PUERILE CERVIX. — The corpus is about normal in size, but the cervix is small and conical, with an extremely small external os. Anteflexion and ste nosis may be present.
The symptoms and diagnosis are the same as for deformities, resulting from imperfect union of Mueller's duct, and may be associated with those of atresia vaginm, or stenosis of the cervix (q. v.).
The prognosis is unfavorable except for puerile cervix.
Treatment. — If treatment is com menced soon after puberty, some benefit may be derived from intra-uterine bipolar faradization and persistent periodical dil atation of the cervix. Divulsion by means of bladed dilators under amethe sia, with packing of the uterus for thirty six hours, may be followed by repeated packings, provided the endometrium is douched out each time with an efficient antiseptic; afterward the cervix may be kept dilated by conical round dilators twice weekly. Pelvic massage and move ments adapted to develop the pelvic mus culature and increase the flow of blood to the pelvis are sometimes used.
Stenosis of the Cervix.—Stenosis of the cervix consists in a lack of development or atrophy of the part sufficient to inter fere with uterine drainage. The con traction may be at the external or in ternal os, or exceptionally throughout the canal, and is often connected with flexion of the uterus. It may be due to puerility in the nullipara, to cicatricial contraction following cervical laceration in the parous woman, and to atrophy in the senile woman.
— Colicky dysmenorrhoea, as in cases of anteflexion, lasting from a few hours to a day or two, is the most common symptom. Colicky pains in the
vesical region are sometimes felt between the menstrual periods, and may be fol lowed by a discharge of mucus, blood, or pus. In old people prolonged retention of secretions, which usually become of fensive and purulent (senile endome tritis), may take place and stretch the uterine walls until the organ resembles a bag. Endometritis with its symptoms is present in long-standing cases.
Sterility, which is often relieved by a dilatation of the cervix, is a common condition.
—If the stenosis is at the external os, the orifice may be scarcely visible, or may look like a small dimple on the end of the cervix. If at the in ternal os a small uterine probe, or a piece of slippery-elm bark cut into the shape of a slender tent, will demonstrate the partial or complete closure of the canal. if the cervix be small and flexed, the stenosis is probably connected with im perfect development and displacement; but if the cervix be large and perhaps lacerated, the stenosis is due to indura tion and contraction of the mucous and submucous tissues at or near the inter nal os. In the latter case the internal os is apt to he quite sensitive to the touch of the sound, and may bleed a trifle upon the withdrawal of the latter. Thick cervical mucus will, as a rule, be visible.