A Text-book of Diseases of Women

by Charles B. Penrose

The pain is increased at the menstrual period. It is most intense immediately before and at the beginning of the flow. If the bleeding is profuse, the pain is often relieved.

Menorrhagia often accompanies chronic oöphoritis, and seems to occur chiefly with the cystic variety of the disease. As most cases of oöphoritis are accompanied by endometritis and salpingitis, it is difficult to determine how important a part in the production of the menorrhagia is played by the ovarian disease. Reflex pain in the region of one or both breasts, usually the left, is often complained of.

The reflex disturbances caused by chronic oöphoritis form a very important part of the woman’s suffering. Loss of appetite, digestive disturbances, nausea, and vomiting occur. Hysteria, profound mental depression, and various cerebral derangements take place. Sterility may be caused by chronic oöphoritis if the ovarian capsule becomes so thickened that rupture of ovarian follicles cannot take place.

Bimanual examination should be performed with great gentleness. The condition of the ovary may be most satisfactorily determined in those cases in which the ovarian lesion is the chief trouble and in which the tubes and other pelvic structures are not coincidently inflamed. If the ovary is felt, it is found to be very tender and usually enlarged. In cases of long-standing interstitial inflammation the ovary may be below the usual size. Palpation is very easy if the ovary is prolapsed in Douglas’s pouch.

Chronic oöphoritis rarely recovers spontaneously. The woman may have periods of relief, but the symptoms may all recur after some indiscretion or unusual exercise. Suffering usually diminishes, and may in time cease, after the menopause, when atrophy takes place and menstrual congestions have stopped.

Treatment.—Chronic oöphoritis usually requires operative treatment (salpingo-oöphorectomy), because it is associated with disease of the tubes. In other cases a great deal may be accomplished without operation, and the woman may be tided over the period of menstrual life until permanent relief is secured at the menopause.

This palliative treatment is usually applicable, however, only to those women who are not dependent for a living upon their own labor. It is best to begin the treatment by putting the woman to bed for one or two months; to administer daily massage; to maintain mild purgation with saline purgatives; to make, once a week, applications of Churchill’s tincture of iodine to the vaginal vault, followed by the glycerin tampon; and to give hot-water vaginal injections twice a day.

If there is any disease of the uterus, such as laceration of the cervix or endometritis, this should be treated first.

After the woman leaves her bed the douches, saline laxatives, and vaginal applications should be continued. Absolute rest in the recumbent posture should be prescribed at the menstrual periods, and at other times if the ovarian pain becomes severe. Coitus should be forbidden during the treatment. If the woman is unable to begin the treatment by prolonged rest, the subsequent part of the treatment advised here may be followed.

This treatment always does good for a time. Unfortunately, its results are not often permanent. The old pain and suffering return as soon as the woman ceases to be under medical care. If the inflammatory changes have become well established, no permanent good results from any medical treatment. This is especially true in those cases in which the original causative state of things continues after treatment is given up. If the cirrhotic ovaries are the result of celibacy, medicine can be but palliative.