A Text-book of Diseases of Women

by Charles B. Penrose

The disease sometimes involves only the lower portion of the vagina, and is most severe on the posterior wall. In other cases it is limited to the posterior vaginal fornix, where it has a tendency to become localized and to persist. In the very early stage the mucous membrane is dry and red. It later becomes covered with a purulent or muco-purulent secretion of a milky color.

If the disease is extensive, severe symptoms may be present. The woman will suffer with burning pain in the pelvis, the pain being increased by any movement.

Acute inflammation of the vagina is usually of gonorrheal origin. A thorough examination of the condition can be made only by placing the woman in the knee-chest position and by exposing the vagina by retracting the perineum with the Sims speculum. The whole vaginal tube, especially the posterior wall near the ostium and the fornices, should be carefully inspected.

Gonorrhea of the vulva may arise primarily, or it may be caused by infection from discharge from the vagina or the cervix. Like gonorrhea of the vagina, it is rare in the adult woman. It is usually seen in girls or in young women. Its occurrence in children has already been referred to.

The disease may extend to the small glands of the vestibule and the fourchette and to Bartholini’s glands; in these situations it may lurk for many years, forming a source of infection to men and a great element of danger to the woman. Suppuration of the glands of the vestibule may result in small urethral fistulæ.

In making an examination of the external genitals the parts should always be thoroughly exposed and the physician should attempt to express the fluid from the orifices of the glands. Microscopic examination of the discharge should be made.

Inflammation of any of the glands of the external genitals is usually the result of gonorrhea.

When the physician examines a woman suspected of gonorrhea, she should not prepare herself beforehand by vaginal douches and washing the external genitals. The urine should not have been voided for some time. Prostitutes, fearing that gonorrhea will be discovered, often remove all discharges as much as possible before they submit to examination. Other women do the same from motives of cleanliness. As the diagnosis depends upon observation of the origin and character of the discharges, such preparation should be avoided.

As has already been said, it may be advisable in doubtful cases to make the examination immediately after a menstrual period, when the discharges are more profuse and perhaps more virulent than at other times. The examiner should always proceed methodically, and should inspect every portion of the external genitals, the vagina, and the cervix. The vestibule, the external meatus, the urethra, the fourchette, the glands of Bartholini, the vaginal walls, the external os, and the cervical canal should in turn be examined. Discharges obtained from these structures should be saved and submitted to microscopic examination.

Though the gonococcus is by no means always found in cases the specific character of which is proved by infection of the man, yet it would escape observation much less often if such thorough examination were made.