Gynecology . alacquired atresia does not produce symptoms until that time, although a fewcases have been reported where non-hemorrhagic secretions have collected be-hind the closure and required attention before the onset of menstruation. 30 466 GYNECOLOGY Usually the affection first makes itself evident when the patient has begunto menstruate. Each month there occur the molimina of menstruation at-tended with severe cramp-like pains in the lower abdomen and back. Some-times there are no subjective symptoms until so great a mass has collected as tocause pressure. If the atresia is at the hymen
Gynecology . alacquired atresia does not produce symptoms until that time, although a fewcases have been reported where non-hemorrhagic secretions have collected be-hind the closure and required attention before the onset of menstruation. 30 466 GYNECOLOGY Usually the affection first makes itself evident when the patient has begunto menstruate. Each month there occur the molimina of menstruation at-tended with severe cramp-like pains in the lower abdomen and back. Some-times there are no subjective symptoms until so great a mass has collected as tocause pressure. If the atresia is at the hymen or low in the vagina the obstructed menstrualblood and uterine and cervical secretions collect in the vagina, forming a so-called hematocolpos. The atretic membrane is ballooned outward between thelabia, while the mass in the vagina may reach an enormous size. In time thecervix becomes stretched out, and eventually the uterus is filled and distendedwith blood, forming a hematometra. J\ c&o &c\^mx. .Obstr u c^ M^cwOovaue Fig. 194.—Acquired Atresia of the Vagina or semidiagram showing the cavities formed in the genital tract by the obstructed menstrualblood. Hematocolpos in the vagina, hematometra in the body of the uterus, and hematosalpinx inthe tubes. A later and more serious manifestation is the formation of a hematosalpinxon one or both sides. The hematosalpinx is produced by a closure of the ostiumand an exudation of blood into the lumen. This blood comes partly from theflow from the uterus and also, as has been proved, from hemorrhages from thetubal mucosa. How the tubal ostium becomes closed is a matter of some believe that it can only be explained as a part of the original inflamma-tory process which caused the atresia of the vagina. Others maintain that thetubal end may become closed without the agency of infectious micro-organismsby the clotting and organization of blood, as sometimes happens in tubal abor-tion. Others t
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