A Text-book of Diseases of Women

by Charles B. Penrose

Urethritis usually accompanies a gonorrheal vaginitis, and demands coincident treatment.

Tumors of the Vagina.—Vaginal Cysts.—Well-defined cysts are sometimes found in the vaginal walls. They occur at all ages from childhood to old age.

Vaginal cysts are usually single. They vary in size from that of a pea to that of a fetal head. The vaginal mucous membrane covers the free surface of the cyst, and may either be movable over it or may be much attenuated and closely incorporated with the cyst-wall. Vaginal cysts may be sessile or more or less pedunculated. The internal surface of the cyst is usually covered with cylindrical epithelium, which is sometimes ciliated. The contents vary in consistency and color. They are often viscid, transparent, and of a pale yellow tint. They may contain pus or altered blood.

The origin of vaginal cysts has been much disputed. It is probable that they arise from the remains of the Wolffian canal—the canal of Gärtner. In the embryo the transverse or longitudinal tubule of the parovarium extends to the side of the uterus and thence down the side of the vagina to the urethral orifice. It persists in this condition in some of the lower animals—the sow and the cow—and may also persist as a closed tube in woman. In such cases it may become distended and form the vaginal cyst.

The treatment of vaginal cyst is removal. If the tumor be situated near the vulva, it may be extirpated by careful dissection. If this operation be deemed impracticable, partial excision of the cyst should be practised. The tumor should be seized with a tenaculum, opened by the scissors, and part of the wall, with the overlying mucous membrane, should be excised. The interior of the cyst should then be packed with gauze.

Fibroid Tumors of the Vagina.—Fibroid tumors sometimes occur in the vagina. They are usually found in the upper part of the anterior wall. They are sometimes adherent to the urethra. They are usually of small size, but may attain a diameter of six inches. The treatment of such tumors is removal.

Cancer and sarcoma may attack the vagina, though these diseases as primary conditions are very rare. When possible, complete removal should be done.

Atresia of the Vagina.—Severe puerperal infection or mechanical injury, followed by extensive destruction of the tissues of the vagina, may result in a cicatricial narrowing or complete closure or atresia of the vaginal canal.

The symptoms of this condition are due to retention of the uterine discharges. There is no discharge of menstrual blood from the vagina. Attacks of pain occur periodically at the menstrual periods. A cystic tumor, which may be felt by rectal examination, is present. The tumor consists of the distended portion of the vaginal canal (hematocolpos), and sometimes of the distended cervical canal and body of the uterus. The contents of the hematocolpos are usually sterile, although they may become purulent (pyocolpos).

The diagnosis is readily made by vaginal and rectal examination.