No one will seriously contend that such reflex spasm is limited to a single muscle. It is only natural that it should affect the entire group of muscles. C' Lain patients with an anal fissure suffer from vaginismus, while in others during the spasm the muscles of the perineum are tensely contracted. Naturally enough then, when there exist painful parts higher up in the vagina, as for instance very sensitive erosion, other groups of muscles and the levator ani as well are spasmodically affected. There re sults, thence, an obstacle to the insertion of the speculum, and the intro.
dnction of the penis is rendered impossible. We give an illustration of the pelvic diaphragm taken from Luschka. The lower end of the vagina (a) and of the rectum (b) is to be seen. On the latter we see the external sphincter ani, the internal bundles of which form the sphincter, while the external cross and join the fibres of the constrictor cunni, to form a bundle (e) which extends backwards to insert at the apex of the sacrum. The fibres of the levator ani or the diaphragmatic muscle of the pelvis surround the rectum. A few fibres (e) arch over the anterior surface of the rectum, but the vast majority lie under it, and they are divided into three portions, the one inserted on the sacrum, the other extending across the pelvis, and the third merging with the fibres of the external sphincter ani. The fibres which extend from the pubes, the pubo-vesical ligament,
and the isehium, come together near the vagina, and are united to it by fibrous not by muscular tissue. Energetic contraction of the levator ani may, according to Luschka, lift the vagina anteriorly, and even compress it a trifle from side to side, but the canal can never be closed by this muscle. Hildebrandt is right then in his belief in regard to the muscle opposing the insertion of foreign bodies into the vagina, but from an ana tomical standpoint, lie is wrong in the assumption that it may cause tonic spasm. One of his observations finds a more rational explanation in contraction of the constrictor cunni, together with approximation of the fibres of the levator ani. It is certain that this latter muscle cannot alone cause closure of the vagina, since it does not surround this canaL As for the constrictor vaginae superior, supposed to exist by Sims, it is likely enough only the muscular layer of the vaginal wall.