THE EXTERNAL ORGANS AND VAGINA.
THE genital organs of the female, when closely studied and compared, will be found to bear a very strong resemblance to those of the male. And in addition to this particular similarity in the structure and functions of some of the parts of the female to those of the male, there will be seen to be a universal and essential correspondence of all the sexual organs of the one sex to those of the other. For as all the sexual organs of the male are structurally and physiologically adapted and intended for giving, so all the sexual organs of the female are, in like manner, structurally and physiologically adapted and designed for receiving. Thus they bear to each other the relation of the two halves which are requisite to constitute one complete physiological whole,-of two equally indispensable means for the accomplishment, physiologically, of the final end of reproduction. This distinction of structural difference and similarity, and of physiological correspondence, is the type of the adaptation of the man to the woman in the married state, the highest condition of human life. And this distinction should be steadily borne in mind, in all our study of the genital organs and reproductive system of the female.
These genital organs, which, as well in structure as in function, are much more complicated in the female than in the male, may be divided into external parts, or those without the pelvis; and internal organs or those situated within the pelvis. The former are the mons veneris, the perineum, and the vulva with its appendages. The latter are the vagina, the uterus, the Fallopian tubes, and the ovaries. And we will proceed to study their anatomy and physiology in the order in which they have just been named. And subsequently notice the principal disorders of the parts and organs described, and indicate the chief characteristic symptoms of the medicines to be employed in remedying these disorders.
THE MONS VENERIS.-The Mons veneris is situated at the lower margin of the abdomen, just on or above the centre of the symphysis pubis. Its diameter is about three inches; it is half an inch thick at its centre, and tapes off to a thin edge as its circumference. It is principally composed of dense cellular or adipose tissue, covered by thick elastic integument, and abundantly supplied with sebaceous follicles. The round ligament terminates in the cellular tissue. The hair which makes its appearance at puberty, as one of its characteristic signs, is said to diminish in quantity in many cases on the cessation of the menses. The growth of the hair varies remarkably in different individuals; and in some cases, where it is very white and scanty, it is supposed to indicate sterility. The excessive growth of the hair is sometimes accompanied by pruritus; and in those who are subject to the plica polonica, this disgusting disease attacks also the hair on the mons veneris, which, at the same time, becomes agglutinated, and attains an enormous length.
The perineum has already been partially described in connection with the muscles of the pelvis. It is composed externally of the common integument, beneath which we find, successively, adipose and cellular tissue, fascia, some portions of the constrictor vaginae, levator ani, transverse and sphincter muscles; and it contains also the superficial and transverse arteries, veins, nerves, and lymphatics. The perineum constitutes an important part of the floor of the pelvis; closing the outlet or inferior strait, so as to retain the pelvic viscera in their proper place. From the cellular nature of its structure, it admits of very great distension in labor, and its elasticity enables it speedily to resume its usual condition. When the last expulsive labor pains are very violent, the perineum, if not properly supported will sometimes undergo laceration.
THE VULVA AND ITS APPENDAGES.-The Vulva is the longitudinal opening between the projecting parts of the external organs of generation, which, situated immediately beneath the mons veneris, is bounded laterally by the labia majora and terminated posteriorly by the perineum. It constitutes the external opening common to the vagina and to the urinary bladder. A more particular description of the vulva will be involved in that of its appendages. These are the labia majora, the labia minora or nymphae, the clitoris, hymen, carunculae myrtiformes, fossa navicularis, fourchette, vestibule and urethra.
The Labia majora are the two folds externally of common integument, internally of mucous membrane, which, commencing on the anterior or superior commissure, immediately beneath the mons veneris, are combined downwards to the posterior commissure, called also the fourchette, Their texture consists of skin, usually soft and delicate, and furnished with sebaceous glands and hair follicles; adipose and areolar tissue; capillary arteries mostly derived from the superficial pudic branches; corresponding veins; lymphatics which discharge into the inguinal glands; nerves from the lumbar plexus; muscular or fibrous tissue, which is a continuation of the superficial fascia of the perineum; and mucous membrane, well supplied with muciparous glands. The sebaceous glands secrete an oleaginous fluid, which serves to moisten the hair which appears more or less abundantly upon the labia, and at the same time serves also to protect the labia themselves from being injured by the motion of the adjacent parts. In like manner the mucous follicles provide abundantly their peculiar secretion,- stimulated and increased by walking, which serves to guard these delicate surfaces,-which are not only in opposition, but in more or less constant movement upon each other,-from the irritating effects of friction, and from subsequent adhesions. The muscular fibres, arising from the pubis above, and being inserted in the perineum below, appear to act as constrictors of the labia through which they pass.
The areolar tissue, or cellular structure of the labia majora, is more loose and spongy than that in other parts of the body. Thus the labia frequently become subject to infiltration of serous fluid, by which they may be enormously tumefied. This may occur in general anasarca. And it is not a uncommon attendant upon that form of dropsy which so often from pressure of the gravid uterus on the lymphatic vessels,-especially in those constitutionally pre-disposed to hydropic effusions,- or in cases where the pelvis is so unnaturally large as to allow the gravid uterus to sink down into its cavity, even in advanced stages of pregnancy.
The Labia minora or Nymphae, are two lateral folds of mucous membrane, interior and parallel to the labia majora, by which they are mostly covered. In appearance they are said to resemble the comb of a young cock, and they extend from the middle opening of the vagina to the clitoris. At this point they divide; the inferior portion uniting with the clitoris; the superior portion rising above it and joining with the corresponding portion from the opposite side, forms a minute fold, called the prepuce of the clitoris. The labia minora contain between their mucous coats a spongy, vascular tissue and nerves. Their use appears to be to enfold and protect the clitoris, meatus urinarius and superior part of the vaginal orifice.
The Clitoris arises from the union beneath the pubic arch, of two cavernous bodies, which spring from the ischio-pubic rami; and its free extremity appears at the superior part of the vulva, a little beneath the anterior commissure of the labia majora. In its internal structure and erectile nature it resembles the copra cavernosa of the male penis, to which organ it corresponds in sensational and passional function. At its anterior extremity, almost entirely covered and concealed by the prepuce, appears a minute gland which is analogous in texture and use to the glans penis. The clitoris is supplied with blood from the internal pubic-arteries; and with nerves from the internal pudic nerves. Like the male penis, the clitoris has a suspensory ligament and an erector muscle. And as in the case of the penis, the urethra passes between the two cavernous branches; but the orifice of the urethra is situated beneath the glans clitoris,- instead of the urethra passing through it, as through the corresponding glans penis in the male.
The Vestibule is the small triangular depression, situated at the upper part of the vulva, bounded above by the clitoris, laterally by the labia minora and beneath by the meatus urinarius, to which, as well as to the vagina, it directly leads.
The Urethra. The meatus urinarius, or orifice of the urethra, is situated immediately below the vestibule and just above the orifice of the vagina. The determination by touch alone of the exact location of the orifice, is important as enabling the physician to introduce the catheter in the most delicate manner, where this operation is required. At the superior margin of the vagina is found a prominent enlargement or tubercle, which may readily serve as a guide in this case. The patient being placed upon her back, the point of the fore-finger of the left hand, with its palmar surface looking upward, should be placed just within the vagina; then slide the catheter along the palmar surface of the finger until it reaches this tubercle of the upper margin of the orifice of the vagina; when by depressing the handle of the instrument it may easily be made to pass over this elevation at which it had been arrested and so glide into the urethra. In this manner, without exposing or uncovering the patient, the catheter can usually be introduced; unless the external parts are very much swollen.
