Pathology and treatment of diseases of women.

  • Martin, August Eduard, 1847-1933.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Pathology and treatment of diseases of women. Source: Wellcome Collection.

    178/500 (page 158)
    vulva extends far forward, so that the urethral and hymenial orifices lie upon the symphysis or the ligamentum arcuatum.118 Any considerable anatomic changes are not demonstrable, either in the external skin or in the nerve terminations lying in it. The Vaginis- mus appears with the first attempt at cohabitation, because copulation is difficult from the extreme sensitiveness of the highly excited young bride or from the abnormal size of the penis, or from awkward attempts at ap- proach under the influence of alcoholic intoxication and excessive excita- bility. Offen also an incomplete erection is involved in neurasthenics. So far as I have observed, immissio penis did not succeed in all these persons suffering from this evil, and as a result the hymen was not com- pletely torn. Spasms of the constrictor cunni occur also after successful immission, as is shown by the accounts of penis captivus.119 Renewed brutal attempts lead to injuries and to inflammatory lesions in these. Offen with the anteposition of the external Organs of genera- tion there occur injuries of the urethra which exceptionally may become dilated, so that the immission into it may succeed. The state of irritation assumes a very serious aspect with continuously unsatisfied attempts, and with timidity about confessing the condition to a physician. The parts become inflamed, particularly if the husband enters the marriage with gonorrhea, and vulvitis, Bartholinitis, Urethritis, also colpitis and endo- metritis result. The most usual consequence is an ill-humor of husband and wife, of whom the latter particularly suffers from dread of the ap- proach of the male and from the feeling of her own feminine imperfec- tion. The susceptibility of the irritation may increase to such an extent,. that every touch of the external genitalia causes severe pains. Finally, the disturbances appear also without contact in some from fear of the approach of the husband, in others from exertions, for instance during defecation and urination. Such women, as may easily be conceived, are mostly sterile, even if cohabitation in spite of the pain is enforced. However, conception may take place by the sperma being dashed against the external genitalia and thus pregnancy results notwithstanding the continued vaginismus. Hofmeier in one case saw always a considerable aggravation of the entire condition during the following pregnancy; Benicke120 observed vaginismus as an obstacle to delivery. Such spasms of the muscles of thepelvic floor, especially the levator ani, may appear also through the influence of colds, just as rheumatic contractions may occur in other muscular structures. It is questionable whether masturbation or other perverted sexual pleas- ures do not play a röle in the etiology. The diagnosis of vaginismusas a rule is established by touching the external genitalia ever so lightly with the finger, with the point of a sound, or even a firm cotton brush. Violent contractions of the muscu- 1 atu re of the pelvic floor occur, the vagina appears closed, even the vulva becomes inaccessible. By an extension of the contractions to the nates and thighs the extreme sensitiveness of the patients may exclude every