A Text-book of Diseases of Women

by Charles B. Penrose

In every case of urethritis of gonorrheal origin it is of the greatest importance that every trace of the disease should be eradicated before the patient gives up treatment. There is always danger of infection extending to the upper parts of the genital tract.

Stricture of the Urethra.—Stricture of the urethra in the woman, unlike the similar condition in the male, is very rare. It is caused by gonorrhea, injury at childbirth or other traumatism, and caustic applications. The stricture may exist at any part of the urethral canal. The form most usually seen is that which occurs at the external meatus, and is caused by the removal of abnormal growths with caustic or with the knife.

The symptoms of urethral stricture in women are much less marked than those in men. There is frequent and difficult urination. Occasionally there is incontinence or partial retention of urine.

If the stricture exist at the external meatus, it may be readily seen and its dimensions determined. If it exist in the upper portion of the urethral canal, it may sometimes be felt by palpation along the course of the urethra through the vagina, the position of the stricture being indicated by local thickening and induration. Its location may also be determined, as in man, by the use of the bulbous bougie or sound.

Treatment.—When the stricture is situated at the external meatus, it may be divided with the knife or forcibly stretched. When it is situated in the upper portion of the urethra, it is best treated by forcible dilatation.

Fig. 189.—Female urethral sound.

The small uterine dilator is the most convenient instrument to use. The dilatation should not extend beyond half an inch, for fear of injuring the urethral walls or producing incontinence. In order to prevent contraction, it is advisable to pass the large urethral sound (10 millimeters) at intervals of one or two days after this operation, until the patency of the urethra is ensured.

In some cases the continual subsequent use of the sound is necessary, as in stricture in the male. The woman may be readily taught the use of the instrument herself.

Prolapse of the Mucous Membrane of the Urethra.—Prolapse of the urethral mucous membrane is of unusual occurrence. Prolapse may be limited to part of the circumference of the meatus, or it may extend around the whole canal. The condition is usually found in weak, debilitated women. It may occur during childhood.