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October 22, 1898


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JAMA. 1898;XXXI(17):976-982. doi:10.1001/jama.1898.92450170030002i

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Relaxed vaginal outlet, concealed lacerations or deep musculo-fascial tears of the pelvic floor, can not be too forcibly brought to the notice of the physician as an important diagnostic indication for colpoperineorrhaphy. Kelly calls such, concealed relaxation. This is a condition of loose, gaping vulva, compared to the mouth of a bag without its puckering-string by Dr. Emmet. If the patient lie on the back the fork of the buttocks looks flattened, the anus appears everted, and one may observe the vaginal mucosa bulging out above or below. The condition is frequently described as rectocele or cystocele, or both. Others call it perineal laceration. Some will write that it can not be perineal laceration, because the skin perineum is longer than the normal one. The skin perineum is longer than normal because, when it was stretched at labor, it never returned to normal (subinvolution). Occasionally one can introduce the four

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