. The diagnosis and treatment of diseases of women. tion, venous congestion, bleedingareas or distinct ulceration. Arterial Congestion of the Vaginal Wall indicates inflammation, usually acute, oractive irritation, as by an irritating discharge or pressary or other foreign differential diagnosis of the various forms of vaginal inflammation has alreadybeen given in this chapter, when considering leucorrhoea (see page 177). Occasionallythere are cases of chronic vaginitis in which there is arterial congestion in spots. In 290 GYNECOLOGIC DIAGNOSIS such chronic cases there is likely to b
. The diagnosis and treatment of diseases of women. tion, venous congestion, bleedingareas or distinct ulceration. Arterial Congestion of the Vaginal Wall indicates inflammation, usually acute, oractive irritation, as by an irritating discharge or pressary or other foreign differential diagnosis of the various forms of vaginal inflammation has alreadybeen given in this chapter, when considering leucorrhoea (see page 177). Occasionallythere are cases of chronic vaginitis in which there is arterial congestion in spots. In 290 GYNECOLOGIC DIAGNOSIS such chronic cases there is likely to be infiltration and hypertrophy of the con-gested areas, giving rise to the condition known as granular vaginitis. Venous Congestion of the Vaginal Wall should always arouse a suspicion of preg-nancy, for that is the most common cause. It may be caused, also, by a tumor orother pelvic mass that interferes with the vaginal circulation, or by extra-pelvicconditions that cause venous stasis in the pelvis, such as heart disease with Fig. 431. Secondary Malignant Ulceration of theVagina. In this case there was a carcinoma of the en-dometrium, and the discharge caused an implantationcarcinoma where the cervix came in constant contactwith the posterior vaginal wall. (Kelly—Oi^erativeGynecology). Bleeding Areas on Vaginal Wall, without a distinct ulcer, are found principallyin senile or adhesive vaginitis, which is described in chapter iv. A Distinct Ulcer on the Vaginal Wall may be simple, chancroidal, syphilitic,tubercular or malignant. In the case of a malignant ulcer, it may be primary onthe vaginal wall (Fig. 430) or it may be secondary (Fig. 431), the most commonsource of secondary malignant ulceration of the vaginal wall being carcinoma of thecervix uteri. ABNORMAL CONDITIONS OF THE CERVIX 291 Conditions of Cervix Uteri. The appearance of the normal virgin cervix is shown in Figs. 432 and 433. Tlieappearance of the approximately normal cervix in the parous
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