Congenital Occlusion of the Vagina.—.Throughout the medical jour-
nals are scattered notices of congenital occlusion of the vagina, sometimes
combined with obvious arrest of development of the uterus,—sometimes
with simply an imperfect condition of the vaginal orifice. We have
upon former occasions mentioned the particulars of cases of extroversio
vesicae in the male, where the generative organs were incompletely formed;
and we recall an observation made by Mr. Coote, that the arrest of de-
velopment was not confined to the external parts, but that it extended
to the whole segment of the body and the system of organs in which
these imperfect structures were situated. The same remark is applica-
ble to congenital occlusion of the vagina. In some instances the nym-
phae alone are adherent; in others, one, two, or more inches of the an-
terior part of the vagina are obliterated ; the uterus may be ill formed,
and the ovaries in no condition to mature ova, but in all cases the arrest
of development of the internal parts is in relation with the amount of
external deformity. The practical points connected with this law are
equally applicable to the two sexes. In the male, suffering from extro-
versio vesicae and fissured penis, the bones of the pelvis are usually
small, and the pelvic cavity is shallow; the bladder, almost an abdomi-
nal viscus, retains its foetal connexions to the peritoneum; the prostate
gland is small and rudimentary; there is no trigon vesicae uncovered by
peritoneum; consequently we read without surprise of surgeons wound-
ing the serous membrane with the trochar in their attempts to establish
a rectovesical fistula as a preliminary step in the cure of this malforma-
tion. As regards the female, we may infer, that if with congenital oc-
clusion of the vagina there be, at the time of puberty, no indications of
the menstrual secretion, both external and internal organs are in a con-
dition which cannot be relieved by surgery; but if the uterus, to all ap-
pearance, be healthy; if it become in course of time distended with men-
strual secretion, and the patient suffer the usual pains and inconve-
niences, we may conclude that there is a vagina, an os tincae, uterus, and
ovaries, but that from some cause the external orifice, and an inch or
more perhaps of the external meatus, are obliterated and adherent. It
follows, then, that an operation, carefully performed, may relieve the
patient of this distressing affliction; the vagina may be opened beyond
the occlusion, and a canal may subsequently be established by the use of
pessaries.
In the New York Journal, 1845, there is an account of a young Ger-
man woman suffering from occlusion of the vagina. She had the sexual
passion, but had never menstruated. Iler general health was good. On
inspection, it was found that she had no vagina. There was no abdo-
minal swelling. Dr. Watson introduced into the urethra a silver catheter,
which he committed to the charge of an assistant. Then passing the
fore-finger into the rectum, he divided the parts at the natural situation
of the vagina, between the catheter and the finger. After dividing an
inch and a half of tissues, the parts yielded to pressure, and the passage
was restored to the os tineas; it was, however, small, and the uterus was
atrophied. The passage was kept open by the pessary, and ultimately
rendered fit for all its functions by continued distension.
The Medical Times, 1845, contains some remarks upon this affection
by Dr. Vaudroy; and Maissonneuve has performed an operation similar
to that of Dr. Watson and of Mr. Wormaid, who has lately successfully
treated a case in most points similar to that which we have noticed above
from the New York Journal.
Emma W., aged 19, a well formed and not bad looking girl, with an
unmeaning and vacant expression of countenance, was admitted into St.
Bartholomew’s Hospital, Nov., 1852, under Mr. Wormaid, with com-
plete occlusion of the vagina. The labia, when open, seemed to bound
a wall of mucous membrane, in which were seen both clitoris and ure-
thral orifice, but there was no passage towards the uterus. The finger in-
troduced into the rectum came in contact with a solid, elastic, bulging
tumor, evidently the uterus distended by menstrual secretion, and press-
ing upon the anterior wall of the rectum. There was no apparent indi-
cation of a vagina, but the uterus bulged downwards to within about two
inches of the surfaee of the perinaeum. The patient suffered considera-
ble inconvenience from pain in the back and loins at the menstrual pe-
riods ; the bowels had become habitually costive. The rectum having
been emptied by proper remedies, and the viscera being in a healthy
state, Mr. Wormaid performed the following operation, December 3 :—
Chloroform having been administered, and the bladder and rectum pre-
viously emptied, the patient was tied, as in the operation of lithotomy.
Mr. Wormaid made an incision in the perinaeum, extending from the
left labium obliquely downwards and outwards to the ramus of the
ischium in the direction of the os tineas, and in the interval between the
urethra and the rectum, the coats of the latter viscus being indicated by
the presence of the forefinger of the left hand introduced per anum.
After carefully cutting in this narrow interval for about an inch and a
half to two inches, Mr. Wormaid came upon some yielding tissues, and
then to the uterus. A trocar passed readily (and it was suspected
through the os tincse) into the cavity of the organ, and there was dis-
charged fourteen ounces of thick, grumous, bloody fluid; a gum elastic
catheter was introduced, and the patient was then removed to bed. There
was an escape of bloody fluid during the next thirty-six hours, but this
has slowly subsided ; the patient has suffered occasionally from retention
of urine, but there have been no unfavorable symptoms, and there is
every prospect of a successful result.
Mr. Callender, the house-snrgeon, examined the fluid microscopically,
and found that it consisted of epithelial scales, and altered blood discs.
There is reason to believe that, in the present instance, the vagina,
which was obliterated to an extent of two inches from its orifice, yet
existed above that spot, but was occupied by the distended uterus, which
has sunk much nearer the perinaeum than natural, owing to its great
enlargement.—London Med. Times and Gaz.