THE VAGINA 387 



the pelvis (Fig. 137). It contains the ovarian vessels and 

 nerves, etc. 



The Vagina. The vagina extends upwards and backwards 

 from the genital cleft in the perineum. It is about 3 inches 

 long and, at its upper end, it is attached to the cervix uteri. 

 This attachment is placed at a higher level on the posterior 

 aspect than on the anterior aspect of the cervix. As a result, 

 the posterior wall of the vagina is slightly longer than the 

 anterior wall, and the recess which is caused by the downward 

 projection of the cervix is deeper behind than in front. This 

 recess is termed the fornix vaginae. The anteror wall of the 

 vagina is related to the urethra and the posterior surface of 

 the bladder, and this close relationship explains the occurrence 

 of urethro-vaginal and vesico-vaginal fistula and vesico-celes. 



Posteriorly, the vagina is related to the perineal body, a 

 nbro-muscular node which separates it from the anal canal. 

 At a slightly higher level, the vagina is closely related to the 

 rectum, from which it is only separated by the visceral pelvic 

 fascia. The uppermost part of the posterior wall of the vagina 

 is separated from the rectum by the lowest part of the utero- 

 rectal peritoneal fossa (Fig. 134). 



A Vaginal Examination gives valuable information about 

 the condition of the pelvic viscera and the contents of the 

 pelvic peritoneal fossae. The orifice of the vagina is guarded 

 by the labia majora, two folds of skin which form the lateral 

 boundaries of the pudendal cleft. When they have been 

 separated, two smaller folds, termed the labia minora, are 

 exposed, and care must be taken not to invert these folds into 

 the vagina when the fingers are introduced. Stretching of 

 the inverted labia minora gives rise to acute pain and dis- 

 comfort. The presence of calculi or other foreign bodies in 

 the urethra or the bladder can be determined by compressing 

 the anterior wall of the vagina against the pubes. In malignant 

 disease of the cervix, palpation of the anterior fornix deter- 

 mines the condition of the bladder, and the possibility of 

 successful surgical interference depends on the freedom of the 



