The urethra itself is larger than its orifice; and may be described as a membranous canal, about an inch and a half in length; slightly curved with its concavity looking upward; passing obliquely upwards and backwards beneath the symphysis pubis, to which it is attached by loose cellular tissue. More interiorly it passes between the crura of the clitoris and just beneath their junction. It is susceptible of very great dilatation and opens interiorly into the urinary bladder. It is composed of three tunics; a muscular coat continuous with that of the bladder, and composed of circular fibres; a thin layer of erectile tissue intermixed with numerous elastic fibres; and a mucous coat, which is continuous externally with the vulva and internally with that of the bladder. It is surrounded also by the muscular fibres of the compressor urethrae, which assist in controlling the flow of the urine. In the various displacements of the uterus, the urethra, by reason of its structural connection with the vagina, is liable to be changed from its natural direction. And this should be especially borne in mind, if called upon to perform catheterism to relieve retention of urine caused by such uterine displacements.
The Hymen. Immediately below the meatus urinarius is found the much larger and irregularly shaped opening which constitutes the orifice of the vagina. The extent of this opening varies greatly according to the sexual condition of the female. In those who are virgins and in some exceptional cases in persons who are not, the orifice of the vagina is very small, oval or crescent-shaped as represented in Fig. 9 and 10.
The hymen is the delicate membranous structure, which covers the greatest portion of the orifice of the vagina,-and which is usually ruptured at the first successful attempt at sexual intercourse. The rupture of this structure ordinarily occasions a slight flow of blood, and sometimes leads to no inconsiderable haemorrhage. The minute reddish tubercles found near the orifice of the vagina, and called carunculae myrtiformes, are regarded as the remains of the ruptured hymen. Sometimes this membrane instead of being thin and easily broken, is dense and firm, requiring to be opened with an instrument, before the marriage rites can be consummated. In other instances the hymen is found entirely imperforate in childhood. And in these cases, unless attention has previously been directed to the difficulty, it is requisite to make an incision in order to allow the exit of the menstrual discharge. Cases of supposed actual tumor of the vagina, have thus been found to consist in the accumulation of the menses; a process which may have gone on for months.
The FOLLICULAR AND GLANDULAR ORGANS of the external parts require more particular attention; with especial reference to the figures in which their situation is represented. They may be divided into two distinct classes; the first consisting of follicles of various kinds; the second including the true, conglomerate, vulvo-vaginal glands.
Fig. 11.
The sebaceous follicles are more numerous than the rest. They appear on the mons veneris, and above the clitoris, on the labia majora and labia minora,-and upon the adjacent integuments. They serve to secrete an unctuous substance, thinner than that from other sebaceous follicles, which shields the delicate organs from cold, keeps them moist and supple, and prevents them from being injured by the perspiration, urine, or vaginal or uterine secretions.
The piliferous or hair follicles nourish and support the hair, which appears more or less abundantly upon the mons veneris and labia majora. As already mentioned, these follicles may become the seat of the exceedingly distressing and annoying affection called pruritus.
The muciparous organs are situated upon different points of the external parts and orifices; and are divided into isolated or augmented follicles, and the vulvo-vaginal glands.
The isolated or augmented follicles, appear at several different points about the vagina, and are variously named according to their situation. The vestibular follicles, some six or eight in number, are found in the vestibule. (Fig. 11 A.) These are very minute; and their small and rounded openings are so oblique to the plane of the mucous membrane, as to give them the appearance of being covered by a thin valve.
The urethra follicles are situated in the cellulo-vascular tissue of the urethra. They are placed beneath the mucous membrane in a line parallel to the canal of the urethra; and discharge upon the inner margin of its orifice. (Fig. 11 B.) Their function is evidently to prevent the orifice of the urethra from becoming dry; and from being irritated by the streams of hot urine which pass over it.
The lateral urethral follicles appear on either side and at some little distance from the orifice of the urethra. They have a common opening at the mouth of a peculiar conical depression. They are not always to be found; and are small and shallow. (Fig. 11 C.)
The lateral follicles of the orifice of the vagina, (Fig. 11 D E ), three or four in number and comparatively large, are found usually upon the lateral parts of the vaginal orifice immediately below the hymen, or carunculae myrtiformes. They are irregular in their number, situation and arrangement; and are not to be found in all females.
A.A. Section of the labia majora and of the nymphae, showing the excretory duct and its orifice. B. The gland. C. Excretory duct. C. Stylet engaged in the orifice of the excretory duct. D. Its glandular extremity. E. Its vulvar extremity and orifice. F. Bulb of the vagina. G. Ascending ramus of the ischium.
The vulvo-vaginal glands, one on each side, are true conglomerate glands, having a bulbous body and an excretory duct. This gland is situated at about the lower third of the orifice of the vagina just inside its lateral margin. Its bulb (D) and excretory duct (C), in size and exact position, are excellently well represented in Fig. 12. This gland is very small, acquiring its full development only at puberty; is often unequal in size on the two sides; but sympathizes very much with the ovary, being larger on that side in which the ovary may be more voluminous. Its diameter, when largest, is from four to five-eighths of an inch. Its secretion is intended principally to lubricate the parts during the sexual intercourse; and it is especially active at such times, and under the influence of lascivious emotions During coition the muscles of the perineum and vulva are excited, and the secretion of this gland is discharged in jets, like those of the semen in the male. There is a coincidence of action between these vulvo-vaginal glands and the other muciparous follicles; and the secretion which so abundantly supplies the vulva and vagina, especially during sexual intercourse, is the joint production of both glands and follicles.
