other struc- 

 tures external to the vagina. 



Ulceration. The minute aphthous ulcers 

 which are dotted over the surface of the va- 

 gina originate in follicular inflammation. The 

 more extensive and irregular ulcers, except 

 those which form upon the more exposed 

 parts when the vagina is inverted, as in proci- 

 dentia uteri, are usually either syphilitic or 

 cancerous. 



Gangrene of the vagina occurs in conjunc- 

 tion with gangrene of the vulva in septic puer- 

 peral processes ; or it results from pressure 

 in protracted labour. Spontaneous gangrene 

 occurs also occasionally in infants and young 

 children. 



Cysts and tumours. The former, if of small 

 size, may result from obstructed mucous fol- 

 licles ; but more often the larger cysts arise 

 in situations external to the vagina, and pro- 

 trude into its canal. In the same way, fibrous 

 or osseous tumours growing from the perios- 

 teum or ligaments of the pelvis, ovarian, or 

 even uterine tumours may, by pushing before 

 them the walls of the vagina, protrude into the 

 canal. Vaginal cystocele and rectocele occur 

 in a similar manner. The tumours which lie 

 free within the vagina are chiefly uterine polypi, 

 or cancerous tumours of the cervix or of the 

 vagina itself. The uterus, when partly in- 

 verted, also forms a tumour occupying the 

 vagina. 



Cancer may originate in the vagina, although 

 it more often constitutes an extension of the 

 same disease from the uterus. In either case 

 it appears most commonly as medullary can- 

 cer, taking the form of tuberculated masses or 

 ridges, which narrow or obstruct the passage, 

 and quickly pass through the stages that cha- 

 racterise the ordinary progress of uterine can- 

 cer. The surrounding parts become infiltrated 

 with cancer matter, and the vagina is fixed in 

 the pelvis, ulceration of the walls and fistulae 

 resulting. Occasionally, at the commencement, 

 this disease appears in the form of soft, rapidly- 

 growing papillary structures, springing from 

 the upper and posterior wall of the vagina 

 (villous cancer). 



EXTERNAL ORGANS OF GENERATION. 



SYN. Vulva. Pudendum. These parts per- 

 form subordinate offices in the act of repro- 

 duction. They are in no way concerned in 

 gestation, and only slightly in menstruation 

 and parturition. They are associated with 

 the vagina in the act of copulation, which 

 has for its object insemination, or the con- 

 veyance of the seminal fluid to the internal 

 or formative organs. The parts which serve 

 to establish this relation between the sexes, 

 with the exception of the vagina, are placed 

 external to the body, and are attached to 



the front of the pelvis. They are included 

 under the general term vulva or pudendum, 

 which extends from the mons veneris to the 

 perineum. The vulva consists of the follow- 

 ing parts, viz. labia, clitoris, nymphae, vesti- 

 bule, vaginal orifice, and hymen. 



THE MONS VENERIS forms a slightly 

 rounded or flattened eminence, of triangular 

 outline, covering the symphysis and horizon- 

 tal rami of the pubes. In fat subjects it is 

 separated from the abdomen by a transverse 

 furrow. It is composed of adipose and fibrous 

 tissue, covered by integument. The latter 

 contains many sebaceous and hair follicles. 

 The hair is not developed until the age of 

 puberty. 



Fig. 480. 



External organs of generation, and commencement of 

 vagina. (After Huguier.} 



I, labium of left side (that of the right side is 

 divided and partly removed to expose the vagina 

 and vulvo-vaginal gland) ; n, nympha ; c, glans 

 clitoridis ; p c, preputium clitoridis ; v, vestibule ; u, 

 orifice of urethra; va, vagina; g, vulvo-vaginal 

 gland, or gland of Bartholin and Duvernay ; d, 

 duct of the same. 



THE LABIA, termed also labia majora, to 

 distinguish them from the lesser labia or 

 nymphae, are two symmetrical tegumental 

 folds(j6g. 480. //), placed one on either side of 

 the rhna or fissure which leads to the vagina. 

 The labia vary considerably in size and form in 

 different subjects. In stout adults they are full 

 and fleshy, closing the vulvar orifice, and con- 

 cealing the rest of the generative organs, 

 which they serve to protect. In the aged the 

 labia become shrivelled and the nymphae pro- 

 trude between them, as they also commonly 

 do in infants and young subjects. The outer 

 surface of each labium is composed of com- 

 mon integument, which at the age of puberty 



