The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    change in the vagina. Although there are exceptions, of which the scope of this paper will not permit the discussion, the general con- sensus of medical opinion is that the changes which occur in the vaffiua usually commence with those lesions of the outlet and con- tiguous tissues dependent upon parturition. A weakness in the base of support, the change of muscular action which causes a drawing upward and backward of the posterior vaginal wall, with an eversion of the vulvar outlet, produces a change in the axis of the vagina, bringing it and the uterus toward a common plane, and then the cervix, instead of being held at right angles, becomes a wedge in line with the vaginal outlet, separating its walls. This change in the position of the uterus causes the weight of the abdominal contents, deflected toward the pubis, no longer to fall upon the organ posteriorly, but vertically, and little by little, following the sacral curve in its descent, prolapsus, with varying degrees of retroversion, ensues. The injuries of the retro-vaginal pelvic fascia, occasionally occur- ring in delivery, have been somewhat recently deservedly emphasized by Freund, Emmet, Baldy, Hadra, and others. The latter author considers that many of the ill results following delivery are due to injuries of the vaginal fornix and the upper portion of the parturient canal, and are consequently often overlooked.1 “The impacted head, in its further progress, tears loose the upper portion of the anterior vaginal wall from the bladder and from the anterior surface of the cervix, turning it into a loose pouch which the bladder will have to follow on account of gravity.” This, he believes, is the more common cause of cystocele. Hadra has devised certain plastic operations (resections of the upper portion of the vaginal canal) to remedy these injuries. In a similar manner, the vagina posteriorly is caught in a fold and protrudes, as a ring, before the advancing head, and in the eversion thus produced it has been assumed, rather than demon- strated, that the posterior folds of the pelvic fascia are sundered, and that the result of the injury may be prolapse with rectocele and deep lateral sulci. Such injuries very probably occur and enter into the sum total of possible damage, but to differentiate and emphasize them as independent of the various muscles which it is 1 Hadra: The Medical Register, vol. i. p. (ill.