Operative gynecology : . culum. its depth on the skin surface; a good perineum, signifying that the distancefrom fourchette to anus measures 2-J cm. (1 inch) or more, whence the faultyconclusion is drawn that the support at the vaginal outlet must likewise begood. The fact is that in many of the worst forms of relaxationthe perineum is deeper on the skin surface than before child-birth, a condition due to the overstretching of the external skin at the timethe outlet was broken down. On separating the labia in a case of relaxed outlet the vaginal walls appearmore or less pouting, and either the
Operative gynecology : . culum. its depth on the skin surface; a good perineum, signifying that the distancefrom fourchette to anus measures 2-J cm. (1 inch) or more, whence the faultyconclusion is drawn that the support at the vaginal outlet must likewise begood. The fact is that in many of the worst forms of relaxationthe perineum is deeper on the skin surface than before child-birth, a condition due to the overstretching of the external skin at the timethe outlet was broken down. On separating the labia in a case of relaxed outlet the vaginal walls appearmore or less pouting, and either the anterior or posterior walls may protrude 294 RUPTURE OF RECTO-VAGINAL SEPTUM AND RELAXED VAGINAL OUTLET. to a marked degree. In rarer cases, lateral, anterior, and posterior walls allprotrude. The relaxed condition of the vaginal outlet may be demonstrated in a variety•of ways. Upon instructing the patient to bear down, both anterior and pos-terior walls roll out, bringing into view a considerable portion of the lower. Fig. 168.—Test for the Relaxed Vaginal Outlet, showing how the Posterior Vaginal Walldrops well away from the anterior wall by simply placing the patient in slms posture. The external skin perineum is well preserved, but in spite of this there is a large lax, gaping orifice. vagina. We are thus enabled to estimate the effects of lifting, walking, orstraining at stool upon such a patient. If a finger is placed upon the cervixuteri, during the act of straining it will be felt descending in the axis of thevagina toward the outlet. The descent is especially marked if the patient is TESTS FOR RELAXED VAGINAE OUTLET. 295 examined in the erect posture, when the surgeon will also be still better able tojudge the effect of exercise upon her pelvic organs. Upon placing the patient in the left lateral position and elevating the upperright buttock, air rushes audibly into the vagina and the posterior vaginal walldrops away from the anterior, leaving the gaping outlet as
Size: 1532px × 1631px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
