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Image from page 61 of “The diagnosis and treatment of diseases of women” (1907)

Image from page 61 of “The diagnosis and treatment of diseases of women” (1907)
Back Pain
Identifier: diagnosistreatmecros
Title: The diagnosis and treatment of diseases of women
Year: 1907 (1900s)
Authors: Crossen, Harry Sturgeon, 1869-
Subjects: Genital Diseases, Female Gynecology Gynecology Women Generative organs, Female
Publisher: St. Louis : Mosby
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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Text Appearing Before Image:
t, and is presumptive evidence of a previous gonorrhoeal in-fection (as other forms of inflammation seldom involve the gland or duct) andshould always lead to further investigation, to establish the presence or absence ofthis disease. PELVIC FLOOR. SIZE OF VAGINAL OPENING. RESISTANCE TO BACKWARD PRESSURE ON PELVIC FLOOR. PROTRUSION OP VAGINAL WALLS. SCARS OR DISTORTIONS. THICKNESS OF PERINEAL BODY. Is there loss of support at the pelvic outlet? Is there so much relaxation, due toimperfect healing of an open tear or of a subcutaneous tear or due to subinvolution of THE PELVIC FLOOR 45 To deter- the pelvic sling, that the pelvic organs are not satisfactorily supported?mine this, investigate the following points: Size of Vaginal Opening. In the adult virgin, the opening in the hymen willusually admit the little finger without much stietching. In a married woman, twofingers can usually be introduced for examination v/ithout causing pain, providedthe care previously mentioned is exercised.

Text Appearing After Image:
Fig. 56. Testing tlie left sulcus. If the vaginal opening will readily admit three fingers, it is decidedly enlargedand there is considerable interference with the integrity of the perineal body. Theperineal body is not, however, an important factor in the real supporting power ofthe pelvic floor. Hence a relaxed vaginal opening does not necessarily mean a re-laxed pelvic sling, though it usually accompanies the same. Resistance to Downward and Backward Pressure on the Pelvic Floor. Usually inthe woman who has borne children, there is not the firm support back of the pos-terior vaginal wall and extending well up toward the cervix, that is found in nulli-para. There is not, however, the marked difference one would naturally expectfrom the enormous stretching that necessarily takes place in child-birth. 46 THE PHYSICAL EXAMINATION The provisions of nature for the restoration of the parts to near their former con-dition, are wonderfully effective when not interfered with by tears or over

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