. The Principles and practice of gynecology : for students and practitioners. l secretion,suppurative when it contains pus, hemorrhagic when it contains anappreciable amount of blood—i. e., when the destructive process hasopened the walls of the vessels—and ulcerative when there is localizednecrosis. The catarrhal often precedes the suppurative infection by adistinct period. VULVITIS, VULVOVAGINITIS, VAGINITIS 173 The skin or mucous mcinhninc in clironic cases iisuallv becomesthick and oHlcmatoiis. The pyogenic microbe does not produce sup-puration until the structures are impaired in a (hgree
. The Principles and practice of gynecology : for students and practitioners. l secretion,suppurative when it contains pus, hemorrhagic when it contains anappreciable amount of blood—i. e., when the destructive process hasopened the walls of the vessels—and ulcerative when there is localizednecrosis. The catarrhal often precedes the suppurative infection by adistinct period. VULVITIS, VULVOVAGINITIS, VAGINITIS 173 The skin or mucous mcinhninc in clironic cases iisuallv becomesthick and oHlcmatoiis. The pyogenic microbe does not produce sup-puration until the structures are impaired in a (hgree. A circum-scribed sn])|)uratino; surface may be surrounded l)y an area of catarrhalinHammation. The necrotic tendency may not go beyond erosion; itmerely may impair without destroying the skin or mucosa, or it mayext(Mid far below the surftice and form a deep ulcer. Vulvitis andvaginitis may exist sejxirately or together. So-called gnmular ri(frova(/i)tifls is due to swelling and hyper-trophy of the vulvovaginal papilhe, is found chiefly in the vaginaj and, FiGUKE Granular vaginitis. Observe the purulent secretion on the posterior vaginal wall. though not confined to that period, is commonest during is characterized by small, round, protuberant granulations scatteredthickly over the affected surface. The inflammation may result in extensive ulceration of the vulvaor vagina, or of both. Sufficient plastic material may be thrown outto cause adhesions more or less firm between the nymphte or the labiamajora, or between the vaginal walls, or between the vagina and thecervix uteri. Partial or complete closure of the vulva by adhe-sions is not uncommon in children. Such adhesions usually yield toslight force. They resemble the adhesions sometimes found betweenthe prepuce and the glans penis of the male child; they also may 174 INFECTIONS, INFLAMMATIONS, AND ALLIED DISORDERS. occur between the clitoris and its prepuce, and may give rise to seriousnervous disturb
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