404 The Vagina 



between the levatores ani. Its curve must be remembered at the time 

 of introducing the speculum. 



The prolonged pressure of the foetal head during a tedious labour 

 may cause a sloughing of the vaginal walls, opening the vagina into 

 the bladder or rectum, the result being vesico-vaginal and recto-vaginal 

 fistula respectively. Urine or flatus would not escape directly after 

 parturition, as in the case of a laceration, but would be delayed until 

 the slough had separated. The condition may eventually be remedied 

 by dilating the vagina with a speculum, vivifying the edges of the 

 fistula, and closing it by sutures. 



In the case of a tumour implicating the anterior wall of the rectum, 

 its size and connections should be examined by one index-finger in the 

 bowel and the other in the vagina. 



Structure of vagina, With the exception of the slight peritoneal 

 connection (p. 389), the vagina has no serous coat, the most external 

 layer being of fibrous tissue, derived from the recto- vesical fascia. 

 Next comes a coat of non-striated muscular tissue, arranged for the 

 most part in a longitudinal and a deeper, circular layer. More inter- 

 nally is a thin coat of erectile tissue ; and, lastly, a lining of mucous 

 membrane covered with squamous epithelium. On the anterior and 

 posterior walls the mucous membrane is raised in a longitudinal ridge 

 with short transverse ridges passing from it. This arrangement is 

 chiefly for preparing the canal for the severe dilatation to which it is 

 submitted during parturition. 



The orifice of the vagina is embraced by the striated sphincter 

 vaginae, which corresponds to the accelerator urinse in the male ; 

 its spasmodic contraction produces the condition known as vaginis- 

 mus ; it might possibly demand a speculum in the vagina for an 

 increasing length of time each day, the sphincter being thus tired out. 

 Sometimes, however, the spasmodic contraction is due to small sensi- 

 tive growths upon the mucous membrane ; a careful inspection of the 

 parts should be made under ether in every case before the adoption 

 of empirical treatment. The state of the ovaries and of the uterus 

 should also be enquired into. 



After rupture of the perineum much of the support of the pelvic 

 organs is lost, and during defalcation and micturition the anterior wall 

 of the rectum or the posterior wall of the bladder is thrust down as a 

 flaccid tumour through the vulva, the condition being a rectocele or 

 vesicocele, as the case may be. The uterus itself may descend until 

 its neck and part of its body habitually remain outside the vulva. The 

 perineal rupture may extend right through the sphincter ani, making 

 of the vagina and rectum a vast cloaca. 



Sometimes the vagina is divided in its length by a vertical septum, 

 the lateral halves of the cavity being associated with the halves of a 

 bifid uterus, as shown on p. 395. 



The blood-vessels of the vagina are derived from the anterior 



