Diagnosis and treatment of diseases of women / by Harry Sturgeon Crossen.
- Harry Sturgeon Crossen
- Date:
- 1912
Licence: Public Domain Mark
Credit: Diagnosis and treatment of diseases of women / by Harry Sturgeon Crossen. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![Ordinarih', however, after a few weeks all the acute and sul)acute evi- dences Jiave subsided, leaving only those that, so far as any distinctive char- acteristics are concerned, might have been there some months or some years. So the question here is essentially whether or not coitus has ever taken place in the case of the individual concerned. B. Evidences of Remote Coitus. Ordinarily, it is easy to tell, by a compara- tively superficial examination, whether or not a girl or woman has probably had coitus. The diflfereuces in appearance of the external genitals and vagina when coitus has taken place (especially if it has taken place several times) are usually so marked that the physician has little difficulty in distinguish- ing them. This is the general rule. There are, however, exceptional cases which present many of the ordinary evidences of coitus when iu fact none has taken place. On the other hand, there are persons who present signs which are considered almost pathognomonic of virginity when in fact sexual intercourse has occurred, and not only sexual intercourse, but pregnancy and labor at full term. So, in exceptional cases it may be very difficult to decide certainly whether or not sexual intercourse has occurred, and in such a case it is particularly difficult to legally prove the same, for the anomalies must then be considered. The evidences of remote coitus or attempted coitus can be summed up as follows: 1. Evidences of previous child-birth at or near term. a. Destruction of the hymen, leaving only irregular tags here and there about the vaginal opening, with scar tissue between. This condition is very strong evidence of childbirth at or near term. It means that there has passed through the vaginal opening some body large enough not only to stretch and lacerate the hymen, but to stretch out the vaginal ring enormously, and to so stretch and compress and bruise the hymen that the subsequent slough- ing and scar-contraction has practically destroyed it. There is really no hymen that can be traced as a circular ring of tissue with simply laceration from intercourse. The hymen, as such, is gone, and there remain only irregular projecting particles of tissue (carunculae myrtiformes) here and there to mark the place where the hymen used to be. Of course a large tumor—e. g., a fibroid—delivered through the vagina might do the same. Also, some destruc- tive inflammatory process or serious injury during childhood or later miglit produce practically the same results, but such conditions are rare and show also other evidences. There are cases of congenital deformity in wliich the hy- men may be present simply as irregular tags of tissue, or it may, as recorded in some cases, be absent altogether. In such cases we would not expect the scar tissue about the vaginal opening nor the marked enlargement of the opening. So the destruction of the hymen as described, when present, is strong pre- sumptive evidence of preA'ious childbirth. Suppose the hymen is not destroyed—does that prove that no cliildl)irt]i lias taken place? Not necessarily. Occasionally during labor the liymen is sim- ply torn and then the ring beyond it is stretched and torn. After labor the](https://iiif.wellcomecollection.org/image/b21225114_1011.jp2/full/800%2C/0/default.jpg)
