A Text-book of Diseases of Women

by Charles B. Penrose

In some cases in which the ovary is not itself grossly diseased it may be possible to avoid oöphorectomy, and to correct the displacement by attaching the ovary by suture to the upper margin of the broad ligament, or by shortening the infundibulo-pelvic ligament by suture. If the ovary has become adherent in Douglas’s pouch, the condition can be relieved only by operation—celiotomy, and usually oöphorectomy.

A variety of pessaries have been invented for the relief of ovarian prolapse. They are of but little, if any, use. In many cases the pressure of the pessary upon the ovary renders its employment impossible. No pessary will cure a simple prolapse of the ovary. The cases in which the pessary does good are those in which there is a primary uterine displacement.

INFLAMMATION OF THE OVARY; OÖPHORITIS OR OVARITIS.

Acute Oöphoritis.—In acute oöphoritis the inflammation may begin on the surface of the ovary (perioöphoritis) and extend inward, or it may begin in the ovary itself. When the disease is caused by extension of the inflammation from the tubes, it usually begins as a perioöphoritis. Both the follicular and interstitial portions of the ovary may be affected. When the inflammation is confined chiefly to the ovarian follicles, it is said to be parenchymatous; when the connective tissue is chiefly affected, it is called interstitial oöphoritis. In acute inflammations all portions of the ovary are usually involved at one time.

The changes are those that characterize inflammation of other glandular structures. The whole organ becomes swollen, hyperemic, and edematous. The liquor folliculi becomes turbid; the membrana granulosa becomes softened and disintegrated. The surface of the ovary may be covered with an inflammatory exudate. In severe septic cases the whole ovary may become destroyed, or one or more ovarian abscesses may be formed. In less severe cases the inflammation subsides before suppuration takes place, or goes on to chronic oöphoritis.

The usual cause of acute oöphoritis is extension of inflammation from the Fallopian tube.

Acute oöphoritis may also occur as the result of septic infection carried by the lymphatics of the uterus. The disease is not uncommon in puerperal sepsis. Here it often forms but a minor part of a general fatal infection.

Gonorrhea may cause oöphoritis in a similar way.

Acute suppression of menstruation is said to result in inflammation of the ovaries.

Acute rheumatism and the eruptive fevers may produce oöphoritis. The disease of the ovaries is often overlooked during the acute attack, while the attention of the physician is engaged by the general affection. These diseases, occurring in childhood, are the probable causes of some of the damaged and chronically inflamed ovaries with which women suffer in later life. To these diseases also are to be attributed many cases of arrested development of the sexual apparatus, the phenomena of which appear only after menstruation has begun. The ovarian disease in these cases may be very insidious. Decided microscopic changes have been found in the ovarian follicles in scarlet fever, though to the naked eye the gland was unchanged.