>> A N N O U N C I N G << "Female Trouble" A selection of images from Beischer and Mackay's /Color Atlas of Gynecology/ digitized by stinkfoot (stnkfoot@kaiwan.com) for the enjoyment and continued education of the denizens of alt.tasteless and a.t.b.p. >> L E A R N << o WHO needed to learn _why_ it `should be easier'! o WHAT `condylomata acuminata' means, and why it is important to _you_! o WHEN the word `chocolate' changes connotation...drastically! o WHERE `My Anal Fissure Bob' leaves off, and `My Beefy Total Prolapse' begins! o WHY John Hollister just might have the right idea! o HOW Lenore, Louise, Pamelush, et al., are more tasteless than you and your microchoad could _ever_ be! >> F E A T U R E S << o 24-bit color JPEGs! o 8/3 filenames for MSDOS weenies! o blurry video artifacts! o single files, because it's AOL's problem, not mine! >> S O U R C E << /Color Atlas of Gynecology/ Text by Norman A. Beischer, M.D., B.S., M.G.O, F.R.C.S.(Edin.), F.R.A.C.S., F.R.C.O.G., F.R.A.C.O.G. and Eric V. MacKay, M.B., B.S., M.G.O., F.R.C.S.(Edin.), F.R.A.C.S., F.R.C.O.G., F.R.A.C.O.G., F.A.C.O.G.(Hon.) Photography by Joseph M. Schramp, L.A.S.(Leiden), F.M.P.I.A., A.I.A.P., M.I.P.T. and Alison M. Scarfe, Dip. Art. Copyright 1981 by W.B. Saunders Company West Washington Square Philadelphia, PA 19105 ISBN 0-7216-1649-6 Library of Congress catalog card number 81-52558 >> I M A G E I N D E X << (blame to stinkfoot for all square-bracketed [] material) "bridge.jpg" Plate 1 - "External genitalia in a 34-year-old para [mother of] 2 with a rather deficient parineal body. The labia minora have been parted to expose the external urinary meatus prior to catheterization. Usually the labia minora are apposed and cover the entrance to the vagina (introitus). Posteriorly they fuse to form the fourchette, seen here as a thin fold of skin. Superiorly the labia minora fuse to form the prepuce of the clitoris." "chunky.jpg" Plate 20 - "Adenocarcinoma of the endometrium [lining of the uterus] in a 71-year-old para [mother of] 3 who presented with intermittent vaginal bleeding for 2 months... The uterus was mobile and bulky. The curettings were typically yellow, profuse and crumbly; often they are even paler and so friable that a semisolid fluid resembling thick pus is obtained..." "fatlips.jpg" Plate 31 - "Acute gonococcal vulvovaginitis. This 19-year-old primigravida [first pregnancy] presented at 26 weeks' gestation with a vaginal discharge, vulval sweeling and acute urinary retention (hence the indwelling catheter). There was a copious, thin, yellow vaginal discharge and marked oedema [swelling] of the labia... Spontaneous labour and delivery followed 2 days after commencement of antibiotic therapy." "forkroad.jpg" Plate 35 - "Midline vaginal septum in a 23-year-old woman who presented with primary infertility... The septum connected the middle of the anterior to the posterior vaginal wall, was 1 cm thick and extended 4 cm up the vagina..." "cherry.jpg" Plate 41 - "Large polypoid Nabothian [cervical] cyst in a 40-year-old para [mother of] 2. This lesion was seen at routine examination for cervical cytology. Treatment was excisional biopsy and cautery." "thrdbase.jpg" Plate 52 - "View from above of a section through the lower pelise. Gloved fingers in the vagina and rectum illustrate the thick medial aspect of the levatores ani muscles (1) (puborectalis) as the fuse to form the levator hiatus, through which urethra (2), vagina (3), and rectum (4) pass from the pelvis to the perineum..." "savingup.jpg" Plate 58 - "Imperforate hymen in a 15-year-old girl admitted to hospital with sudden onset of right iliac fossa pain... The bulging hymen is shown." Plate 59 - "Incision of the occluding membran by the scalpel released a copious volume of typical chocolate-coloured, fluid, old blood." "vaginil.jpg" Plate 62 - "Congenital absence of the vagina in a 32-year-old Italian woman who presented 4 years after marriage with primary amenorrhoea [failure of onset of menstruation] and because she thought intercourse `should be a lot easier'! She had normal breast development and external genitalia..." "padiddle.jpg" Plate 68 - "Congenital absence of the left breast associated with absence of pectoralis major muscle." "spltmilk.jpg" Plate 69 - "Breast asymmetry in the only daughter of a wealthy family, resulting in pathological antisocial behavior. Note that the nipple is smaller and higher on the hypoplastic side." Plate 70 - "Same patient show in plate 69 after augmentation of the right breast... Her psyche and social behaviour were restored to normal." [Note: The pictures are nothing special, but the text is a hoot. Also note the posture and implied demeanor in the `before' and `after' pictures.] "deuxbad.jpg" Plate 72 - "Huge, symmetrical, pendulous breasts showing postlactational involution... Often the sudden change in dimensions of the breasts alarms and embarrasses the patient and her husband." Plate 73 - "Same patient shown in plate 72 after bilateral reduction mammoplasty." "busted1.jpg" Plate 74 - "Pregnancy-induced gigantomastia (diffuse hypertrophy) in a 27-year-old multigravida [second or subsequent pregnancy] at 28 weeks' gestation. This condition is exceedingly uncommon (1 in 30,000 pregnancies). The breasts had not enlarged excessively in the previous pregnancy." "busted2.jpg" Plate 75 - "Pregnancy-induced gigantomastia in a 24-year-old primigravida. Previously, when taking the contraceptive pill, her breasts had enlarged from brassiere size 32A to 36B. They returned to 32A when the pill was discontinued. This condition can also occur at puberty. During pregnancy, the breasts hypertrophied to size 46DD by 20 weeks' gestation. At this time, the right breast weighed 4.3kg [9.5lbs] and the left 4.7kg [10.5lbs] when assessed by displacement into buckets of water..." [gif!] "4xalady.jpg" Plate 76 - "Bilateral accessory axillary breasts in a 38-year-old lactating multigravida [second or subsequent pregancy] photographed 5 days after delivery. The ectopic breast tissue had enlarged to a lesser extent during previous lactations. The axillary breasts were tender and engorged but non-functional since they lacked nipples. Excision was planned as the lumps were tender and an embarrassment to the patient. Accessory breasts are less common than accessory nipples and are usually located in the axilla." "vntrlqst.jpg" Plate 97 - "Fusion of labia minora in a 64-year-old nullipara who presented with a 9-month history of dysuria. She thought there was a `blockage' in her urinary tract. This condition also occurs in young girls. Treatment with oestrogen cream locally is as effective as surgical separation and is less painful." "confused.jpg" Plate 98 - "True hermaphrodite. This 20-year-old patient was raised as a male from birth, and presented to hospital 5 years after commencement of breast enlargement and regular menstruation. The 179cm [5ft 10in] tall patient had well developed breasts, phallus of notmal dimensions but with pronounced bowing (chordee), no palpable gonads in the labioscrotal folds, and what appeared to be a perineal hypospadias." Plate 99 - "At examination under anaeesthesia, a uterus was felt on rectal examination... This view shows the bowed phallus and apparent hypospadias." "oopsie.jpg" Plate 102 - "Incomplete abortion in a 21-year-old primigravida [first pregnancy] who presented with heavy vaginal bleeding and lower abdominal pain after 10 weeks' amenorrhoea [secondary; cessation of menstruation]. The cervix was 2cm [0.8in] dialated so the patient was taken to theatre for curettage. This photograph illustrates the common finding in such patients of a dialated vagina filled with blood clot." "gramma.jpg" Plate 144 - "This 72-year-old para [mother of] 1 presented with purulent vaginal discharge and episodes of vaginal bleeding. It is uncommon for senile vaginitis to be associated with such copious discharge and trichomonal and monilial vaginitis were excluded..." "grapes.jpg" [Properly: "fruit of my loins."] Plate 148 - "Large, multiple condylomata acuminata [flat, raised lesions] of the vulva in a single 24-year-old nullipara (1 termination of pregnancy). She presented with pruritus vulvae [itching of the external genitalia] for 2 months, worse at night. The vulval warts had been steadily increasing in size for 2 years. She had a yellowish-green vaginal discharge displayed by the opened sponge forceps..." "syphilis.jpg" Plate 157 - "Snail-track ulcers of the palate seen as greyish leasions near right tonsillar area and uvula. This is one of the clinical manifestations of the secondary stage of syphilis, appearing 6 weeks to 6 months after the primary treponemal infection." Plate 159 - "Multiple condylomata lata [flat, raised lesions] involving labia majora and perineum and associated vulval oedema [swelling]. This is another manifestation of secondary syphilis... These lesions have a greyish necrotic appearance and are usually multiple as in this patient." "insdout1.jpg" Plate 168 - "Large cyst of Gartner's duct in a 40-year-old para [mother of] 2 who had noted the mass for 5 years." "insdout2.jpg" Plate 169 - "Huge procidentia [extensive prolapse] in a 73-year-old patent who presented with acute retention of urine--hence the indwelling catheter. Vaginal eversion is incomplete and the uerethra became kinked where the lower anterior vaginal wall remained normally supported. A cherry-red urethral caruncle is also visible... When replacing such a prolapse push back enterocele contents first, the uterus and finally cystocele; this is the reverse order of descent of such a prolapse when the patient strains (or stands). "insdout3.jpg" Plate 170 - "This, the largest procidentia [extensive prolapse] we have seen, was an incidental finding in a 60-year-old para [mother of] 2 diabetic admitted to a medical ward with hypertensive cardiac failure and peripheral vascular disease causeing gangrene of the left foot! The mass has been irreducible for many years... The mass consisted of a vaste cystocele (ureters kinked outside the body), third degree uterine prolapse, and an enormous enterocele containing loops of intestine." "strestoy.jpg" Plate 171 - "Huge procidentia [extensive prolapse] in a 75-year-old diabetic grand multipara [grand/mother of 2 or more] living in the west of Ireland. The mass had been present for 30 years and shows gross keratinization and ulceration. Usually ulceration involves the cervix, but this huge enterocele was the lowest part of the mass and most prone to injury... Note complete eversion of vagina..." "dontpush.jpg" Plate 172 - "Large uterovaginal and rectal prolapse in a patient at the Mater Misericordiae Hospital, Dublin. These neglected lesions are not a sign of lack of medical or hospital facilities, but are testimony to the equanimity and acceptance of disabilities by the aged. Many elderly women with large prolapses refuse surgery, claiming `the lump is no bother at all'. Others ultimately consent to surgery when urinary symptoms develop or ulceration causes haemorrhage." "balloon.jpg" Plate 207 - "Neurofibroma of the vulva in a single, 17-year-old virgin. One might wonder where she hid the tumour when she sunbathed in her bikini! She weighed 48.3kg [106.5lbs]. The lump had grown during the past 12 months and had been painful for 2 months; it was attached by a 1cm [0.4in] base to the right labium majus and was 15cm [5.9in] in length and ulcerated in 2 areas. There was an intact annular hymen." "glassjaw.jpg" Plate 208 - Vulval haematoma extending into buttocks and right labium majus. The patient was unable to void and hence the indwelling catheter. She required a 4-unit blood transfusion. Treatment was conservative and the clot discharged 9 days later... This patient had had a difficult forceps delivery and third degree tear. The same condition can be due to falling astride..." "chezcake.jpg" Plate 209 - "Classical diabetic vulvitis in an obese (80kg [176.4lb]) 69-year-old para [mother of] 3. This typical brick-red appearance and labial oedema [swelling] subsided with control of her diabetes..." "krispies.jpg" Plate 210 - "Secondary syphilis. These multiple condylomata lata [flat, raised skin lesions] of the vulva and perineum show pregnancy induced hypertrophy... Note that the lesions extend onto the patients thighs." "cottage.jpg" Plate 218 - "Extreme hyperkeratosis of the vulva in a 58-year-old woman who had complained of vulval irritation for 1 year. The lesion extended to the urethral orifice and lower third of the anterior vaginal wall. Such white plaques can obscure more sinister lesions deeper in the vulval skin. Leukoplakia means `white patch'... This patient was treated by simple vulvectomy." "hiroshma.jpg" Plate 221 - "Leukopakia localized to the anterior aspect of the vulva involving the clitoris, labia majora and labia minora. Note that the remainder of the vulval skin is atrophic. Treatment was local excision of the white area..." "notsack.jpg" Plate 223 - "Fibrolipoma of the vulva in an 84-year-old para [mother of] 2 with Parkinson's disease/ She was a strong-minded old lady and insisted that this lump, which had been present for many years, did not bother her. She consented to its removal (a simple 5-minute procedure...) only when ulceration resultedd in haemorrhage. As explained in the legen to Plate 172 ["dontpush.jpg"], the ages do not complain and indeed often refuse surgical treatment that is clearly indicated. This patient also had an asymptomatic cystocele, enterocele and rectocele [vaginal and recal prolapses] of moderate dimensions." "lthrface.jpg" Plate 232 - "Radical vulvectomy specimen showing bilateral involvement of inguinal lymph glands from a squamous cell carcinoma of the clitoris in an 83-year-old nullipara [no pregnancies] who presented with a lump in the vulva of 6 weeks' duration. Four months later masses were palpable on the lateral pelvic walls and she died 14 months after operation." "stchntim.jpg" Plate 233 - "Postoperative appearance after radical vulvectomy and bilateral lymphadenectomy. The suture line around the new introitus [vaginal entrance] cannot be seen (Plate 419 ["faceoff.jpg"]). These patients are often obese and primary skin closure is possible as here... She is alive and well 16 years after surgery." "poptart.jpg" Plate 234 - "Cryptomenorrhoea ["hidden menstruation" - flow retained behind vaginal obstruction] due to a transverse vaginal septum in a 15-year-old girl who presented because of vague abdominal pain for 6 months... Rectal examination revealed a fluctuant mass filling the pelvis. The septum was excised and..." Plate 236 - "Tarry fluid blood escapes under pressure after a scalpel has incised the...septum... The mass was entirely due to the haematocolpos which contained 1,200ml [1.3qts] of blood... These cases would not occur if it was routine practice to take the temperature of all female infants at birth with a thermometer inserted into the vagina." [Note: these two plates are from different cases.] "sausage.jpg" Plate 244 - "Large necrotic ulcerating squamous cell carcinoma of lower anterior vaginal wall in an 85-year-old woman who had had a large procidentia [extreme prolapse] for 20 years... The metal catheter displays a polypoid urethral caruncle and a cervical polyp is also shown... Treatment was local excision and the vagina healed completely! She died of unrelated causes 12 months later." "thirdleg.jpg" Plate 251 - "Large chronic complete inversion of the uterus and vagina due to a large submucous fibromyoma in a Papua New Guinean. She was para [the mother of] 3 and had noted a large lump protruding from the vulva for 10 months. The 10cm [3.9in] submucous polyp had a broad base, attached to the fundus of a completely inverted uterus..." "bloatie.jpg" Plate 360 - "Benign mucionous cystadenoma in a 70-year-old para [mother of] 6 alcoholic widow (weight 46kg [101.4lbs]) who presented with a 12-month history of abdominal distension...and vomiting... A provisional diagnosis of ovarian tumour with malgnant ascites was made. At laparotomy, 21 litres [5.5 gallons] of mucinous, dark brown fluid was aspirated..." Plate 362 - "Laparotomy revealed this huge, mobile, polycystic enlargement of the left ovary (28x18x13cm [11x7x5in])..." [Note: these two plates are from different cases.] "faceoff.jpg" Plate 418 - "Simple vulvectomy was performed. The oval incision extends to deep fascia, includes labia majora, and ends posteriorly at the fourchette [joining of labia at perineum]. A second circular incision is made around the introitus, sparing the external urinary meatus." Plate 419 - "The cut edges of skin were readily approximated (an advantage of loose skin folds around the vulva)... She died peacefully in her sleep 6 months after the vulvectomy [at age 86]." "muppet.jpg" Plate 428 - "Wound dehiscence imminent and inevitable. The patient was an obese (86kg [189.6lb]) 36-year-old para [mother of] 3 diabetic who felt `something go in her stitches' during a fit of coughing 3 days after Caesarean section. She then developed the copious, pink watery discharge that is pathognomonic of a dehiscence of the deep wound layers." Plate 429 - "The patient was taken bad to theatre 7 days after Caesarean section. After the sutures were removed, the wound literally fell apart." --------- ...stinkfoot