A Text-book of Diseases of Women

by Charles B. Penrose

Treatment consists in incision and excision of the vaginal septum and the suture of the vaginal mucous membrane above to that below the obstruction. In very severe cases it is difficult to maintain the patulous condition of the vaginal canal on account of subsequent cicatricial contraction. In such cases the repeated passage of vaginal bougies or the transplantation of mucous membrane has been resorted to.

Vaginismus.—The term “vaginismus” has been applied to a condition characterized by a spasmodic contraction of the muscles which close the vaginal orifice. The muscular spasm occurs reflexly when penetration of the vagina is attempted, as at coitus or a digital examination. The condition is due to dread of pain, and is usually the result of some painful local lesion, such as a urethral caruncle, fissures or sores of the vulva or anus, etc.; or it may be due to some painful condition of the tubes and ovaries. Similar contraction is observed in the sphincters of the anus when there is present a painful anal lesion.

Vaginismus has been said to occur in neurotic and hysteric women in whom there was no discoverable local lesion.

Treatment consists in the removal of any local cause of pain or irritation.

If the reflex spasm of the muscles persists when coitus is attempted, notwithstanding the removal or the absence of any discoverable local cause, operative measures have been advised.

Under anesthesia the vaginal entrance has been stretched by means of large dilators or the fingers, or the fibers of the sphincter vaginæ have been cut on each side of the fourchette and a glass or vulcanite tube of suitable size has then been placed in the vagina and retained for two or three weeks by a perineal pad and T-bandage.

Vaginismus is a very rare condition. Operative treatment, except that which may be required for the removal of some local cause of irritation, is rarely, if ever, necessary.

Coccygodynia.—Coccygodynia is a rare affection characterized by pain in the coccyx and surrounding structures. The pain is caused by pressure, as in sitting, or by any movement involving the muscles attached to the coccyx. The disease is usually caused by traumatism, and in most cases is due to injuries to the coccyx in labor, as a result of which the bone is fractured or dislocated, and becomes fixed in an abnormal position. Sometimes osteitis or necrosis develops. In the unusual cases, in which no structural changes are detected, the condition may be due to rheumatism. Coccygodynia is very rarely found in men.

The diagnosis may be made by introducing the index finger in the rectum and palpating the anterior and lateral surfaces of the coccyx, and by moving the bone between the finger in the rectum and the thumb placed in the crease of the nates. The mobility, deformity, and tenderness may be readily determined. If a local lesion is found, and the symptoms have not yielded within a reasonable time to expectant treatment, removal of the coccyx by operation is indicated. The coccyx is exposed by a median incision, the bone is separated from its muscular and tendinous attachments, and is removed at the sacrococcygeal articulation with scalpel or scissors. If the articulation is ankylosed, it may be necessary to use the chain-saw. The wound is drained with a few strands of silkworm-gut and closed with interrupted sutures.

Operation should not be advised hastily. The painful symptoms are not always relieved by it. Operation should not be performed unless bony deformity or other distinct lesion is found.