Vaginal Irrigations

VAGINAL IRRIGATIONS, introduced into general medical practice by Kiwisch (Kiwisch, 1845). The physiological justification for this method was given by Runge. However, it is known that even in antiquity Galen and Avicenna used irrigations with the addition of various decoctions. Due to their simplicity, vaginal irrigations are currently one of the most common therapeutic procedures. The apparatus used for irrigation consists of an Esmarch's flask (irrigator) with a capacity of 5-6 glasses, a gutta-percha tube 1.5 m long, and a slightly curved glass vaginal nozzle with one wide or several lateral openings at the end. Before use, the irrigator should be thoroughly rinsed. The nozzle after irrigation must be boiled and kept in a weak soda solution. To have a beneficial effect, it is necessary to explain all the details of this simple procedure to the patient, otherwise it may do more harm than good. Any irrigation should be performed necessarily lying on the back, with the pelvis raised, on a bedpan. The flask is hung or held at a height of 72 cm above the bed. The fluid from the irrigator (boiled water of a certain temperature and with the addition of medicinal substances), after expelling air from the intestine, is introduced as a flowing stream into the vagina. It is recommended for hot irrigations, to avoid burns, to pre-lubricate the skin of the external genital organs with some fat. The stream of water should be weak, the pressure low. The flask of 5 glasses should be used for at least 5 minutes to allow the individual portions of water to have a longer contact with the vaginal mucosa. After irrigation, the patient should lie in bed for at least half an hour. The best time for irrigation is in the hours before sleep, so that the patient can remain in bed all night. If the indicated conditions are not observed, 50% of the beneficial effect of irrigations is lost. The main significance of V. s. is based on the thermal effect caused by them. Under the influence of warm, not below 37.5°, V. s., primary dilation of the vessels of the sexual sphere occurs; in irrigations, starting from 37.5° and above (42.5-45°), a short-term contraction of the vascular wall is first observed, which is then replaced by its dilation. Hot irrigations also cause an increase in the tone of smooth and striated muscle. The latter is distinctly manifested in the contraction of the muscles of the pelvic floor, which in some cases is so strongly expressed that it prevents the reverse outflow of fluid from the vagina. As a result of vessel dilation, an intensified influx of blood, active hyperemia of the pelvic organs occurs, with an increase in lymph circulation in them. The latter factor determines an increase in local metabolism and the resorption of inflammatory infiltrates and exudates. In addition to the thermal effect, one should also point to the mechanical irritation of the Frankenhaeuser's cervical nerve plexus. The therapeutic action of V. s. depends, on the one hand, on the temperature of the liquid used and, on the other, on its composition (additions of medicinal substances). In terms of temperature, one can distinguish hot irrigations at 47.5°- 50° (resorptive action, sometimes- hemostatic and partly analgesic), warm irrigations at 37.5-40° (soothing action), cool- without designation of temperature, so that the patient subjectively feels a sensation of coolness (tonic action), and, finally, cold irrigations- below 34-35° (sharp irritating action - first causes ischemia, and then a strong influx of blood). At present, cold irrigations are rarely used. The therapeutic effect associated with the composition of the liquid used depends on the medicinal substances which are added to the flask. The number of means proposed for medicinal irrigations is enormous (part of them are often only a product of speculation and lack medical significance). Among medicinal irrigations, it is customary to distinguish disinfecting, astringent, deodorizing, analgesic, and hemostatic. As disinfecting agents, sublimate (1:1.000), sublamin (1:1.000), carbolic acid (1-2%), lysol (a teaspoon per flask per se), formalin (a teaspoon of commercial formalin per flask), boric acid (a tablespoon per flask), and others are used. Taking into account the bactericidal action of the named agents, one should not forget their toxic action on the organism (the vaginal mucosa still possesses a certain ability to absorb). As astringent agents for irrigations, Zincum sulfuricum (a teaspoon per flask), Alumen (a teaspoon), tannin (a teaspoon), wood vinegar (a tablespoon), and others are used more often than others. In inoperable forms of cancer, in decomposing polyps, sarcomas, etc., one has to resort to deodorizing irrigations. For this purpose, Kali hypermanganicum (a tablespoon of a 2-3% solution per flask), a 10% alcoholic solution of thymol, formalin, hydrogen peroxide, etc., are applied. Among hemostatic agents (in inoperable cancer), Oleum Martis (Liquor ferri sesquichlorati) is more often used - a teaspoon per flask. Finally, rarely as an analgesic agent, T-ra opii simplex (a teaspoon) is added to the flask. It is especially necessary to mention irrigations with milk acid, which, restoring or increasing the acidic reaction of the vaginal secretion, thereby improves the normal biological conditions of the vaginal wall, restoring the existing normal interaction between the reaction of the vaginal contents, the vaginal flora, and the glycogen of the vaginal epithelium. Thanks to the contact and establishment of a normal ratio between the indicated factors, various pathogenic microorganisms brought from outside into the vagina are neutralized. Indications for the use of vaginal irrigations: all chronic inflammatory processes of the pelvic organs and pelvic connective tissue, catarrhal processes of the vagina and cervix, known forms of underdevelopment of the uterus with signs of menstrual insufficiency, bleeding caused by benign and malignant tumors of the uterus, retroversion and prolapse of the uterus, climacteric bleeding, etc. Contraindications: all acute and subacute inflammatory processes, especially processes of a purulent nature, menstruation, pregnancy, suspicion of ectopic pregnancy. For women not living a sexual life, irrigations are, as a rule, unnecessary. In married women, there are sufficient reasons for irrigations (during intercourse one should take into account contamination and even infection). However, one can say that many women perform V. s. too often and without benefit. Irrigations performed day after day loosen the vaginal epithelium, cause transudation from the underlying venous vessels, and in some cases not only do not lead to a decrease in discharges, but, on the contrary, support and strengthen the existing fluor. In addition to this, tedious and incessant irrigations often act directly depressing on the psyche of patients.