University of Virginia Library

CHAPTER II.
ANATOMY OF THE GENERATIVE ORGANS.

The Vulva; the Hymen; Condition, of the Hymen as a Proof of Virginity; the Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; Fallopian Tubes; Ovaries.

The Vulva.--The female generative organs consist of three groups--the external, the intermediate, and the internal. The vulva, or external generative organs, comprises all those organs which are external to the body.

The vulva is pierced by two openings, the smallest and most anterior of which is the external opening of the urethra, or excretory duct of the bladder. This opening is surrounded by a slight eminence and has a somewhat puckered aspect.

The larger opening is the vaginal orifice. In the virgin this is partially closed by the hymen. About one inch back of this is the anus, or the external orifice of the large bowel. This part of the bowel is known as the rectum.

The Hymen.--The hymen consists of a thin duplicature

of mucous membrane strengthened by fibrous tissue, and is stretched across the posterior part of the vaginal orifice, which it partly occludes. Rupture of the hymen usually, but not always, occurs during the first sexual intercourse. In rare cases it is found intact at the time of the birth of the first child. In women who have borne children the vaginal orifice is surrounded by small irregular elevations; these are the remains of the ruptured hymen, but are usually present only after labor has taken place, since the torn hymen is converted into eminences as the result of the pressure incident to child-bearing, and not to coitus.

The Condition of the Hymen as a Proof of Virginity.--Formerly much stress was laid on the condition of the hymen as a proof of virginity. The hymen tightly closed, barely admitting the tip of a small index-finger, is positive evidence of virginity. But the hymen may lose its tone by a local catarrhal condition or by a general muscular relaxation; it may then become so relaxed that the only positive evidence rendered by the intact hymen is that the woman has not borne a child.

In a paper on the preservation of the hymen, Dr. Hannah M. Thompson writes: "Further, if the hymen was intended as a guarantee of moral character, and for moral protection, either of man or woman, would we not have some reason for reflecting on the wisdom and righteousness of a Creator who has failed to make equal provision, and to give a like guarantee of an uncorrupted manhood? As physicians, we know too well

that where one woman enters the marriage relation tainted in body there are thousands of men reeking with disease; and there is no demonstrable test to distinguish these, no proof for the young woman of the virginity or virtue of the young man."

The Bladder.--The female bladder is relatively broad and capacious, and is also highly distensible. When the bladder is allowed to become overdistended, it is carried backward and tends to cause a backward displacement of the uterus. The urethra, or excretory duct of the bladder, is about an inch and a half long, and lies firmly imbedded in the anterior vaginal wall.

The Vagina.--The intermediate organ is the vagina. This is a musculo-membranous canal which connects the external with the internal organs of generation. The vagina lies in relation with the bladder and the urethra in front, and with the rectum behind. The vagina is sufficiently distensible to allow of the passage of so large a body as the child.

The Uterus.--The internal organs of generation are the uterus, the ovaries, and the Fallopian tubes. Of these, the ovaries and the uterus are the essential female organs of generation. The virgin uterus is a small, hollow, muscular organ, somewhat pear-shaped, whose cavity is about one and a half inches deep. The uterus is divided by a natural constriction into a body and a neck. The neck, or cervix, is somewhat spindle-shaped, and has a canal running through its center which opens by a small aperture--the so-called external

orifice,--into the vagina. In the virgin uterus the apposition of the anterior and posterior walls reduces the cavity to little more than a longitudinal cleft. With the advent of old age the whole organ suffers marked atrophy.

The uterus is situated in the middle of the pelvic cavity, between the bladder and the lower bowel. It is held in place by broad elastic bands which go to different sides of the pelvis; it is also in part supported by the structures below and above it. But so loosely is the uterus held that it is easily pushed about--as, for instance, by a full bladder or a packed bowel. And persistently allowing the bladder to become overfull, and failure to have a daily evacuation of the bowels, are prolific sources of displacements of the womb.

Respiratory Movements of the Uterus.--When no constrictions are placed about the waist, the uterus moves freely up and down with every respiration. So distinctly and with such regularity do these movements take place that an operator by watching the movements of the uterus can tell the effect that the anesthetic is having on the patient's breathing. These so-called respiratory movements play a very important role in the circulation of the uterus, and in the return of the venous blood to the heart.

Anything which interferes with these movements, as the use of corsets, or of tight bands around the waist, prevents the free return of the venous blood. The uterus becomes congested, and through the constant

abnormal weight of the organ itself, as well as the pressing down upon it from above of the superincumbent organs, the uterus is pushed down below its normal position, the ligaments whose duty it is to hold it up become relaxed, and the unhappy woman suffers all the agonies that are attendant on the "falling of the womb." For this reason the disorder is frequently met with in women who have never borne children as well as in those who have.

The Fallopian Tubes.--The Fallopian tubes extend from the upper, rounded angles of the uterus, within and along the free margin of the broad ligaments, for a distance of about two inches, to the vicinity of the ovaries, where each one terminates in a funnel-shaped orifice surrounded by a series of fringed processes. The lumen of the tube is narrowest at its inner end, where it opens into the cavity of the uterus by a minute orifice which scarcely admits a bristle; the diameter of the canal gradually increases until it reaches its ovarian extremity. The mucous lining of the tube is clothed by a single layer of hair-like epithelium, whose current sweeps from the ovarian toward the uterine end of the tube; and it is these movements which propel the ovum from the ovary to the uterus.

The Ovaries.--The ovaries are two small bodies of an almond shape, and lie on either side of the uterus. The bulk of the entire organ consists of connective tissue, in which lie imbedded the Graafian follicles or

ovisacs, in which the ova are contained. These follicles or ovisacs are minute cells which are packed immediately beneath the surface, where they occur in all stages of development. With the increase in size which accompanies their development the follicles pass toward the surface, where they form a distinct projection, and at this point will occur the final rupture of the sac and the escape of the ovum. It is supposed that the ovum is grasped by the fringe-like extremity of the Fallopian tube and is carried through it by the movements of the ciliary epithelium to the uterus.

The formation of new follicles continues only for a short time after birth, when the Graafian follicles are the most numerous; the entire number contained within the ovaries of the child being estimated at over 70,000. In view of the unquestionably large number of follicles in very young ovaries, and the relatively small number of ova which reach maturity, the degeneration of many follicles after reaching a certain degree of development seems certain.