A Text-book of Diseases of Women

by Charles B. Penrose

In chronic urethritis the subjective symptoms are usually absent—except, perhaps, frequency of urination. The diagnosis is made by physical examination. If the woman has not urinated for several hours, the examiner will be able to express, by vaginal pressure along the course of the urethra, a drop of muco-purulent fluid resembling the gleety discharge of the male.

The endoscope reveals the presence of congestion and inflammation of the mucous membrane.

Treatment.—In the acute or the painful stage of the disease no local applications should be made. The external genitals should be bathed several times a day with hot water, preferably by means of sitz-baths. Vaginal douches are not indicated unless the vagina be involved in the inflammation. The vaginal syringe may be the means of carrying infection higher up in the genital tract. Rest in the recumbent position, if possible, is desirable. The diet should be non-stimulating, and large quantities of diluent drinks, such as flaxseed tea, should be prescribed. The bowels should be kept loose by saline purgatives.

In the subacute or the chronic stages of the disease boracic acid (gr. x-xx three or four times a day), salol, oil of sandal-wood, cubebs, copaiba, and other drugs used for the similar condition in the male are indicated. After painful micturition has ceased, the physician may make local applications to the urethra, in case the inflammation does not subside satisfactorily without them. Such local applications are not always necessary, and they may do harm unless proper care is exercised in their administration. Asepsis and gentleness are necessary, and the applications should never be too strong or irritating.

Frequent douching of the urethra (two or three times a day if possible) with sterile hot water is often of much benefit. Skene’s reflux catheter should be used ([Fig. 188]). The shaft of this instrument is fluted or grooved to permit the return of the fluid. The catheter should be introduced as far as the internal meatus; a fountain syringe should be attached to it, and the urethra should be washed out with a quart of hot water.

After the irrigation the catheter should be withdrawn and a urethral injection of nitrate of silver (gr. j or ij to ℥j) should be administered. The injection may be given by means of a glass pipette the nozzle of which is large enough to encircle the external meatus. The nozzle should be placed over, not in, the meatus. The female urethra will hold about 15 minims of fluid; more than this should not be injected. As the condition improves the frequency of these treatments may be diminished.

Fig. 188.—Skene’s reflux catheter.

If the condition does not yield to such treatment within a few weeks, application should be made directly to the mucous membrane of the urethra through the endoscope. The urethral canal should be washed out as just described, and the endoscope should be introduced as far as the internal meatus. As it is slowly withdrawn the application should be made over the whole inner surface of the urethra by a fine applicator wrapped with cotton. Nitrate of silver (gr. v-x to ℥j) should be employed.

Sometimes it is found that the suppuration persists in Skene’s glands. A small drop of pus may be found exuding from the orifice of the gland after the rest of the urethra has been restored to a healthy condition. In such a case the gland should be split up on the urethral surface by introducing into it one blade of a fine scissors, and the tract should be carefully wiped out with pure carbolic acid or a strong solution of nitrate of silver.