. The diagnosis and treatment of diseases of women. This brings the urethralpus to the meatus (Fig. 47). Chronic inflammation in the urethra is likely to be situated in Skenes glands, andin such a case some pus may be pressed from these small glands by compressing theurethra (by pressure through anterior vaginal wall) just back of the meatus. Insome cases, particularly in multipara, the urethral mucosa pouts out, so that by Fig. 43. Practically Normal External Genitals—multipara, labiatogether. The corrugations of the labia majora can hardly becalled abnormal. 34 THE PHYSICAL EXAMINATION caref
. The diagnosis and treatment of diseases of women. This brings the urethralpus to the meatus (Fig. 47). Chronic inflammation in the urethra is likely to be situated in Skenes glands, andin such a case some pus may be pressed from these small glands by compressing theurethra (by pressure through anterior vaginal wall) just back of the meatus. Insome cases, particularly in multipara, the urethral mucosa pouts out, so that by Fig. 43. Practically Normal External Genitals—multipara, labiatogether. The corrugations of the labia majora can hardly becalled abnormal. 34 THE PHYSICAL EXAMINATION careful examination, the orifice of one or both of Skenes glands may be seen. shows such a gland-opening (left side) and also a drop of pus which has beenpressed from the gland on the right side. The vulvo-vaginal glands (Bartholins glands) are situated symmetrically, one oneither side of the vaginal opening, as shown in Fig. 49. The opening of the duct of thegland of each side is situated laterally, just in front of the remnants of the hymen. Fijr. 44. Labia separated, to expose upper part ofvestibule. Fig. 45. Labia separated, to expose lower partof vestibule. and a little below the middle of the lateral margin of the vaginal opening. Drawaside the labia in this situation and look for the opening of the gland and determinewhether or not the opening is reddened and if there is any discharge from it (Fig. 50).To examine either vulvo-vaginal gland, to determine if there is any thickening ortenderness from inflammation or if pus can be squeezed from it, grasp the region ofthe gland between the index finger in the vagina and the thumb outside, as shown inFig. 51. SECURING PUS FOR EXAMINATION 35
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