A Text-book of Diseases of Women

by Charles B. Penrose

Sterility is a not unusual accompaniment of laceration of the cervix. It may be due to the malposition of the external os or to the profuse cervical discharges. In case conception occurs, abortion may follow on account of the pathological condition of the body of the uterus and of the endometrium.

Sometimes very marked reflex nervous disturbances are caused by a laceration of the cervix. Such disturbances are most pronounced in those cases in which there is much cicatricial tissue, and in those in which the cervix is hard and sclerotic or cystic as a result of long-standing inflammation—in other words, in those cases in which the substance of the cervix is most affected.

Neuralgia may occur in any part of the body. It is usually situated in the pelvis, or it may extend to the groin and down the thigh. Reflex nausea and vomiting may result from this as from other lesions of the uterus. Cataleptic convulsions and neurasthenia may also result from an old laceration of the cervix. The pelvic focus of irritation is constantly wearing and exhausting nervous energy.

Diagnosis.—The diagnosis of laceration of the cervix is readily made by digital examination. The palpating finger feels the one or more angles of laceration. The cervix loses its normal dome-like shape and becomes broader and flatter. In those cases of bilateral laceration where the eversion of the lips of the cervix is so marked that the angles of laceration are obliterated—becoming, in fact, 180 degrees—or where the angles have become filled up by a plug of cicatricial tissue, the angles of the laceration, of course, cannot be felt. We may often, however, detect the presence of the plug of cicatricial tissue, which feels harder than the surrounding tissues of the cervix; and we can always determine the presence of the eversion which seems to have obscured the lesion. As the finger is passed over the flattened presenting cervix it is found that the shape is not round, but oval, with the long axis antero-posterior. The finger passes around a corner or edge as it glides into the anterior or posterior vaginal fornix. This corner or edge is the extremity of the torn everted lip of the cervix. It corresponds approximately with the margin of the normal external os. The apparent external os, or the opening of the cervical canal, which occupies the center of the presenting cervix, is really a part of the cervical canal higher up than the normal os—a part of the canal that has been exposed by the laceration and separation of the lips. This fact should be remembered when the length of the uterus is measured by the sound. The measurement taken from the apparent external os is often half an inch, or even one inch, less than it would be if the cervix were restored. The degree of subinvolution of the uterus indicated by the measurement of the length is often, therefore, considerably greater than would be supposed after such imperfect measurement.

The presence of an erosion on the face of the cervix may also be determined by palpation. The eroded surface has a soft and somewhat velvety feeling, in contrast with the smooth surface of the normal vaginal cervix covered with squamous epithelium.

The cystic degeneration is readily detected by feeling the small shot-like cysts that cover the cervix; and the sclerotic condition is indicated by the increased hardness or induration, which is easily perceptible to the finger.

The most satisfactory visual examination of a lacerated cervix is made through the Sims speculum, with the woman in the Sims or the genu-pectoral position. The bivalve speculum, by separating the upper vaginal walls, often increases the eversion of the lips and masks the lesion.

The nature of the injury in cases of bilateral laceration with eversion may readily be proved in examining through the Sims speculum. If the anterior and posterior lips of the cervix be seized with tenacula and then drawn together, it will be observed that the area of erosion disappears and the normal shape of the cervix is approximately restored.

Treatment.—All forms of laceration of the cervix in which there exist eversion, erosion, cystic degeneration, and sclerosis should be operated upon. A slight laceration in a young woman in the active childbearing period does not demand operative treatment if there are no symptoms referable to the laceration. In women approaching middle life (forty years of age) all lacerations of the cervix should be closed, whether or not they produce symptoms.

It should always be remembered that cancer is most likely to originate in a cervix that has been lacerated, and the woman should be protected against this danger.