File:Gynaecology for students and practitioners (1916) (14778586311).jpg

Identifier: gynaecologyforst00eden (find matches)
Title: Gynaecology for students and practitioners
Year: 1916 (1910s)
Authors: Eden, Thomas Watts, 1864-
Subjects: Gynecology Gynecology
Publisher: New York : Macmillan
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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greatly reduced, often to the thickness ofstout paper. If the vaginal orifice is now opened up by the fingers,a deep sulcus will be found in the posterior vaginal wall runningupwards and to one side ; sometimes there are two sulci of unequaldepth, one on each side. On the fioor of the sulcus an irregular lineof cicatricial tissue will be found. The deep part of the perineal bodyhas been destroyed by a puerperal laceration extending into it from ANATOMY OF PROLAPSE 597 the posterior vaginal wall, and this internal injury weakens the vaginalorifice as much as, or even more than, an external one. In suchcases very marked relaxation of the orifice may be present, so that itmay be stretched sufficiently to admit three or even four fingerswithout giving the patient pain (see Fig. 317). Incompetence of the anus is one of the most distressing complica-tions of perineal injuries, and careful attention should always be paidto the condition of the external sphincter. In its normal condition, the
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Fig. 317. Relaxation of the Ostium Vagina in a Parous Woman, due to laceration of the posterior vaginal wall. The skin-surface of the perineal body is uninjured. (From a photograph.) presence of shallow radial folds of skin around the anus indicates itsfunctional activity (.see Fig. 317); when the anterior part of the musclehas been involved in a perineal laceration these radial folds, thoughstill seen at the sides and posteriorly, are absent in front, the anteriorwall of the anus being represented by a band of smooth cicatricialtissue. The ends of the torn muscle have retracted so that it is now 598 GYNECOLOGY horseshoe shaped, and the position of the retracted ends is oftenindicated by a shallow pucker or dimple in the skin on each side. As arule the retracted ends are not precisely opposite one another (see Fig.494, p. 819). Cystocele. In this condition the anterior vaginal wall, and withit the base of the bladder and the urethra, protrude from the vulva (see

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