VAGINA AND VULVA, DISEASES OF.
Diseases of the Vagina.
It is not strange that an organ which is subject to excessive use and abuse as the vagina should be so susceptible to disease and injury. This organ is an essential part of the parturient canal; sexual passion, in love or licentiousness, is concentrated upon it; and its relation to the other pelvic organs is so intimate that it is quite certain to bear a larger or smaller share of the ills which they experience.
Vaginitis.
The inflammatory affections of the vagina may be divided into the (1) trau matic and (2) infectious.
Traumatic Vaginitis.
Symptoms.—Pain, swelling, local ele vation of temperature and congestion are distinguishing symptoms. Even moder ate pressure, the introduction of a specu lum, or violence of any kind may cause great pain and more or less bleeding. The acute symptoms are usually of short duration, and may disappear in a few days with judicious treatment. An in flammation in such vascular tissue as the vagina is easily excited, and its abundant lymphatic supply and large absorbent surface demand that the conditions be kept as aseptic as possible. Especially in those cases in which there is suppura tion or sloughing should one remember the possibility of converting the case from one of simple inflammation to one with infectious and constitutional ele ments.
Etiology.—This, like the kindred vul var disease, may be accidental or inten tional. The former, as in the vulvar disease, may arise from violent and brutal coitus, from the thrust of sticks or other substances of wood or metal, from violent and unskillful attempts to produce abortion, from prolonged or complicated parturition, and from the caustic effect of heat and chemicals.
The infectious variety may proceed from wounds inflicted by the surgeon (e.g., those which are made to facilitate delivery), from strangulation of tissues which have been too tightly ligated in the repair of vaginal injuries, or from the actual or potential cautery.
Vulvo-vaginitis in the young girl may be divided into simple and gouorrhceal.
Simple catarrhal vaginitis is due. in a large majority of cases, to lack of clean liness, and subsides when the proper treatment is instituted.
vulvo-vaginitis in young children is more common than is generally supposed. While more frequently met with amid unhygienic surroundings in large cities, it is by no means a rarity in the less thickly settled districts. Gonorrhoeal disease is more frequent below the age of six: it is more common in girls than in boys. Specific vulvo-vaginitis in the large majority of cases arises from actual contact of the patient with some infected person. A study of the re ported epidemics, however, shows that the disease may be spread by other means, such as a common bath, towels, bed-linen, etc. The ordinary staining methods will prove satisfactory in mak ing a differential diagnosis between spe cific and other forms of vulvo-vaginitis. The parts affected in their order of frequency are the labia, urethra, vagina, and cervix; the vagina is more fre quently affected in the child than in the adult, owing to the character of its epi thelium. The tubes, ovaries, and perito neum may be involved in the patholog ical process. It is not improbable that certain diseases of adult life may be ascribed to gonorrhoeal infection in in fancy. Purulent ophthalmia and rheu matism are quite frequent complications. The strictest prophylaxis should be observed in order to avoid the former. The treatment of specific vulvo-vaginitis must be energetic to be of any avail. Under certain conditions the vaginal orifice should he widely dilated and the vaginal pus-cavity properly drained. Peterson (Amer. Medicine, Jan. 11, 1902).
Treatment.—Simple measures of treat ment arc always the most effective. Gentleness of manipulation will be help ful; harshness will prolong the unfavor able conditions. Douches with hot saline solution or weak solution of lead and opium (IT. S. P.) will serve the double purpose of cleanliness and ing pain. The douches may he repeated twice daily and in the interval a pad of absorbent cotton may be secured against the vulva and kept moist with the and-opium wash. The bowels must be kept open with salines or any approved mild cathartic. Rest in bed will hasten the termination of the inflammatory process.