714 



UTERUS AND ITS APPENDAGES. 



venous plexuses surrounding the vaginal 

 orifice, together with their communicating 

 branches, have been already described. The 

 external pudic veins, collecting the blood from 

 the mons veneris and the interior of the labia, 

 take a course similar to that of the correspond- 

 ing arteries, and empty themselves into the 

 saphena. 



The lymphatics of the external organs ter- 

 minate in the inguinal glands. 



The nerves. The external parts are abun- 

 dantly supplied with nerves derived chiefly 

 from the pudic. The pudic nerve arising from 

 the lower part of the sacral plexus passes 

 through the sacro-sciatic foramen and accom- 

 panying the pudic vessels divides into two 

 branches. 



The inferior, or perineal branch, sends twigs 

 to the labia, nymphae, and roots of the clitoris, 

 and then gives off the superficial perineal 

 branch, which is distributed to the constrictor 

 muscle of the bulb of the vagina. 



The superior, or branch of the clitoris, corre- 

 sponds with the dorsal nerve of the penis. 

 Beneath the pubic arch it passes between the 

 roots of the clitoris and is distributed along 

 the side of that organ in the manner already 

 described (fig* 481. z z'). Some of its ramifica- 

 tions are distributed upon the prepuce and in 

 the nymphae and upper parts of the labia. 



The labium also receives nerves from the 

 branches of the inferior pudendal nerve, a di- 

 vision of the small sciatic nerve. These com- 

 municate with the superficial perineal branches, 



ABNORMAL ANATOMY OF THE EXTERNAL 

 ORGANS. 



Labia. The labia, together with the whole 

 of the external generative organs, may be 

 deficient, or they may retain through life an 

 undeveloped or fetal condition, consisting 

 only of a very narrow fold of integument. In 

 rarer cases, the labiurn of one side only has 

 been developed. The labia may, on the other 

 hand, present the form of a double or even a 

 triple fold. In cases of deficiency of the lower 

 part of the abdominal integument and ante- 

 rior wall of the bladder, with separation of 

 the pubic symphysis, the labia are imperfectly 

 formed, and are set wider apart than usual, 

 inclining somewhat outwards. The labial 

 commissure is then also deficient. The pos- 

 terior commissure of the labia may be much 

 hypertrophied, projecting unusually forward, 

 and covering more or less the entrance to the 

 vagina. The labia are occasionally so com- 

 pletely coherent along the median line, that 

 the vulvar fissure is obliterated, leaving only 

 an aperture sufficient for the passage of urine. 

 This condition is commonly the result of in- 

 flammation of the vulva in early infancy. 



The diseases affecting the tissues of the 

 labia may be superficially seated, or may in- 

 volve more or less their entire substance. 

 The principal superficial affections are erythe- 

 matous inflammations, often accompanied by 

 vesicular, chiefly herpetic or eczematous, and 

 sometimes pustular eruptions ; enlargement 



of the follicles, increased secretion, occasion- 

 ally watery, and in excessive quantity, occur- 

 ring in combination with a solid oedematous 

 condition of the part (oozing tumour of the 

 labium), excoriations, aphthous or specific 

 (chancrous) ulcers ; and condylomata, espe- 

 cially of the softer and syphilitic kind. The 

 deeper seated affections are acute, and chro- 

 nic inflammation of the fibrous and cellular 

 tissue ; induration and hypertrophy, some- 

 times of considerable extent (elephantiasis); 

 serous infiltration, associated with pregnancy, 

 or cardiac disease; suppuration producing 

 large collections of pus within the labium ; 

 sloughing and gangrene. The veins of the labia 

 frequently become varicose in multiparae, and 

 haemorrhagic effusions take place into their 

 substance. These effusions may be produced 

 during straining efforts, or by external vio- 

 lence, but are especially apt to occur during 

 labour, from pressure of the child's head upon 

 the veins returning the blood from the venous 

 plexuses that surround the vaginal orifice, 

 whereby the latter become over-distended 

 and ruptured, a considerable interstitial hae- 

 morrhage often resulting. Cysts enclosing a 

 glairy fluid, and adventitious growths of a 

 more solid kind, such as are common to fibrous 

 and cellular tissue, are not unfrequently found 

 within the labia. Cancerous degeneration is 

 more rare, but it may occur, either alone, or 

 in combination with vaginal or uterine cancer. 

 The labia may suffer laceration during labour, 

 from forcible violation of the person, and in 

 other ways. FLstulae, communicating with the 

 rectum, and permitting the passage of fcecal 

 and gaseous fluids, occasionally form in the 

 labia as sequelae of suppurative processes. 

 Lastly, these parts are occasionally the seat 

 of hernia of the intestine, and, more rarely, 

 of the ovary. 



Clitoris. -Entire absence of the clitoris pro- 

 bably seldom or never occurs alone. But the 

 clitoris and nymphae may be deficient even 

 when the labia are present. The clitoris is 

 sometimes so small that its presence may 

 escape detection. More often it is of unusual 

 size, projecting beyond the labia. Such en- 

 largements, though occasionally occurring 

 without degeneration of the tissues, are more 

 commonly the result of inflammatory hyper- 

 trophy, or are occasioned by profuse condylo- 

 matous (syphilitic) growths, in which the 

 prepuce also may be included. The clitoris 

 is also subject to cancerous degeneration, 

 sometimes attaining an enormous size. 



NymptuB and vestibule. The protrusion of 

 the nymphae between the labia, which occurs 

 as a normal condition in infants, is not unfre- 

 quently observed in adults, when these parts, 

 exceeding their ordinary dimensions, hang 

 down below the posterior commissure : their 

 lower extremities may in rare cases be pro- 

 longed as far back as the anus. The number 

 of the nymphae may be increased to two 

 (Morgagni), or even three pair (Neubauer). 

 Excessive hypertrophy of the nymphae is 

 common in certain climates. It may be asso- 

 ciated with corresponding enlargement of the 



