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Radical surgical methods of treatment who should eliminate not only clinical symptoms, but also contribute anatomical conditions to the PROLAPSE OF THE UTERUS, VAGINAS was most efficient and also to prevent possibility of postoperative backsets. Under method of choice of radical treatment the PROLAPSE OF THE UTERUS, VAGINAS. perceived the complex of operations consist of the following four interventions (I.L.Braude): 1) forward colporrhaphy, 2) the operation rectify improper situation of uterus, 3) trachelectomies and 4) colpoperineoplasties. Therefore it is impossible to agree with some authors (D.O.Ott, Heidenhain, D.A.Gudim-Levkovich, etc.) suggest confining one plastic operations. In the same way at uterus with bent of last to abaissement it are necessary to consider application of ventrofixation one only as error. Many surgeons which are insufficiently familiar with etiology and pathogenesis the PROLAPSE OF THE UTERUS, VAGINAS resorted only to excision of the drop-out uterus. Such surgical intervention didn’t reach the desired effect as soon there came backset of hernia (abaissement of urinary bladder, coliform loops). In similar events operation of vaginal hysterectomy with reduction of pelvic bottom (M.E.Elkina, M.S.Aleksandrova’s operation, Mayo) are recommended. Operation concluded colporrhaphy and colpoperineoplasty. At patients of advanced age, except colporrhaphy and colpoperineoplasty, applied hanging of uterus for circular ligaments or metropexy or vaginal path. From the operations pursue the aim of hanging of uterus for truncate circular ligaments, operation of Menge and modification was worthy. A.Kozinskogo, and also operation of Dzhilyama in R.V.Kiparskogo’s modification. These operations were show at young women at whom it is necessary to conserve generative function. From methods of metropexy vaginal path at elderly patients surgeons resorted to operation interpositions of uterus on S.A.Aleksandrova-Shauta method – Vertgeyma. Operations of vaginofixation of uterus that on technique are close to interpositions of uterus are much less often appl. At incipient states of prolapse of the uterus applied operation of ventrofixation, on Kokheru, in B.M.Tyedera’s modification. The nature of operation is reducing to bracing to abdominal wall not uterine fundus, and is more it’s than the forward wall. The uterus in this case are fix on the big extent and lay not perpendicularly to abdominal wall, and are almost collateral. Operations of hanging of uterus for the truncate circular ligaments and operations of ventrofixation should be supplement with colporrhaphy and colpoperineoplasty.

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Prophylaxis should consist in elimination of the factors promote originating of frank prolapse. In this respect crucial importance is g by prophylaxis of diseases at nursery age and in puberty. Expressly develop complexes of exercises during pregnancy and after the delivery promoted strengthening of muscles of prelum abdominale and pelvic bottom, rising of tonus of uterus and the ligamentary apparatus, high-grade involution of sexual organs after the delivery. The early rising after the delivery promoted the best involution, correct function of urinary bladder and intestine. For the purpose of strengthening of abdominal wall and pelvic bottom it are recommended with 2-3 days after the delivery systematically and (are carefully dos) to manufacture medical gymnastics.

Special value is attaching reasonable conservative conducting labors, limitation of number of obstetric operative measures who should be manufacture only on strict indications. Especially larger trauma of maternal generic paths is observed at the force delivery by application of forceps at highly set head (tearing up of m. levator). In all events of lacerations of the perineum last should be in due time and are sew correctly up.

Prophylaxis the PROLAPSE OF THE UTERUS, VAGINAS provided also correct, expedient choice for the woman of kind of work who didn’t demand serious exercise stress, appreciable strain and rising of intraperitoneal strain.

Treatment. The choice of method of treatment the PROLAPSE OF THE UTERUS, VAGINAS in many respects depended on degree of metrectopia and vagina, age of the patient and state of her health. It is accepted to distinguish operative and not operative methods of treatment the PROLAPSE OF THE UTERUS, VAGINAS.
Surgical methods of treatment were in turn section on radical and palliative. In ice-film, time there is considerable quantity of various operative methods of treatment of abaissement. At choice of method of operative measure it are necessary to consider specific features of the patient, degree of abaissement, the causes which have cause the PROLAPSE OF THE UTERUS, VAGINAS of ratio and especially age of the patient. The choice of surgical method of treatment at young women is most responsible. In these events it is necessary to prefer those methods of operative treatment that wouldn’t break sexual and generative functions.

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Vulvitis the vulgar catarral. Disturbance of surface epithelial integument (sub coitu, during gynecologic research), maceration of outer cover excretions from overlying sexual organs, urine and so forth promoted reproduction and infiltration of pyogenic germs (streptococci, staphylococci, pneumococcus’s, coliform bacillus), and also Trichomonas. On occasion the vulvitis could arise owing to masturbation or initially are itch of outside sexual organs – pruritus vulvae. Helminthes (oxyuris, especially at girls), coliform and genitourinary fistulas, abundant excretions (lochia’s) in puerperal period, disintegration of neoplasm of uteral cervix and vagina, cystitis and pyelites, syringing’s of vagina by strong solutions of Lysoformium, mercury bichloride, etc., foreign bodies (pessaries, it are long in vagina) could be the cause of originating of vulvitis also. Clinically distinguished acute and chronic vulvitis. At acute, the burning sensation in the field of the outside sexual organs, strengthen are observe during emiction, sometimes pain at removal. Further the burning sensation gradually petered, occur bed more or less strong itch. Slimy at vulvitis intensely red, morbid at touches, sometimes sleek and hydro pic, in certain cases with pulled rough surface, it are coated slimy or it are purulent – slimy scurf. At chronic vulvitis the main subjective symptom are the itch, and objective – transferring of diffusive hyperemia of acute vulvitis in spotted? Macula was visible on inner surface of small labiums and on caruncles of hymen. Sometimes the erythema remained only in circle of outside hole of lead-out duct of bartholin’s gland. The clitoris is hydro pic and is more hyperemic. On inner surface of small labium’s it are often possible to see original grain: the slimy are as though cover the smallest warts that it are not necessary to admix with acute condylomas. At careful examining it are possible to notice fine, no more pin head, nodules of yellow color. These are hyperplastic sebaceous glands. Sometimes as a result of chronic vulvitis the hypertrophy of small labium’s are observe. Prophylaxis of vulvitis consisted in keeping of the all-hygienic requirements b with care of outside sexual organs. Washing boiled warm water with soap, application of menstrual bandages, the prevention of abrasion linen and clothes pleated skins and perineum’s, and also the prevention and the conforming treatment of diseases of urinary paths and the inner sexual organs which result often are the vulvitis. Therapy of vulvitis consisted first of all in treatment of the basic gynecologic disease to which the vulvitis accompanied. In acute stage bed and sexual dormancy are show. Outside sexual organs should be wash warm boiled water with intercalation of several crystals of potassium permanganate before reception weakly – pink color of fluid. This procedure are convenient for prescribe in the form of assiduous baths. Instead of potassium permanganate it is possible to use extract from camomile, 2 – 3 % solution of Acidum boricum. After washing and careful superficial drying (mild towel or sterile gauze) the surface of vulva should be powder clear Talcum or routine powder. At chronic vulvitis to powder it are possible to add medicinal materials, e.g. zinc oxide. Greasing of surface of vulva by the wad moisten in 5 – 10 % solution of Acidum boricum in Glycerinum well reacted. For elimination of itch prescribed drugs of Brome, Valerian, etc.

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Malformations of the Vulva – see. Sexual organs (female).

Damages of a vulva. The hematoma the Vulva arose most often after the delivery, less often at damages (impact, fall on a blunt subject) as complication after operation (for example, after an extirpation of a bartholin’s gland). Development of a hematoma the Vulva is accompanied by sense of a pain, a strain, difficulty when walking. At very big hematoma the phenomena anemisationses was observed.

Damages the Vulva was occasionally observed at the sexual intercourse. The diagnosis is position on the basis of detection in area the Vulva of tumorous formation of bluish-red color. The hematoma could propagate upwards to a pubis, downwards – to a perineum and an anus; in depth the hematoma reached a genitourinary diaphragm, occasionally propagate in fossa ischio-rectalis.

Treatment, as a rule, conservative – a confinement to bed. Dissection of a hematoma is showing at the phenomena it a becoming infected and a pyesis.

Gunshot wounds the Vulva (in the conditions of a no predatory and military situation) met very rarely. So, from 26 events of urogenital wounds and the damages observed by I.F.Zhordania, wound and damage the Vulva descending in 6 events; in 5 events simultaneously there were a wound of a vagina, in a one event – and urinary bladder; in two events these wounds accompany by damages of pelvic bones. Treatment, as a rule, the operative.

Diseases of a vulva. Inflammatory processes – a vulvitis (see) the bartholinitis (see), vegetation’s. Hyperkeratosis – a leukoplakia (see). The leukoplakia are sometimes combine or passed in a kraurosis (see) and are routinely accompany by sense of an itch in the field of outside sexual organs.
Tumors the Vulva met good-quality (fibromas, myomes) and malignant. The fibroma sprouted from a fat of the larger vulvar lips, is more rare – from fascias of a basin and a parametric fat, and represented dense knot on the wide establishment or on a leg (fibroma pendulum). Weight of a tumor could reach several kegs the Forecast the favorable. At recognition it should be differentiate with an inguinal or femoral hernia. The myome the Vulva educed from the outside extremity of circular uterine ligament. Treatment of fibromas and myomes of the Vulva the operative.

Malignant tumors: melanoma, crayfish, sarcoma. From a skin of vulvar lips, in particular in the presence of birthmarks, the melanoma occasionally could educe. The tumor is represented in the form of the solitary or plural clusters of dark-brown or black color. Similar (very rarely me) the tumor are describe by L.I.Krotovoy (1957). Treatment – early operative; the forecast are poorly favorable.