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TABLE 11-2 ■ Bulges and Swelling of the Vulva, Vagina, and Urethra

Cystocele

A cystocele is a bulge of the anterior vaginal wall, together with the bladder above it, that results from weakened supporting tissues. The upper two thirds of the vaginal wall are involved.

Urethrocele

Cystocele

Urethrocele

Cystocele

Cystourethrocele

When the entire anterior vaginal wall, together with the bladder and the urethra, is involved in the bulge, a cystourethrocele is present. A groove sometimes defines the border between urethrocele and cystocele, but is not always present.

Bulge

Rectocele

A rectocele is a herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.

Labial swelling

Labial swelling

Bartholin's Gland Infection

Causes of a Bartholin's gland infection include gonococci, Chlamydia trachomatis, and other organisms. Acutely, it appears as a tense, hot, very tender abscess. Look for pus coming out of the duct or erythema around the duct opening. Chronically, a nontender cyst is felt. It may be large or small.

Caruncle

Urethral Caruncle

A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. It occurs chiefly in postmenopausal women, and usually causes no symptoms. Occasionally, a carcinoma of the urethra is mistaken for a caruncle. To check for this, palpate the urethra through the vagina for thickening, nodularity, or tenderness, and feel for inguinal lymphadenopathy.

Prolapsed urethral mucosa

Prolapse of the Urethral Mucosa

Prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. It usually occurs before menarche or after menopause. Identify the urethral meatus at the center of the swelling to make this diagnosis.

TABLE 11 -3 ■ Variations in the Cervix

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