A8 for the manner in which this abnormality prevents conception, we can scarcely believe that the penis passes by it into the fornix; the abnor mal length of the cervix is rarely so considerable that the ejaculation of the sperms could result too high up above the os externum. This could only occur where there is the penis-like elongation of the vaginal portion, a form which, however, is not closely related to the conical form. It is much more probable that the narrowness of the os externum, almost always combined with it, and its consequences may prevent the entrance of the sperma. The success of merely slitting it open for the cure of the sterility, speaks decidedly in favor of the fact that it is not the form and length, but the narrowness of the os externum that forma the most im portant feature of the abnormality.
We next come to the benign, simple hypertrophies of the vaginal por tion. They may occur in various forms in women who have never borne children, but they are generally the consequences of difficult labors or diseases of the uterus, and therefore properly belong under the consider ation of causes of acquired sterility. The hypertrophy would scarcely assume such dimensions as to prevent or even greatly to obstruct the en trance of the penis. When the penis is not introduced deeply, ejaculation of the sperma in the vicinity of the os externum may indeed ensue; if there are no further changes in the cervix, conception of course may oc cur. But if the penis passes by the elongated vaginal portion, the sperms will be deposited in the fornix at a considerable distance from the exter nal os, and the chances for the sperma to enter the os are much less. It is similar with a considerable hypertrophy of one lip--the os indeed is in the fornix, but the ejaculation constantly takes place into the fornix op posite the os externum. Thus the enlarged hp forms a barrier between sperma and os uteri. But according to my opinion the hypertrophy must be a considerable one; the abnormality, therefore, known as apron like vaginal portion, is scarcely of that importance which Marion Sims and Beigel ascribe to it, for that which is generally described and depicted as an apron-like vaginal portion, is too insignificant to offer any obstacle, even if there be but a moderate quantity of semen. Very probably the changes in the cervical mucous membrane, out of which such hyper trophies easily arise, are here the obstacle to conception.
It is similar with the hypertrophies of the supra-vaginal portion of the cervix. Here also the abnormal condition of the excessively long cervical canal may form the chief cause of sterility. The low position of
the os uteri would scarcely favor conception, inasmuch as even with these forms of elongation the one fornix is sometimes placed high, so that the penis may pass by its aim and get lost in the fornix, or else the relaxed vaginal walls permit the penis to force them up. As such hypertrophies rarely occur without other combinations that are related, in regard to etiology-, to the disturbance that we are speaking of, these complications deserve our full attention.
Marion Sims and Beige' also regard the deficiency of the vaginal por tion as an obstacle, though a slight one, to conception, since that portion of the uterus, which should dip into the receptaculum seminis, is absent. (See post, among defects of the vagina.) This arrangement, considered by some to be of great usefulness for the purpose of conception, will receive further attention elsewhere. I deem it so important that I can not share that opinion; on the contrary, it seems to me that the absence of the vaginal portion renders conception easier, since the sperma is hereby con ducted more directly to the os externum. When sterility accompanies this condition, it is much more likely that general atrophy of the uterus, congenital or acquired, which occurs much more frequently than is gen erally believed, is the cause of it, or else the ulcerative processes which lead to a destruction of the vaginal portion, have brought about changes in the canal of the cervix itself—as for instance stenosis, which may ob struct the advance of the semen.
Slenosts of the Cervix.—Among the affections of the cervix, stenosis plays an important part. It may affect the entire canal, or a gre,at part of it, or it may be confined to one or both ostia,.
Total stenosis of the cervix not infrequently occurs as a congenital de fect A very fine probe penetrates without much difficulty through the external os, that can scarcely be seen or felt, and enters through the canal into the uterine cavity proper, but it is impossible for a uterine Bound of the ordinary calibre. To judge from my experience, this high degree of stenosis, which may render the entrance of the sperma difficult, or may even entirely prevent it, occurs very rarely with an otherwise nor tnal uterus. The smallness of the vaginal portion and of the body, which not rarely appears anteflexed, show that the narrowness of the canal is merely one symptom of the faulty development of the uterus itself. Scan ty menstruation together with the anatomical condition speaks decidedly in favor of this supposition.