ABNORMAL ANATOMY OF THE EXTERNAL ORGANS.
Labia.—The labia, together with the whole of the external generative organs, inay be deficient, or they may retain through life an undeveloped or fcetal condition, consisting only of a very narrow fold of integument. In rarer eases, the labium 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 multiparm, and hmmorrhagic 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 hm 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. Fistulm, communicating vvith the rectum, and permitting the passage of fcecal and gaseous fluids, occasionally form in the labia as sequelm 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 nymphm 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.
Nymphce and vestibuk.—The protrusion of the nymphm 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 nymphm may be increased to two (Morgagni), or even three pair (Neubauer). Excessive hypertrophy of the nymphm is common in certain climates. It may be asso ciated with corresponding enlargement of the clitoris. The nymphm are subject to the same inflammatory and specific disease as the labia, but they more commonly affect the sur faces than the substance of these parts, which, being of a denser texture than the labia, are not so easily infiltered with the venous, san guineous, or purifortn fluids, that readily collect within the latter.
The morbid conditions of the vestibule con sist chiefly in inflammatory hypertrophy of the vestibular follicles, especially of those which immediately surround the urethral ori fice and line the sides of the ostium vagina.. They present the appearance of small red gra nulations. A more decided spongy vascular growth often springs from the border of the urethral orifice, where it forms either a bright red fringe, or a soft tumour, varying in size from a pea to a cherry (vascular tumour of the meatus). The vulvo-vaginal gland and its duct may be the special seat of blennor rhcea, sometitnes of an infecting kind. This may be made to ooze from the orifice of the duct, by pressure behind the labium.
The most frequent varieties in the condi tions of the hynzen and ostium vagina have been already' noticed.* The vaginal orifice may be nearly or completely obstructed by an adventitious membrane, or by the hymen pre ternaturally developed. Some of these states are congenital, but others are acquired. In either case, attention is often not called to them until after the establishment of puberty. According to their degree, they interfere with the functions of the vagina, partly or alto gether preventing intromission, and rendering insemination imperfect or impossible, They inwede the exit of the products of conception and the escape of the menstrual fluid. In the latter case, when menstruation is esta blished, the fluid collects in and dilates the vagina and cervix uteri, and lastly the body of the uterus, and even the Fallopian tubes. Spontaneous rupture of the hymen, or mem brane, may then occur, liberating the fluid,