From cases of absolute absence I differentiate sharply those of non development of all or of portions of the external genitals.
In case of marked extrophy of the bladder, the labia majors are as a rule undeveloped, and are purely little flaps of the integument. There exist, however, cases of lack of development, aside from this malformation. Seggel cites Pear's and Morgagni's cases of abnormal smallness of the geni tals, the one in case of a young girl, the other in case of a sterile woman. In all the external genitals were undeveloped. Coste also reports a case where, in a girl of twenty-one, the labia majors, were rudimentary and the clitoris enlarged.
Cases of congenital absence of the labia minors, formerly called the water channels, have been observed, where the labia majora were normal (Mayer, Hartmann, Granville). Meckel has twice noted absence of the left labium minus without trace of cicatrix. Together with absence of the minors, is often associated absence or lack of development of the clitoris. Not a single instance of presence of the clitoris and absence of the other external organs has been recorded.
When the external genitals suffer from lack of development, they re semble naturally in size and appearance those of the infant, and we speak then of the vulva infantilis. The surgeon obviously can do nothing in these instances.
Oases of hypertrophy of the otherwise normal organs are frequent enough. Meissner states that there may exist even threefold labia majors, although such excess is more common in the nymphse. Morgagni re cords an instance where there were four, and J. E. Neubauer one where there wore six nymplue.
Further still, such excess in development of the labia majors are re corded that they hung from the mons veneris to below the anus. Simi larly the labia minors may be found developed Fo greatly as to spread over the labia majors, and hang down to the anal opening, so as to en .
tirely cover the perineum. Hall( has recorded an instance where the nymph completely covered the anus. More frequently, however, the labia minora are increased in size lengthwise, forming the so-called Hot tentot apron. (See Plate.) In premature fwtuses the nymplue are normal in size. In the foetus at term they are covered by the labia majors, and this is a sign that the Rails is born at term. There are numerous variations, however. Later,
that is to say, after a few months, and during the first years of the child's life, the labia majora have greatly increased in size from the deposition of fat, and they lie together covering all the other parts. Thus normally they remain throughout life. Still, in Europeans of various races, at puberty, the upper border of the nymph so often appear to a degree at the rims pudendi, that such a condition cannot be called pathological. This statement is not contradictory to that of Marie Vogtlin, that hyper trophy of the nymphet is not in causal connection with the repeated irri tation from frequent labors.
In old age, with the general disappearance of the adipose and the elasticity of the skin, the labia majora shrink into mere integumentary flaps, and no longer cover the nymphu and the vestibule. The nymphet then become again apparent, but in different shape and form from what they were in youth, for they too have withered with age.
The nyniphse of all the external genitals have the greatest tendency to hypertrophy. They grow and spread outside of the rima pudendi, like the wings of a Zwank's pessary. Such enlargement is apparently a fre quent affair in Turkish and Persian women, and occasionally requires amputation, as also in Coptic and Moorish women, about whom Strabo and Plinius wrote " nympha3 aliquando enormes aunt, quare Copt.% et Mauri cireumcidunt." About the Hottentot and Buschmen so much has been written that we may take it for granted that hypertrophy of the labia is peculiar to all the women of the race. In them they grow to the extent of eight and nine inches long, and in the adult they hang like an apron over the external genitals.
According to Otto there are three explanations offered for this so-called apron: the first that it is due to great increase in the nymplue; the second that it is caused by a swelling of the labia majora; the third thaf it is the result of the development of the muscles and the skin, hanging by a pedicle from the pubic bone, enclosing the clitoris and covering the rima pudendi. These suggestions of Otto's must, however, in the light of recent researches, be modified.