DIAGNOSIS OF DISEASES OF FEMALE EXTERNAL GENITAL ORGANS Inflammations. — Vulvitis, vaginitis, and urethritis are recognized by discharge from the inflamed surfaces, as well as by swelling, redness, heat, and pain; often all three coexist. To determine the existence of urethritis, the labia should be separated, and the meatus minarius carefully wiped clean; the finger should then be passed into the vagina and pressed along the urethra, when a drop of pus may be seen at the meatus. The discharge should be examined for the gonococcus and other organisms to determine the nature of the inflammation. If a labium is swollen, reddened, oedematous, painful and tender, and is tense and fluctuates on the inner aspect posteriorly, it is an acute abscess of Bartholin's gland. If the signs of inflammation are less intense it is a subacute labial abscess. A rapid sloughing of the vulva is sometimes seen in young children — noma vulvae. Tumours. — When, without any signs of inflammation, a fluctuating swelling is found bulging towards the orifice of the vagina beneath one of the nymphæ, it is a cyst of Bartholin's gland, or labial cyst. A deep-red, painful and tender swelling at the meatus urinarius, attended with pain in micturition, is a urethral caruncle; this tumour is most common in women of middle and later life. Hyper-trophy of the nymphæ or great enlargement of the labia, with pendulous solid outgrowths, is not uncommon. A chronic ulcer with an irregular granular or fungating base and firm edges, growing steadily, with enlarged inguinal glands, is epithelioma. A small deeply pigmented tumour arising from the anterior part of the vulva, and bleeding early and severely, with rapid involvement of the inguinal glands, is a melanoma. Ulcers. — Both hard chancre and soft chancre are common in this situation; for their diagnosis see pp. 622, 624. Occasionally, numerous small punched-out superficial ulcers are found on the inner surface of the labia, on the nymphæ, and on the clitoris, which result from the breaking-down of small superficial nodules; it is a rare disease, follicular vulvitis. Chronic ulcers with sloughy base and ragged edges are due to late syphilis; they may, when very chronic, be indurated, but the history and signs of constitutional syphilis distinguish them from the primary sore. Mucous patches and erosions are common in the secondary stage of syphilis. Degenerations. — There are two forms of degeneration of the vulva met with in elderly women Both are characterized by intense pruritus or itching. Leucoplakia is diagnosed when the skin and mucous membrane of the vulva of an elderly and, usually, multiparous woman are found covered with red raw patches on which the epithelium becomes heaped up, and which then become white, scarred, and contracted, so that the whole vulval orifice is narrowed and the labia minora are smoothed out. Cracks and fissures are also found. If the condition is treated, epithelioma develops. Kraurosis is much more uncommon, affecting only the labia minora and vestibule in young women, and is further distinguished from leucoplakia by the absence of cracks and fissures and of thickened epithelium, and by the greater contraction of the parts. Epithelioma does not follow. <Callout type="important" title="Critical Examination">It's crucial to examine the discharge for gonococcus and other organisms to determine the nature of inflammation.</Callout> <Callout type="warning" title="Severe Condition Warning">A rapid sloughing of the vulva in young children is a severe condition known as noma vulvae.</Callout>
Key Takeaways
- Recognize vulvitis, vaginitis, and urethritis through discharge, swelling, redness, heat, and pain.
- Identify Bartholin's gland abscesses by their symptoms of swelling, tenderness, and fluctuation.
- Distinguish between chronic ulcers due to late syphilis and primary sores based on history and signs.
Practical Tips
- Separate the labia and clean the meatus minarius before examining for urethritis.
- Look for deep-red swelling at the meatus urinarius in women of middle age as a sign of urethral caruncle.
Warnings & Risks
- A rapid sloughing of the vulva is indicative of noma vulvae, a severe condition requiring immediate medical attention.
- Chronic ulcers with ragged edges and induration may be signs of late syphilis; constitutional syphilis should be ruled out.
Modern Application
While modern medicine has advanced diagnostic techniques for female genital diseases, the fundamental principles outlined in this chapter remain relevant. Recognizing symptoms such as discharge, swelling, redness, heat, and pain is still crucial for initial triage and emergency response. The historical insights into specific conditions like Bartholin's gland abscesses and urethral caruncles provide a basis for understanding current medical practices.
Frequently Asked Questions
Q: What are the signs of vulvitis, vaginitis, and urethritis?
Vulvitis, vaginitis, and urethritis can be recognized by discharge from inflamed surfaces, along with swelling, redness, heat, and pain.
Q: How do you diagnose urethritis?
To diagnose urethritis, the labia should be separated, the meatus minarius wiped clean, and a finger passed into the vagina to press along the urethra for signs of pus.
Q: What distinguishes leucoplakia from kraurosis?
Leucoplakia is characterized by red raw patches that become white, scarred, and contracted with cracks and fissures, while kraurosis lacks these features but shows greater contraction of the parts.