Fig. [67].—Lipoma of the right labium majus, occluding the vaginal inlet.
Hypertrophy of the nymphæ, which, as the so-called Hottentot Apron has to be regarded as a racial peculiarity, is known also in Europe as a pathological condition which may at times constitute a hindrance to sexual intercourse (Fig. [68]). According to Otto there are three fundamental forms of the Hottentot apron, viz., excessive enlargement of the nymphæ, overgrowth of the labia majora, and, lastly, the formation of a peculiar lobe of flesh and skin, attached to the mons veneris by a pedicle, containing the clitoris, and covering the genital fissure as with a valve. Hypertrophy of the nymphæ is said to be common also in Turkish and in Persian women. Owing to the obstacle to intercourse presented by hypertrophied nymphæ, it is among certain races an established custom to amputate clitoris and nymphæ together. Virey writes: “The Portuguese Jesuit missionaries to Abyssinia in the sixteenth century, endeavoured to abolish this practice of the circumcision of women, which they regarded as a relic of Mohammedanism; the uncircumcised maidens, however, could find no husbands, owing to the inconvenient length of their nymphæ. The pope sent surgeons to the country, to enquire into the matter, and their reports were in such sense that circumcision was permitted as necessary.” Davis reports observations made by Sonini on the female indigens of lower Egypt, in whom the vulva hangs down in the form of a loose, flabby mass of flesh, of striking length and thickness, completely covering the genital fissure. He believes that the circumcision that was practised on the women of ancient Egypt consisted in the removal of this hypertrophied vulva.
Fig. [68].—“Hottentot apron” in an adult woman, hanging down between the thighs. (After Zweifel.)
Courty saw a case in which the remarkable length of the labia minora, which when an attempt was made to introduce the penis, covered the vaginal orifice, had rendered coitus ineffective, and had caused sterility for five years. Resection of the labia minora was followed by successful intercourse and conception.
The lipomatous form, especially, of elephantiasis vulvae often attains a gigantic size. Growths of this nature, of the size of a child’s head, weighing six or seven kilo (thirteen to fifteen pounds), and reaching down to below the knee, are by no means rare. I have known several cases in which an excessive accumulation of fat in the vulva associated with pendulous belly has constituted a mechanical obstacle to the completion of sexual intercourse.
Fig. [69].—Elephantiasis of the labia majora
Hypertrophy of the clitoris may constitute an obstacle to coitus. In exceptional cases, this organ is as large as the male penis, and hangs down over the genital fissure like a valve. Hyrtl relates that in certain African races, this congenital enlargement of the clitoris is so enormous, that the organ, made fast to the perineum with rings, serves for the protection of virginity. Schönfeld describes the case of a woman aged twenty-eight years, in whom the vaginal orifice was almost completely occluded by a dry and firm growth, with a granulated surface. Close observation proved this growth to be produced by a hypertrophied and degenerated clitoris, which had attained the size of a child’s head. Elephantiasis of the clitoris is especially inconvenient in consequence of the hindrance which the enlarged organ offers to sexual intercourse. Bainbridge describes a case of tumour of the clitoris measuring 8 cm. (3.2 in.) in length and 5 cm. (2 in.) in width. The following remarkable case is recorded by Oesterlen: A young man wished to break off his engagement on the ground that his intended wife was a hermaphrodite. Examination, however, disclosed the existence of a strong intact hymen, a very large clitoris, and pregnancy of the twentieth week.