II. FEMALE PELVIS. 1. Rectum. Note same things as given above for the examination of the rectum in the male. Gonorrhœa, stricture due to syphilis and traumatic fistula (due to child-birth) are more common in the female.
2. Vulva. The most important pathologic conditions are: congestion, œdema, hæmorrhage, hæmatoma, trauma (laceration), vulvitis (catarrhal, gonorrhœal, chronic, diphtheritic, gangrenous, phlegmonous, ulcerative, abscess), erythema, eczema, herpes, acne, furunculosis, pruritus, kraurosis vulvæ, leukoplakia, Bartholinitis, retention-cysts, cysts of the glands of Bartholin, hydrocele muliebris, syphilis (primary, secondary and tertiary lesions), tuberculosis (lupus), elephantiasis, condylomata, neoplasms (lipoma, fibroma, lymphangioma, papilloma, fibromyxoma, fibromyoma, chondroma, neuroma, carcinoma [usually very malignant in type], sarcoma [rare] and metastatic tumors [very rare]).
3. Urethra. Same conditions as noted above for the male. Small polypoid granulomata (caruncles) are very common; usually gonorrhœal in origin. Primary carcinoma is more common in the male.
4. Bladder. Note same conditions as given above. Rectovesical and vesicovaginal fistulas are not rare as the result of child-birth. Secondary carcinoma is more common than in the male (from uterus and cervix), primary carcinoma more rare. Ascaris and oxyuris may enter bladder from vagina through a rectal fistula.
5. Vagina. Note size (about 5-8 cm. long), contents (foreign bodies, pus, blood, etc.), color of membrane, condition of rugæ, hymen, etc. The color of the mucosa varies from a delicate rosy red to a bluish purple in the late stages of pregnancy. The most important conditions are: colpitis (acute and chronic, catarrhal, diphtheritic, gangrenous, emphysematous, granular, nodular, adhæsiva, exfoliativa, vetularum, ulcerative; gonorrhœa the chief cause; also caused by mercuric chloride and other poisons; occurs also in cholera, typhoid fever, variola, scarlatina, diphtheria and other infections), ulcers, abscesses, erosions, strictures, varices, prolapse, atresia, trauma (lacerations, rupture, hæmatoma, fistula), tuberculosis (rare), syphilis (primary less common than on vulva, secondary lesions common, gumma rare), thrush, cysts (retention, remains of Müllerian and Wolffian ducts, gas-cysts), neoplasms (papillary fibro-epithelioma, fibroma, myxoma, myoma, rhabdomyoma, rhabdomyosarcoma, myxosarcoma), carcinoma (primary rare, secondary relatively common, particularly of malignant chorio-epithelioma; primary ectopic chorio-epithelial tumors occur in vagina also), and parasites (trichomonas vaginalis, oxyuris vermicularis). Note particularly condition of hymen.
6. Uterus. The developed uterus weighs 33-41 grms. In women who have not borne children the dimensions are 7-8 cm. long, 4 cm. broad, 2.5 cm. thick; in women who have borne children the dimensions are 8-9 cm. long, 5-6 cm. broad, and 3 cm. thick. The dimensions of the postpartum uterus vary greatly, where normal contraction has taken place the length is 8-9 cm., breadth 5-6.1 cm., thickness 3.2-3.6 cm., and weight 102-120 grms. Note size, shape, character of peritoneal coat, consistence, character of cut-surface, size and contents of cavity. Length of uterine cavity 5.2-5.7 cm. Note relations between body of uterus and cervix. In adults the circumference of the body of the uterus is greater than that of the cervix; before the age of puberty it is less than that of the neck. In old age the entire organ contracts, but the body more than the cervix, so that the organ again assumes an infantile form. The external os in the virgin uterus is round or oval; in women who have borne children it appears as a transverse cleft. The most common conditions of the cervix are the so-called erosion and ectropion, cystic glands (ovula Nabothi), cervical catarrh, hyperplasia, ulcers, polypi, myofibroma and carcinoma. Note contents of cervical canal (normally glassy, tough mucus; in catarrh becomes thin, cloudy or purulent); length and shape of canal (elongations, dilatations, stenosis, etc.). Color of mucosa should be grayish-red; the folds should be distinct and symmetrical. Purulent and diphtheritic inflammations, lacerations, polypi, cysts, fibromyoma, carcinoma and tuberculosis are the most common conditions affecting the cervical canal.
The uterine cavity is normally empty; during menstruation or as the result of inflammation it may contain blood and bloody mucus; and the mucosa may be deep-red. The normal mucosa is gray-red and 0.5-1.0 mm. thick. In the puerperal uterus portions of the placenta, fœtal membrane, purulent or bloody lochial discharges are present. The placental site is shown by its uneven surface and presence of blood-clots. Gangrenous and purulent areas are greenish, gray, brownish-green, and black, with opaque and ragged surface. Gas-bubbles may be present. The normal consistence of the uterus is firm, diminished in the puerperal uterus, increased in chronic metritis. The cut-surface is smooth in the virgin uterus, rough in the uteri of women who have borne children and in chronic metritis. The most common pathologic conditions of the uterus are: abortion, hæmorrhage, apoplexia uteri, hæmatometra, hydrometra, pyometra, rupture, perforation, traumatic lesions, endometritis (acute, chronic, hæmorrhagic, interstitialis, glandularis, hyperplastica, cystica, polyposa, adenomatosa, infective, decidual, atrophic, etc.), foreign bodies, tuberculosis, syphilis, actinomycosis, hyperplasia, metritis (acute, chronic, hyperplastic, atrophic), perimetritis, parametritis, atrophy, neoplasms (myoma and myofibroma the most common; adenoma, adenomyoma, adenomatous polypi are very common; carcinoma [adenocarcinoma, cystocarcinoma, medullary, papillary, colloid, scirrhous, squamous-celled, malignant chorio-epithelioma] very common; sarcoma less common but it is not rare [myosarcoma the most common form; often represents a sarcomatous transformation of a myofibroma]; metastatic carcinoma and sarcoma are rare), and parasites (echinococcus).
7. Tubes. Note length, thickness, shape, character of peritoneum, patency, fimbriated extremities (swelling, redness, exudate, tubercles, hæmorrhage), contents, color and thickness of mucous membrane, thickness and consistence of entire wall. Tubes should be straight, not tortuous; in inflammation they are usually twisted, tortuous or bent. Hæmatosalpinx is usually caused by a tubal gestation. The most common pathologic conditions are: salpingitis (usually gonorrhœal, acute, chronic, catarrhal, purulent, pyosalpinx, hydrosalpinx, interstitial, perisalpingitis, tubo-ovarian abscesses and cysts), tuberculosis, actinomycosis (rare), syphilis (very rare), hæmatoma (ectopic gestation relatively frequent), neoplasms (rare: adenomyoma, fibromyoma, fibroma, myosarcoma, sarcoma, carcinoma, chorio-epithelioma and teratoma; secondary carcinoma from uterus, ovary and intestine).
8. Ovaries. Note size, form, consistence, color, character of cut-surface, number of Graafian follicles, corpus luteum, etc. Ovary at puberty weighs about 10 grm., measures 4-5.2 cm. long, 2-2.7 cm. broad, 1.0-1.1 cm. thick. The adult ovary weighs about 7 grm., and measures 2-4 cm. long, 1.4-1.6 cm. broad, 0.7-0.9 cm. thick. A corpus luteum is 1.0-2.0 cm. in diameter. Ovary is compared to an almond in size and shape. In young individuals the surface is grayish-white and smooth; with age the surface becomes more and more irregular, the organ smaller and its consistence firmer. The cut-surface in young individuals is normally very moist (this should not be regarded as œdema). The most important conditions are: inflammation (acute and chronic, hæmorrhagic, purulent, etc., oöphoritis, abscess), tuberculosis, cystic follicles, lutein-cysts, cystadenoma (multilocular, monolocular, surface papilloma, simplex, papillary), parovarian cysts, carcinoma, fibroma, sarcoma, dermoid cysts, teratomata, malignant teratomata, embryoma, parasites (echinococcus is very rare).
9. Uterine Ligaments, Vessels and Lymphatics. Peritoneum over the broad ligament should be moist-shining, delicate and transparent. Inflammatory processes are very common in the parametrium, particularly in puerperal cases. The peritoneum is cloudy, opaque, injected, or covered with fibrinous or purulent exudate. Great numbers of small cysts containing clear fluid are often found in the peritoneum of the broad ligament as the sequelæ of inflammation. Note contents of blood-vessels (thrombi, concretions, neoplasms), and character of walls. Parovarian cysts, myomata, adenomyomata (round ligament), secondary carcinoma, chronic inflammations, hæmatoma and tubercles are the most common pathologic conditions.