Vaginal discharge

“ In many cases the discharge is of so acrid a character that it excoriates the vulva and surrounding parts. Walking, or even standing, is often painful, particularly the former, owing to the attrition of the inflamed or excoriated surfaces.
A physical examination causes pain, and if the inflammation has extended to the vulva, urethra, or the vulvo-vaginal glands, it will often produce intense suffering. When the vaginitis is acute, the labia are swollen, the vagina assumes a more or less intense red color in place of the light or pale rose-color of health ”

“ The patient usually breathes much more comfortably after this change in contour takes place, but, at the same time, she may have cramps in her legs as a result of the increased pressure; more difficulty in walking; frequent micturition and desire to empty her bowels, while the vaginal discharge may be considerably increased. It is at this time that the presenting part enters the superior strait and is spoken of as being “engaged.”
The time at which engagement takes place depends upon three factors: Whether the patient is a multipara or a primipara; the size and normality of the pelvis ”

“ Courty enumerates as prodromal symptoms which are observed in the majority of girls before the first appearance of menstruation: swelling and tenderness of the breasts, sensation of fulness and weight in the hypogastric region, moderate intestinal meteorism, sacrache, aqueo-mucous vaginal discharge, finally, an itching sensation in the genital organs. These manifestations may also assume a morbid character, taking the form of violent abdominal and lumbo-sacral pain, general fatigue and weakness, dyspepsia and diarrhœa, cephalalgia, various kinds of neuralgia, some degree of moral aberration. ”

“ The woman will suffer with burning pain in the pelvis, the pain being increased by any movement.
Acute inflammation of the vagina is usually of gonorrheal origin. A thorough examination of the condition can be made only by placing the woman in the knee-chest position and by exposing the vagina by retracting the perineum with the Sims speculum. The whole vaginal tube, especially the posterior wall near the ostium and the fornices, should be carefully inspected.
Gonorrhea of the vulva may arise primarily, or it may be caused by infection from discharge from the vagina or the cervix. ”

“ Symptoms. The external symptoms are those of acute vaginitis, with greyish, fœtid, purulent or sanguinolent discharge. On examination, the mucous membrane is found to be covered with yellowish, greyish false membranes, and with vegetations of a greyish, dirty, 546verrucous appearance. The entire extent of the vaginal mucous membrane may be attacked, together with the neck of the uterus. In Moussu’s case the uterus itself was entirely invaded.
These false membranes and vegetations are very adherent, and bleed freely at the slightest touch. They are apt to extend by degrees. ”

“ That abortions, even when criminally induced, may sometimes be safely borne by the system, is of little avail to disprove the evidence of numberless cases to the contrary. We have instanced death. Pelvic cellulitis, on the other hand, fistulæ, vesical, uterine, or between the organs alluded to; adhesions of the os or vagina, rendering liable subsequent rupture of the womb, during labor or from retained menses, or, in the latter case, discharge of the secretion through a Fallopian tube, and consequent peritonitis; diseases and degenerations, inflammatory or malignant, of both uterus and ovary ”

“ If she sleeps long, so much the better, so much more will she be benefited by the presence of the semen and its absorption. When she naturally wakens, she may bathe the vulva region with warm water; but there is no need of, nor is it wise to try to cleanse the vagina and the uterine tract by the use of a vaginal syringe. Above all, never inject cold water into the vagina, especially do not do this immediately after coitus. Some women use a cold water injection immediately after coitus. There is no surer way to ill health and ultimate suicide. ”

“ Certain occupations are especially potent in the causation of the diseases peculiar to women, principally, for the reason that they do not permit of the requisite repose during menstruation. Thus, washerwomen, vocalists, and sewing-machine operatives, suffer with especial frequency from diseases of the genital organs.
Great care in the cleansing of the genital organs is indispensable in the case of women; the vulva and its environment should be frequently and carefully washed; and an occasional vaginal injection is advantageous. ”

“ There is greater liability to irritation of the bladder and rectum, and the menstrual flow may be superseded by a white, acrid discharge, caused by an inflammation of the mucous membrane of the vagina. Even if the system be not enfeebled by excessive losses of blood, debility may result from a continued irritation of the uterine organs, and cause the morbid discharge. The nervous system sympathetically responds, becoming exceedingly irritable, and thus implicating in this derangement every bodily organ. ”

“ The vagina may also be partially occupied, and coitus may be impeded, by elongation of the hypertrophied cervix uteri, by inversion or prolapse of the uterus, by cystocele or rectocele, and by uterine polypi. Horwitz records the case of a woman aged twenty-two years in whom impotentia coeundi was dependent upon the occlusion of the vaginal orifice by a rounded, strongly projecting body, which proved on closer examination to be a hypertrophied vaginal bulb. ”

“ If attempts at coition are persevered in, the symptoms are further intensified, so that the spasm and violent contraction of the sphincter vaginal muscles induce agonizing pain. Besides having the characteristic pain, patients with this disorder are, as a rule, sterile. If a physical examination be made in a well-marked case of vaginismus, it frequently occurs that the slightest touch on the part of the physician about the site of the hymen will bring on painful contraction of the vagina and sphincters, and cause the patient to spring up and show much nervous disturbance. ”

“ It is very resistant to treatment, particularly in girls. The reason it is so resistant to treatment is because the [144] discharge, while coming from the vagina, does not usually originate in the vagina; it originates in the neck of the womb, and the hundreds and hundreds of injections that women take for their leucorrhea only reach the vagina; they cannot penetrate into the womb. And it is only by treating the cavity of the cervix, which can only be done by a physician, through a speculum, that the root of the trouble can be reached. ”

“ For recent researches have shown, on the one hand, that the vagina constitutes 280a natural mechanism for the destruction of pathogenic organisms, and on the other hand, that complete disinfection of the vagina is extremely difficult to effect. Inflammations of the vulva, which are somewhat frequent in consequence of excessive perspiration and undue discharge from the genital canal, demand careful cleansing with soap and water and the use of a soft brush. ”

“ It is said that healthy squaws have no flow of blood with menstruation, or after delivery. If there is no constitutional disturbance, there need be no anxiety about a scanty flow. If caused by a chill, fever or inflammation, etc., prompt attention will be required, according to accompanying symptoms.
Metrorrhagia, or profuse flow, often requires treatment before medical aid can be secured. Hot fomentations, hot sitz-bath and hot vaginal injections are the very best applications. Recently the medical profession recognize that heat is better than cold, to arrest hemorrhage. ”

“ With the recession of the head during the interval between pains a portion of the oil is carried upward into the vagina.
In the puerperal period the warm carbolized douche stimulates uterine retraction and promotes the rapid healing of wounds in the vaginal canal; in hospital practice it possesses the additional advantage of preventing the accumulation of putrid albuminoid matters in the air. In private practice the patient should employ a new syringe; in hospitals every woman should be supplied with a glass tube to be attached to the irrigator. ”

“ There is considerable excoriation around, and a swelling of the organs, much ardor urinæ, and the same constitutional disturbance as in the other sex.
The medical treatment of both sexes is constitutionally alike; but the female has to depend more upon local treatment than the male. Hence the importance of injections. Now here is another source of difficulty: women are as [152] averse to the use of the syringe as they are to the speculum; and the consequence is, vaginal diseases are generally protracted to double as long as they need be. ”

“ The affection is dependent upon trauma, sustained in maladroit, frequently repeated attempts at sexual intercourse; for this reason it is met with, in the great majority of cases in young, newly married women. Impotence in the male is by no means necessary for its production, and such impotence is not even a frequent antecedent. Abnormal narrowness of the vagina, or extreme firmness of the hymen, is occasionally found, but neither is in any way necessary; all that can be said in this connection of a small vaginal orifice is, that it predisposes to vaginismus. ”

“ Duplex vagina has been observed by Bartholinus, Malacarne, Asch, Meckel, Osiander, Purcell, and other older writers. In more modern times reports of this anomaly are quite frequent. Hunter reports a case of labor at the seventh month in a woman with a double vagina, and delivery through the rectum. Atthill and Watts speak of double vagina with single uterus.
Robb of Johns Hopkins Hospital reports a case of double vagina in a patient of twenty suffering from dyspareunia. The vaginal orifice was contracted; the urethra was dilated and had evidently been used for coitus. ”

“ Retention of the menses may result from malformation of the vaginal canal, which sometimes terminates before it reaches the womb, being simply a short, closed sac. If the uterus and ovaries are perfect, all the feminine characteristics are manifest, and a vaginal exploration discloses the nature of the difficulty. If, however, the sides of this passage adhere in consequence of previous inflammation, they may be carefully separated by a surgical operation, and this function restored. ”

“ Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue shortness of the vagina, unless great care is exercised by the husband, will induce painful coitus, and may bring about sterility by favoring the formation of a copulation sac outside of the axis of the uterine canal, and consequently misdirection of the semen.
Scrofula, probably by its effects on the general condition, leading to deficient development of the whole body, the genital organs included, may be productive of sterility. ”

“ The first reason, which need not be gone into in detail, is an esthetic one. The second reason is that intercourse during menstruation may in some cases lead to congestion of the uterus and ovaries. Third, the menstrual discharge, which as we know does not consist of pure blood but is a mixture of blood, mucus, and degenerated lining membrane of the uterus, may give rise to a catarrh of the urethra in the man. Fourth, and this is a point to be borne in mind, any discharge that a woman may be suffering from is always aggravated during menstruation. ”

“ The effect of these excesses on aged women is different, but not less serious. After the function of menstruation has at length entirely ceased, a remarkable change gradually develops in the organs of generation. The womb shrinks and hardens, the vagina loses its peculiar softness, and becomes harsh and dry — the vaginal secretions, in fact, are altered and abolished. Everything goes to prove the inaptness of these organs for the act of reproduction. Cancer of the womb or neighboring organs, so common in women of advanced age, is often the result of these unnatural connections. ”

“ Many women suffer from this complaint towards the close of menstruation, when the discharges are acrid and most irritating.
Promptly Cured.—This inflammation can be promptly cured by the frequent use of Lydia E. Pinkham's Sanative Wash. Prepare this strictly according to the directions on each package, and use it as a vaginal injection two or three times a day. The cure will be hastened by employing a sitz-bath (sitting in a tub of hot water, or in a bath-tub) . ”

“ Vaginismus dependent upon general neurasthenia especially in cases in which there is no strong affection for the husband to give the spur to desire, and to enable the woman to bear with fortitude the pangs which form the necessary introduction to the joys of wedded life. It must not be forgotten, as throwing light on the origin of vaginismus, that in the digital vaginal examination of a virgin or even of a young wife, unless extreme care is taken, pain and painful muscular spasms are liable to be evoked. ”

“ Uterine discharges which cause vaginitis are not generally irritating until they reach the vulva, where by exposure to the air they become changed, first causing vulvitis, and next inflammation of the vaginal mucous membrane.
Some women have slight attacks of vaginitis after each menstrual period, but they are generally slight and soon subside; others will have attacks after each coition or after great physical exertion, but with such patients the disease is not severe, and usually passes off without any signs remaining. ”