A Text-book of Diseases of Women

by Charles B. Penrose

The cervical glands share in this condition of subinvolution, retaining much of the increased size and activity that are normal in the pregnant state.

Changes due to chronic congestion and inflammation also take place. The connective tissue increases in amount, and the cervix becomes hard, indurated, or sclerotic.

The racemose glands, which open upon the cervical mucous membrane, become inflamed, and, as a result of change in the consistency of the glandular secretion or of obstruction of the gland-orifices, retention takes place, with the production of small cysts called Nabothian cysts. Such cysts often extend peripherally, so that the distal end of the occluded gland approaches the vaginal aspect of the cervix, and appears beneath the mucous membrane as a translucent vesicle about the size of a small pea. Puncture of such a vesicle permits the escape of a drop of gelatinous fluid.

The whole of the body of the cervix may be filled with innumerable cysts of this kind, of varying size. When projecting beneath the mucous membrane they feel like small shot imbedded in the cervix. A cervix in this condition is said to have undergone cystic degeneration. The inflammation of the lower exposed portion of the mucous membrane of the cervical canal extends upward, so that a condition of general chronic cervical catarrh results. This exceedingly common disease is usually caused by laceration of the cervix.

The focus of continuous irritation in the cervix interferes with the normal involution of the body of the uterus, so that there occurs a condition of uterine subinvolution, which may be the cause of the chief symptoms with which the woman suffers. The endometrium shares in the subinvolution, and, as a consequence of this, and perhaps also from extension of inflammation from the cervical mucous membrane, various forms of endometritis may occur.

In some cases of laceration of the cervix no groove corresponding to the angle of the laceration can be felt or seen, because it has been filled with a plug or mass of cicatricial tissue. In such cases this plug of scar-tissue may be felt, distinguished by the palpating finger from the softer surrounding tissues of the cervix.

Symptoms.—The symptoms of laceration of the cervix uteri are usually referable to pathological conditions that are secondary to the laceration, and are in no way characteristic. Leucorrhea, or a discharge from the exposed and inflamed cervical mucous membrane, is usually present. Menstruation is often irregular, and is increased in duration and amount as a result of the subinvolution of the uterus and the chronic congestion, and perhaps inflammation, of the endometrium. Backache and vertical headache may also be present from the same cause.

If the tear is at all extensive—and especially if it extends through the cervix into the cellular tissue of the broad ligament—pelvic pain, referred to the general position of the scar, may be experienced.

Movement of the cervix or of the uterus that causes traction upon the scar in the broad ligament produces pain. Such pain may result from the bimanual examination, from jarring or movements of the body, from defecation, or from coitus.

Much of the pelvic pain with which women suffer in laceration of the cervix is probably due to the pelvic lymphangitis and lymphadenitis that are caused by the continuous irritation of the diseased cervix.