. The diagnosis and treatment of diseases of women. Fig. 239. An old Laceration from Labor. Most of the perineum has been torn and there isprotrusion of the posterior vaginal wall (posterior colpocele). (Baldy—Am. Text-hook of Gynecology.) 190 GYNECOLOGIC DIAGNOSIS perineum down to thesphincter ani muscle, and also a posterior colpocele. Figs. 240and 241 show such a laceration with the anterior and posterior vaginal walls begin-nings to protrude, and there is also protrusion of the bladder and rectum (cystoceleand rectocele). In such a condition, if the patient be directed to bear down, thepro
. The diagnosis and treatment of diseases of women. Fig. 239. An old Laceration from Labor. Most of the perineum has been torn and there isprotrusion of the posterior vaginal wall (posterior colpocele). (Baldy—Am. Text-hook of Gynecology.) 190 GYNECOLOGIC DIAGNOSIS perineum down to thesphincter ani muscle, and also a posterior colpocele. Figs. 240and 241 show such a laceration with the anterior and posterior vaginal walls begin-nings to protrude, and there is also protrusion of the bladder and rectum (cystoceleand rectocele). In such a condition, if the patient be directed to bear down, theprotrusion will become still more marked. Fig. 242 shows marked protrusion ofthe anterior vaginal wall accompanied by the base of the bladder (cystocele). The fact that the bladder wall is prolapsed along with the vaginal wall, is indi-cated by the fact that the patient has more or less difficulty in urinating, and in_^^ ^^ some cases she must push back the mass before she can urinate satisfactorily. When there is doubt as to whether the. Fig. 240. Cystocele and Rectocele of moderate ex-tent. (Thomas and Munde—Diseases of Women.) Fig. 241. Cystocele and Rectocele of moderate ex-tent. Sectional view. (Thomas and Munde—Diseasesof Women.) bladder wall comes down, the lowest part of the bladder cavity may be locatedwith a steel bougie (Fig. 243). • Fig. 244 shows slight rectocele (protrusion of the posterior vaginal wall accom-panied by the anterior rectal wall). Fig. 245 shows a large rectocele. The pointas to whether or not the rectal wall really follows the prolapsed vaginal wall, maybe settled in such a case by rectal examination (Figs. 246, 247). Inflammation of Vulva (erysipelas, cellulitis). There are the usual signs andsymptoms of acute inflammation. Owing to the large amount of loose cellulartissue, the inflammatory infiltration may cause very marked swelling. Hematoma of Vulva. There is rapid swelhng following a puncture with a hypo-dermic needle or a fall or other i
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