A Text-book of Diseases of Women

by Charles B. Penrose

If the disease persists in the external meatus or urethra, it must be treated by the local applications appropriate for urethritis.

Fig. 16.—Appearance of the external genitals in a woman with gonorrhea: G. m., gonorrheal macula situated at the base of a vaginal caruncle.

Inflammation of the Vulvo-vaginal Glands.—The vulvo-vaginal glands are two in number. They are about the size of a bean, and are situated deeply on the inner aspect of the labia majora, where they may be felt in thin women. The duct of the gland is about one inch in length, and opens immediately in front of the hymen, about the middle of the side of the ostium vaginæ. In cases of vulvitis the duct of the gland usually becomes inflamed, and the inflammation may extend to the gland, producing abscess of the vulvo-vaginal gland.

Inflammation of the duct and the gland may also occur independently of vulvitis, from direct septic or gonorrheal infection.

Suppuration of the duct may be demonstrated by pressing over the course of the duct, when a drop of pus will escape from the opening. In such cases the orifice of the duct is usually surrounded by a red areola, resembling a flea-bite, which has been called the gonorrheal macula ([Fig. 16]). This macula persists long after all other traces of inflammation about the vulva and vagina have disappeared, and after all frank suppuration in the duct has subsided. Its presence indicates at least the probability of previous gonorrheal infection.

When the duct of the gland alone is the seat of inflammation, it should be laid open with fine scissors or knife, and the tract thoroughly cauterized with the nitrate-of-silver stick, pure carbolic acid, or a solution of chloride of zinc (2 per cent.).

Suppuration of the vulvo-vaginal gland is accompanied by marked swelling and peripheral edema. The swelling may extend to the anus, and is of characteristic shape ([Fig. 17]). The pain is always severe. Fluctuation is first apparent on the inner surface of the labium majus. If the condition is not treated, one or more fistulous openings appear below the orifice of the duct, and the pus is discharged. The condition then becomes chronic. The fistulous openings persist. Acute inflammation disappears from the gland, leaving it in a condition of hypertrophic induration. A thin, milky or greenish, purulent fluid may be pressed out of the duct or the fistulous openings. Infection from this discharge may be communicated to man, or may ascend the genital tract, producing inflammation of the endometrium or of the Fallopian tubes.

Fig. 17.—Abscess of right vulvo-vaginal gland.