Clinical notes on uterine surgery : with special reference to the management of the sterile condition . er edge of the peri-neum. A glass dilator was worn three or four hours aday for a month ; but at the end of this time the mouthof the vagina was just as sensitive and as the operation. I now determined to remove all the hypertrophiedtissue at the fourchette and divide anew the partsbeneath. Wishing to make pressure with the dilatormore in the direction of the fourchette and perineumthan laterally, I had the instrument made as repre-sented in fig. 129, which seems to be a g
Clinical notes on uterine surgery : with special reference to the management of the sterile condition . er edge of the peri-neum. A glass dilator was worn three or four hours aday for a month ; but at the end of this time the mouthof the vagina was just as sensitive and as the operation. I now determined to remove all the hypertrophiedtissue at the fourchette and divide anew the partsbeneath. Wishing to make pressure with the dilatormore in the direction of the fourchette and perineumthan laterally, I had the instrument made as repre-sented in fig. 129, which seems to be a great improve-ment on the purely cylindrical instrument. Instead ofexpanding the outer end of the dilator, as seen in , it is often necessary to roll its border inwards toprevent pressure on the labia. 330 UTERINE SURGERY. In some instances the instrument is too long, andproduces pain by pressure against the cervix uteri. Itwill then be necessary to make it shorter. The down-ward curvature of the conical extremity, as here repre-sented, prevents it from striking against and hurting Fig. 129. I have now operated on thirty-nine cases of vaginis-mus, and in every instance with perfect success. Manyof these were complicated with other causes of a sterilecondition, such as painful menstruation, contracted os,conical cervix, fibroid tumour, or malposition. Butnotwithstanding this, six conceptions have followed theoperation. Some others, from whom I have not heard,have probably conceived, and a few more of them willalmost certainly do so. They have usually been so wellsatisfied with the removal of the vaginismus that theydid not care to undergo any further treatment for acondition that might be attended to at a more conve-nient season. Churchill, Debout, and some others, have thoughtthat a state of vaginismus could hardly exist long wherethe husband possessed strong copulative capacity; butI am sure this is an error; for I have seen severalinstances in which the viri
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