. A manual of gynæcology and pelvic surgery, for students and practitioners. podermaticallyis distinctly dangerous. The wound left is often much largerthan would be expected, and the hemorrhage difficult to controleven by suture as the tissues are friable and deep suturesmay occlude the urethra. 112 DISEASES AND INJURIES OF THE VULVA Vaginismus.—Vaginismus is a spasm of the muscles whichclose the vaginal orifice. In its pure form it is strictly a neurosiswhich manifests itself whenever coitus is attempted, thus making m /l^C » Fig. 37.—Hirsts operation for vaginismus. An incision is made in ea
. A manual of gynæcology and pelvic surgery, for students and practitioners. podermaticallyis distinctly dangerous. The wound left is often much largerthan would be expected, and the hemorrhage difficult to controleven by suture as the tissues are friable and deep suturesmay occlude the urethra. 112 DISEASES AND INJURIES OF THE VULVA Vaginismus.—Vaginismus is a spasm of the muscles whichclose the vaginal orifice. In its pure form it is strictly a neurosiswhich manifests itself whenever coitus is attempted, thus making m /l^C » Fig. 37.—Hirsts operation for vaginismus. An incision is made in eachvaginal sulcus which meet in the midline at the fourchette and extend posteriorlytoward the anus. penetration by the male organ impossible. In some instancesattempts at digital or specular examination are rendered difficultor impossible, the vaginal orifice contracting spasmodically VAGINISMUS 3 whenever approached. The spasm is always severe enoughto be painful and is often positively unbearable. In extremecases the muscles of the anterior abdominal wall are spas-. FlG. 38.—Hirsts operation for vaginismus. The incisions are sutured trans-versely. First suture inserted. medically contracted as well as those of the vulva. A muchmilder form of spasm is met with occasionally in affections ofthe genitaHa which render intercourse painful, the spasm under8 114 DISEASES AND INJURIES OF THE VULVA these circumstances being protective in character. This issometimes found with urethral caruncle, vulvitis, inflamedremnants of the hymen, kraurosis vulvae, and inflammation orprolapse of the tubes and ovaries. Treatment.—A careful search should be made for any organiclesions which might be responsible for painful intercourse. The
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