Gynecology . an artificial vagina are described in Part III. GENITAL ATROPHY The clinical importance of the pathologic changes that may result fromatrophy of the female genitals is not sufficiently recognized, and for that reason,in order to direct attention to it, a special section is devoted to the subject. Under normal physiologic conditions senile involution of the internal andexternal genital organs begins at the time of the climacteric, and proceedsgradually to degrees varying in different individuals. SPECIAL GYNECOLOGIC DISEASES 469 In the uterus the muscle elements of the wall diminis
Gynecology . an artificial vagina are described in Part III. GENITAL ATROPHY The clinical importance of the pathologic changes that may result fromatrophy of the female genitals is not sufficiently recognized, and for that reason,in order to direct attention to it, a special section is devoted to the subject. Under normal physiologic conditions senile involution of the internal andexternal genital organs begins at the time of the climacteric, and proceedsgradually to degrees varying in different individuals. SPECIAL GYNECOLOGIC DISEASES 469 In the uterus the muscle elements of the wall diminish and become pro-portionately less than the connective tissue. The entire organ becomes shorter,thinner, and more flaccid, finally shrinking to a mere sac, while the surfaceassumes a pale and anemic appearance. The position of the atrophied uterus is always that of the second degree ofretroversion—-4. e., pointing in the direction of the axis of the vagina, and theaxis of the uterus is practically Fig. 195.—Atrophy of the power near junction of middle and isthmic portions of the tube. The villi have disappeared,leaving a nearly round lumen which is lined by a layer of low epithelial cells which are inactive. Thereis a distinct layer of connective tissue taking the place of the stroma of the villi between this epitheliallayer and the muscular wall of the tube. The mucous membrane shares in the general involution and becomes thinand smooth. The glandular elements diminish in size and number and finallydisappear altogether, while the ciliated surface epithelium is transformed to alow cuboidal type without cilia. The stroma of the endometrium shrinks andtakes on the spindle-form type of connective tissue. The cervix becomes smallerand less prominent, and in time may appear only as a dimple in the vault of the 470 GYNECOLOGY vagina. The uterine canal also diminishes in caliber, and may become partiallyor completely obstructed. The tubes are shorter and straig
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