1. Defect And Excess Of Formation

The vagina may be totally absent, or partially deficient; in the latter case there is a cul-de-sac opening externally, or the vagina terminates blindly at a greater or less distance from the labia, or opens posteriorly into the urethra - in this instance the development takes place from both points, but an intervening portion is defective, thus forming a transition to congenital atresia. When the other parts of the sexual apparatus are atrophied, or certain of its sections, as, for instance, the clitoris, approach the male type, or in cases of hermaphrodisia per excessum, the vagina is not duly developed, and is found rather narrow than short, smooth, and without rugae.

We must here allude to an apparent excess of development, called the double vagina, or division of the vagina into two channels which lie in juxtaposition to one another. It is produced by a vertical septum that descends along the mesial line of the vagina; and in a low degree is indicated by a more ridge-like elevation of the columnar rugae. The division of the vagina may be complete, and is then associated with division of the uterus and its orifice, and with a double hymen; or it may be incomplete, and in this case the septum ceases above, and the fornix vaginae is common to both passages, the os tincae being at the same time single or double; or else the septum does not reach down to the vaginal entrance, which is protected by a single hymen, and the vagina is single to a greater or less extent; or, lastly, the septum is incomplete, inasmuch as it presents partial defects. The deviation of the septum from the mesial line, which occurs in rare cases, is of interest and importance; the passage on one side may then be imperfect, or have a blind termination above or below. The following case, taken from our collection, is an instance:

Sexual organs of a very imperfectly-developed female of fifteen, who was covered with scrofulous ulcers and cicatrices, and died of tubercular phthisis of the lungs and the intestines. Two very delicate, elongated, fusiform uteri, each provided with one Fallopian tube and one large ovary, unite at the point of the internal orifice at an obtuse angle (uterus bi-cornis), and are from this point separated by a vertical septum, so that each cervix has its distinct vagina. The two vaginae descend on both sides of a septum, which is a continuation of the septum uteri, down to the external pudenda, which are closed by a single hymen, the left vagina being considerably wider and presenting larger rugae than the right. The latter terminates at about the middle of the entire vagina, in a blind sac formed by the septum; the left vagina immediately bulges out to the right in the shape of a single canal. The external organs are, like the uterus, in an extremely undeveloped condition. It is a curious coincidence that the right kidney was absent, the left being at the same time enlarged, and its hilus directed forwards.

The hymen is often too large, owing to excess of development, so as almost to close up the entire passage; it deviates at the same time from its normal shape and mode of attachment, inasmuch as it is generally connected with the internal labia by a small round column, by which means two orifices are formed which lead into the vagina.

2. Anomalies Of Size

The congenital anomalies involve a greater or less dilatation, such as we find to be peculiar to some nations; and the contraction which we have spoken of above, the highest degree of which is complete closure.

Congenital atresia, which we have above classed with partial defect of the vagina, is commonly produced by an enlarged hymen, or, in exceptional cases, by a horizontal or obliquely placed membrane, which occupies different parts of the passage; if carefully examined we should probably find that it was formed by the adherent parietes of a vagina, ending above and below in a cul-de-sac. This form of atresia would, in that case, have to be considered as partial (and slight) deficiency of the vagina.

The acquired irregularities appear, on the one hand, as unnatural elongation or dilatation; on the other, as shortening or narrowing, amounting even to complete obturation.

The vagina is liable to a uniform or partial elongation, with disappearance of the rugae and diminution of its arch, in consequence of traction exerted by the uterus or ovaries, owing to uterine tumors or enlarged ovaries that mount into the abdomen, or to morbid growths that force those organs upwards. Prolapsus uteri, tumors projecting into its cavity, especially fibroid tumors, polypi of the uterus, pessaries, and the like, induce dilatation of the vagina.

Shortening or narrowing is the result of injury and loss of tissue that has been intentionally or accidentally induced, of ulceration and the resulting cicatrices. The vagina is also narrowed when the passage is elongated by traction, and its cavity is diminished when the cervix uteri becomes atrophied.

Acquired atresia may be complete or incomplete, and result from adhesion of the anterior and posterior walls of the vagina to a greater or less extent, in consequence of excoriation or ulceration; or it may be produced by flat or rounded cords that pass horizontally or diagonally across the vagina and reduce its calibre. The latter may consist of vaginal folds brought on by traction, or of the membranous bands left after the cure of ulcerative loss of substance.

3. Deviations In Position And Form

The form of the vagina is modified in a manner corresponding to the anomalies which we have first examined, and in a medico-legal point of view we have to notice the unusual forms presented by the hymen after it has been ruptured. Instead of the carunculae myrtiformes, a more or less considerable annular tumor remains; or if the hymen was inserted into the nymphaa, one half is left so as to form a species of valve, or it is entirely torn out in the shape of a ring.

Among the deviations of position we notice intussusception and prolapsus of the vagina, which affect mainly the anterior wall of the vagina, and the eversion of the anterior or posterior vaginal parietes in vaginal hernia (cystocele vaginalis, hernia vaginalis posterior).

4. Solutions Of Continuity

Besides the injuries inflicted by means of cutting instruments, which generally implicate various neighboring organs, and the ruptures caused by concussion and contusion, we have to mention the contusions and ruptures of the vagina occurring during parturition, whether or not occasioned by operative interference, and the loss of substance by ulceration. The contusions or lacerations affect the vagina alone, either superficially or throughout its tissues, or they are associated with contusions and lacerations of the uterus; in the last case, the injury affects the vagina and the uterus simultaneously, or a laceration of the latter is carried down to the former to a greater or smaller extent. Neighboring organs, and especially the bladder, may also be involved in the solution of continuity.

In difficult or hurried parturition, when the parts have not been properly supported, the vagina, the posterior commissure, and the perineum may be ruptured, and when the parturition is effected by the perineum, the vagina is perforated above the sphincter.

Ulcerative destruction is not always limited to the vagina, but frequently gives rise to communications between the cavities of the vagina, the bladder, or the rectum, or with both at the same time by means of fistulae or large cloacae.