Venereal Diseases

VENEREAL DISEASES.) Diseases of the External Genital Organs.—The vulva corn prises several structures grouped together for convenience of de scription. (See REPRODUCTIVE SYSTEM.) The affections to which these structures are liable may be classified as follows : In juries, either occurring during parturition or accidental; the corn monest is rupture of the perineum, (2) Inflammation of the vulva or vulvitis. Simple vulvitis is due to want of cleanliness or to irritating discharges and in children may result from thread worms. Severe infective vulvitis is usually due to gonorrhoea. The symptoms of vulvitis are heat, itching and throbbing, and the parts are red and swollen and bathed with discharge. In the gonorrhoeal variety the local inflammation is very severe, the dis charge profuse and purulent and there is scalding pain on micturi tion. The treatment of simple vulvitis is rest in bed, cleanliness and bathing the vulva with warm antiseptic lotions. Gonorrhoeal vulvitis is almost invariably associated with infection of the urethra, vagina and cervix; the treatment, which is prolonged and requires an expert, consists chiefly in the precise application of a special antiseptic, such as two per cent acriflavine, to the above mentioned sites of infection. For obvious reasons, a complete cure must be obtained, and the infection must be prevented from spreading to the Fallopian tubes. (3) The vulva may become the seat of various cutaneous diseases the most important of which are eczema, erythema, herpes, furunculosis, tubercle, elephantiasis, leucoplakia and kraurosis. These diseases present the same char acters as in other parts of the body. In leucoplakia the surface of the vulva becomes thickened and covered with white patches, and later cracks and ulcers appear; the disease is important be cause, if neglected, it is often the forerunner of cancer. (4) Tu mours of the vulva, cysts of Bartholin's gland and vascular caruncles of the urethral orifice are the commonest. Any part of the vulva may be the seat of new growths, simple or malignant. Pruritus of the vulva is the name given to persistent itching of this part; it is a symptom more than a disease, and accompanies vulvitis and most of the conditions given under (4) above. It is a frequent accompaniment of diabetes and may be an early symptom of cancer; for these reasons it should not be disregarded.

Diseases of the Vagina.

The vaginal walls are kept moist by a thin opalescent fluid containing desquamated epithelium and cervical mucus; its acid reaction is due to the vaginal bacilli. When the vaginal secretion is excessive it is called leucorrhoea or "the whites." (I) Malformations. The vagina may be absent in whole or in part or may present a longitudinal septum. Occlusion of the lower end by a membrane prevents the escape of the men strual flow and leads to the gradual distension of the vagina with blood ("haematocolpos") . Prolapse of the vagina is a hernial protrusion of the pelvic contents through the opening in the pelvic floor muscles, the vaginal walls forming the covering of the pro trusion; there is usually concomitant prolapse of the uterus ("utero-vaginal prolapse") . Protrusion of the anterior wall by herniation of the bladder is called cystocele, and protrusion of the posterior wall by the rectum is called rectocele. Vaginal prolapse can be permanently cured by an operation ; the palliative treat ment is by vaginal pessaries. (3) Fistulae may form between the vagina and bladder, or vagina and rectum ; they are usually the result of parturition and require closure by operation. Fistulae may also form in the late stages of carcinoma of the cervix uteri. (4) Vaginitis. (a) Simple catarrhal vaginitis is due to the same causes as simple vulvitis; occasionally in children it is important from a medico-legal aspect. (b) In gonorrhoea the vagina is in fected together with the vulva and cervix; the vaginal walls are intensely red and covered with profuse yellow discharge. The treatment is the treatment of gonorrhoea. (c) Chronic vaginitis may follow the acute variety and may persist for a long time. The vagina is rarely the seat of tumours, but cysts are not uncommon.