1. Inflammation

a. Catarrh affects the vagina very frequently in the protracted acute, or, if blennorrhoic, in the chronic form, and presents the most various characters. It may be a simple benignant catarrh, or have the specific qualities of the scrofulous, arthritic, syphilitic, impetiginous, or gonorrhoeal catarrh; it is sometimes complicated with blennorrhcea of other mucous membranes, and is either idiopathic or symptomatic, accompanying various local inflammatory, ulcerative, or degenerate processes in the vagina, the uterus, and neighboring organs.

The vagina appears flabby, its mucous membrane tumefied and pale, invested with a pale thick coating of epithelium, or excoriated and reddened, with enlargement of the follicles, which are surrounded by a vascular ring. It contains and discharges a secretion varying in quantity and quality, and mixed up with the products of the associated inflammatory and ulcerative processes. In its pure condition it is a white, thin, milky, or creamy mucous, which is commonly secreted in considerable quantities, and indicates an abundant formation of epithelium and desquamation, or it appears as a vitreous, grumous, and viscid, or as a yellow puriform mucus.

Catarrh of the vagina is an important disease, not only on account of the extreme loss of fluids which it often entails, but also on account of the imminent danger of its extension to the uterus and the Fallopian tubes, and the consequent morbid affection of these organs. It predisposes to intussusception of the vagina, owing to the relaxation it induces; it leads to excoriation and superficial ulceration, both of the vagina, the external pudenda, the parts in their vicinity, and of the cervix uteri, to closure of the os tincae, to follicular suppuration, atresia vaginae, permanent hypertrophy of the follicles, and dilatation of the vaginal vessels. It follows that a cure is effected with extreme difficulty, and that relapses occur very frequently.

B. Exudative Processes

In rare cases primary croup occurs on the vaginal mucous membrane alone; but it exists more frequently in complication with an exudative process on the internal surface of the uterus, in the shape of puerperal disease. As the latter generally predominates, the affection is usually found to have spread from the uterus to the vagina. Exudative processes with various products occur more frequently in patches, or throughout the vagina as secondary diseases, both as a result of puerperal affection of the uterus, as well as in consequence of an infection of the blood proceeding from other causes, or from a degeneration of the typhous and various exanthematic processes. They correspond to the condition of the blood and its products, and accordingly produce a solution of the mucous membrane and the submucous layer, varying in shape and depth, and not unfrequently resembling gangrenous destruction. A loss of substance may ensue, and to this cause undoubtedly many cicatrices found in these parts are to be attributed. They also not unfrequently extend to the pudenda, the perineum, and the nates, and give rise to extensive disorganization.

We must make special mention of the secondary form of typhus occurring in the vagina. It does not appear to exhibit itself in the vaginal mucous membrane in its genuine form, but is often found degenerated into croup and gangrene. It is remarkable that an existing blennorrhcea, especially if of a gonorrhceal or syphilitic character, exerts a powerful attraction upon it.

C. Inflammation Of The Submucous Cellular Tissue Of The Vagina

It very rarely appears in the chronic form; it leads to considerable thickening and coriaceous induration of the vaginal parietes; the latter at the same time become less movable, so as to seem agglutinated to the adjoining parts.

2. Ulcerative Processes

We here meet with the simple (catarrhal) follicular ulcer, the circumscribed or diffused solution of the tissues resulting from exudative processes, the syphilitic ulcer, the phagedaenic ulcer of the os uteri, which generally spreads from the cervix uteri to the vagina, and the true cancerous ulcer. At the cervix we find some other ulcers, of which we shall have occasion to speak more fully at a future period.

3. Gangrene Of The Vagina

Gangrene is the result of pressure and contusion produced during difficult parturition; it also occurs in the shape of gangrenous eschar and gangrenous or putrid fusion of the mucous and submucous layers.

4. Morbid Growths

Their occurrence is altogether unusual, and even the fibrous and cancerous tumors that we meet with are but rarely observed. The cysts that are found in this region are developed in the cellular tissue external to the vagina, and, anatomically speaking, bear a very subordinate relation to the latter.

Fibroid productions almost invariably coexist with similar growths in the uterus; they may be developed in the external fibro-cellular layer of the vaginal parietes, and especially at their posterior surface; they then project with a larger or smaller segment, in the shape of round tumors, into the vaginal cavity. In other instances they are developed in the cellular tissue that is interposed between the vagina and the rectum, and, though in close relation to the vagina in point of origin, project chiefly into the rectum, and more or less obstruct its inferior portion. The latter circumstances are characteristic of the relation in which these morbid growths stand to the uterus and to the accumulations of cellular tissue which occur in these regions.

Carcinoma of the vagina is, in most cases, cancer of the uterus which has spread to the vagina; however it may exist, though the latter is in a very undeveloped state, and even without it, in the shape of primary carcinoma of the vagina. It belongs to the fibrous or medullary variety, and, in proportion to its growth, induces thickening of the parietes, tu-berculated condensation of the internal surface, and corresponding contraction of the passage; the vagina becomes adherent to the neighboring parts, in consequence of cancerous degeneration of the cellular tissue surrounding it and the rectum, and finally cancerous ulceration and excrescences are established. The greater part of the vagina generally becomes involved, and the lower portion is prolapsed; the disease extends to the rectum, the bladder, the urethra; by the pressure it exerts it causes retention of the urine and dilatation of the bladder, and, when it has reached the ulcerative stage, recto- and vesico-vaginal fistulae result.

6. Anomalies Of The Contents Of The Vagina

Under this head we class, besides the anomalies of the mucous secretion in vaginal catarrh, the products of exudative and ulcerative processes, the contents of the bladder and the rectum, when introduced by fistulous communications, the products of the diseased mucous membrane of the uterus and the Fallopian tubes; blood that may be derived from various sources, and in various states of coagulation, discoloration, and decomposition. The presence of blood assumes particular importance when it is retained by a redundant hymen, or by congenital or acquired obturation; we include in this category pessaries and the adherent calculous deposits, various substances that have been introduced from without, and, lastly, the problematic cases of vaginal pregnancy.