A Text-book of Diseases of Women

by Charles B. Penrose

If the finger be introduced into the vagina and be pressed backward and outward in either vaginal sulcus, resisting structures are felt. There seems to be a band, perhaps half an inch in breadth, immediately within the ostium vaginæ, that holds forward the perineum and the posterior vaginal wall and resists the pressure of the finger.

Compare these characteristic features of the uninjured perineum with what we observe in a woman in whom there has been an untreated laceration of the perineum in the vaginal sulci. Here the supporting structures of the perineum have been destroyed.

Fig. 44.—Diagram showing the sling of muscle and fascia supporting the perineum and the posterior vaginal wall. In A the parts are intact; in B there has been a laceration in the left vaginal sulcus; in C there has been a laceration in both sulci; a suture has been introduced on the right side.

The anal cleft is shallow. The anus is prominent; the surrounding structures present the appearance of relaxation. The perineum is deep; the distance from the anus to the external meatus is longer; the anus has really dropped back. The skin-surface of the perineum is flat and relaxed.

If the labia are separated, the anterior and posterior vaginal walls will not be found in close apposition. The ostium vaginæ is patulous and gaps open ([Fig. 45]). If the woman is made to bear down, the anterior and posterior vaginal walls are not pushed together; they are rolled out and protrude through the ostium vaginæ.

If the vulva is pricked with a needle, the woman draws herself away; there is no reflex muscular action, closing the vagina and drawing up the anus. The muscles of the perineum have been destroyed.

If the finger is introduced in the vagina and pressed backward and outward in either vaginal sulcus, the tissues are yielding and soft; no supporting sling of muscle and fascia is felt.

These phenomena have an unmistakable meaning, and indicate clearly the loss of the supporting structures of the pelvic floor.

The student should acquire familiarity with these tests by repeated experiments on injured and uninjured women. It will easily be understood that the same phenomena characterize the fourth form of injury to the perineum—the subcutaneous laceration.