. The diagnosis and treatment of diseases of women. Fig. 238. Laceration of Perineum with resulting Fistula, fromViolent Coitus. (Hirst—Diseases of Women.) SWELLING ABOUT EXTERNAL , Cystocele, Rectocele. These swellings appear as the result of lacera-tions. Fig. 239 shows a severe second degree tear, involving practically all the. 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 m
. The diagnosis and treatment of diseases of women. Fig. 238. Laceration of Perineum with resulting Fistula, fromViolent Coitus. (Hirst—Diseases of Women.) SWELLING ABOUT EXTERNAL , Cystocele, Rectocele. These swellings appear as the result of lacera-tions. Fig. 239 shows a severe second degree tear, involving practically all the. 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
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