Defects in the vagina may also be con genital or acquired. The former may consist in a small or imperfectly devel oped tube and in one or more septa dividing the vagina into loculi. These septa may extend the entire length of the vagina, they may he attached to the pnrtio vaginalis uteri at or near the os, or they may avoid the uterus entirely. Sometimes they extend across the vagina like a secondary hymen.
Acquired defects of the vagina may consist in narrowing or atresia after un successful operations, after inflammatory diseases with sloughing or necrosis, after severe labor, after cauterization from heat, acids, etc., as the result of injuries or the infiltration of a malignant dis ease process, and as the consequence of atrophy which comes with age or the premature appearance of the menopause.
Atresia. which comes with old age or the premature menopause, is usually ir remediable. When it is due to other causes it may sometimes be overcome by the judicious use of dilating instruments and the cutting of bands and strictures.
Diseases of the Vulva.
No age or condition of life is free from disease of this structure. The relatively greater prominence of the vulva in child hood compared with mature life renders it the more exposed to disease and in jury; hence the not infrequent instances of suffering, as to the vulva, in little children •from accident, want of cleanli ness, parasites, etc.
Vulvitis.
This general term includes a variety of inflammatory conditions with more or fewer elements and symptoms. It may signify merely an inflammatory condi tion of the skin, an inflammation of the subcutaneous connective tissue, an in flammation of the vnlvo-vaginal glands and the tissue surrounding them, or an inflammation of the mucous membrane contiguous to the vagina.
The varieties of vulvitis may be classi fied as (1) traumatic and (2) infectious.
Symptoms.—Symptoms which attend traumatic vulvitis are those which at tend similar injuries in other parts. If the skin is not broken or bruised, ecchy mosis will mark the injured surface, and at a later stage, if suppuration has oc curred, fluctuation will be apparent. Pain is almost always a prominent symp tom, arising from pressure if an effusion of blood underneath the skin renders the tissues tense, or attributable to direct in jury to the nerve-endings if the actual or potential cautery has been used, or due to bruising of the tissues and sub sequent inflammatory reaction in con nection with lacerated and contused wounds.
II emorrhage may be external or inter nal, that which proceeds from the venous plexuses, with which the vulva is richly supplied, being sometimes very profuse.
Swelling is usually a conspicuous symp tom, the swollen tissue being soft and compressible when the bleeding has taken place within the loose tissues of the vulva, or hard and firm when clue to inflammatory exudate; it gradually sub sides as absorption takes place or the fluid is released by incision.
Suppuration occurs not infrequently, for the tissues are vascular; cellular tissue is prone to suppurate, while the secretions of the vulvo-vaginal glands, if retained, during the inflammatory process readily undergo degenerative changes. Uncleanness and want of care in the treatment of traumatisms of the vulva will predispose to suppuration here as elsewhere.
There is no discharge from the mu cous surface of the vulva during the acute stage of this condition, the glandu lar secretions being checked. As the acute inflammatory symptoms subside, however, the mucous membrane becomes moist again. The constitutional impres sion from this condition varies with the individual; robust women and children show little febrile reaction, while those who have poorer resisting power may suffer much. If the wound becomes in fected. enlargement of the inguinal glands and general disturbance may fol low.
A traumatic inflammation of this char acter if treated antiseptically may show acute symptoms three or four days, the exudate, if there is any, disappearing in two or three weeks. Should the treat ment be defective, the duration of the disease may be indefinitely prolonged.
Etiology.—The question of infection enters so largely into the consideration of all inflammatory conditions that it is often argued that the non-infectious conditions are few and not easily differ entiated, or even that they do not exist. While it is almost impossible to say that infectious elements are wanting in cer tain cases of vulvitis, we can at least point to traumatic factors as dominating and originating. Traumatism in this, as in every other part of the body, may he accidental or intentional. It may con sist in any kind of a wound or bruise and be followed by more or less intense symptoms of inflammation. Among the accidents which cause vulvitis may be mentioned falls astride a chair or fence, thrusts from sticks or implements of wood or metal, applications of various forms of caustic material (mineral acids, chloride of zinc, etc.). heat from boil ing water, from the flames of burning clothes, etc.. the horns of angry animals. bites and stings of insects or other ani mals. etc.