Bubble feeling in vagina, reference from 1800's

Submitted by aza on November 17, 2009 - 9:51pm
Body: 

I recall reading something in these forums about women having a feeling of a bubble or air in their vagina. Then yesterday I read this in the book "A Hospital by the River" about a fistula hospital in Ethiopia (hope it is ok to mention the title?). This is an excerpt talking about Marion Sims, the man who invented forceps among other things.
A woman had been thrown from her pony when it was scared by a pig (sheesh, of all the luck...!) "On examination he found that there was a retroversion of the uterus. Placing the woman on her knees on the edge of the bed, he introduced his middle and index fingers into the vagina and began to try to push the uterus back. 'I turned my hand with the palm upward, and then downward, and pushing with all my might, when all at once I could not fell the womb nor the walls of the vagina. I could touch nothing at all. It was if I had put my two fingers into a hat and worked them around without touching the substance the substance of it. While I was wondering what it all meant, Mrs Merrill said, 'Why doctor, i am so relieved." My mission was ended but what had brought relief I could not understand.'
Sims told his patient to lie down on her side As she did, there was an explosion as though there had been an escape of air from the bowel. Mortified, she began to apologise but Sims told her, "This is not from the bowel, it is from the vagina and it has explained now what i did not understand before." SIms concluded that when he dilated the vagina, the air pressure rushing in had restored the uterus to its proper place."
He then was so driven by excitement that he had some sort of very effective method that he went around in his buggy for months working with other women with prolapses, fistulas, etc with great success, then began to design instruments to facilitate this (these instruments later became modern day forceps).
Anyway, I sense that this may be an interesting piece of this incredible puzzle? I am so curious about the bubble!

louiseds

November 17, 2009 - 10:50pm

Try searching "sstomach vacuum", "vaginal air", "air in the bladder", "nauli" and "inversion exercises". Imagine if he had taught the community midwives how to do this manoeuvre? Perhaps many fistulae would never have happened? why does it have to be secret doctors' business? And why did he not know what had happened? Who had trained him? Very interesting.

aza

November 17, 2009 - 11:36pm

Ok, so the bubble feeling comes from air in the vagina, which can be cause by loosened pelvic floor muscles. Or, more seriously, it can be from a fistula that allows air to found its way into the bladder (vesico vaginal), or air from the bowels that has found its way to the vagina (rectovaginal), or from the intestines that has somehow gotten into the bladder (enterovesical). Apparently some bacteria that can cause bladder infections can produce gas as well but this is pretty rare. Does that sound right? Do most of you who have experienced the bubble feeling - did you already know you had some sort of POP or compromise? It seems that there would be evidence of a fistula. I have known about these conditions but had not heard the air part of it.
To be totally honest, I don't quite understand what he experienced or saw, such as described in this from the "Evolution of Pelvic Surgery" which is his rendition of the above event:
“Full of thought I hurried home-and the patient (with vesicovaginal fistula) was placed in the position described, with an assistant on each side to elevate and retract the nates. I cannot, nor is it needful to describe my emotions, when the air rushed in and dilated the vagina to its greatest capacity, whereby its whole surface was seen at one view, for the first time by any mortal man. With this sudden flash of light, with the fistulous opening seen in its proper relations, all the principles of the operation were presented to my mind...And thus in a moment, in the twinkling of an eye, new hopes and new aspirations filled my soul, for a flood of dazzling light had suddenly burst upon my enraptured vision, and I saw in the distance the great and glorious triumph that awaited determined and persevering effort...I thought only of relieving the loveliest of all God’s creations of one of the most loathsome maladies that can possibly befall poor human nature...Full of sympathy and enthusiasm, thus all at once I found myself running headlong after the very class of sufferers that I had all of my professional life most studiously avoided.”
What do you think?
Louise, me sense is that this was all new experiences and realities for care providers of that era. Surely fistulas had been happening for eons, unfortunately, but at that time malnutrition wracked many pelvis' beyond recognition, resulting in prolonged and obstructed labours with already compromised (often very young) bodies. Interesting to think that forceps, like many 'tools' were probably quite helpful when they were invented but now cause more harm than good. Sims went to med school but what do ya reckon they knew about the pelvic floor? ;)

louiseds

November 18, 2009 - 12:58am

Hi Aza

I can see the connection with fistula but I don't think that is what our Members talk about. I put in the 'air in the bladder' term because we were talking at the time about a sensation described as a bubble of air in the bladder. However, I always thought it was actually air in the vagina, and it was caused by the organs kind of sealing off the vagina with the air above them. I imagine the sensation would have been the walls unsticking from each other and separating, allowing the air bubble to get closer to the introitus so it could ultimately escape. In my experience the air gets in there when I do some sort of inversion, eg bending deeply from the hips and my organs go slop, towards my chest and create a vacuum in my vagina, which then sucks air in. I can either bear down slightly to expel the air before standing up again, or just stand up, in which case my organs will settle again across the vagina, closing it up and the air will usually mostly 'fart' out on the way up. Sometimes a little air remains, and that feels like a bubble. It is in the general area of the bladder, and may even be in the bladder, but it kind of plops out quietly after a few seconds.

I have always regarded it as no big deal, but I don't get embarrassed because I don't do mixed yoga classes! It is just a body noise to me. I guess if you don't have POP, all your organs are tethered quite tight inside, so they don't drag air in when they move towards the chest.

And yes, we do need to remember that doctors were not always trained as they are now. Many surgeons were also barbers, which is a bit of a scary thought.

The positive way to use this air is that if you can get it to happen you have successfully created a vacuum effect, and there is now some air and extra room in there, so you invert, and can jiggle your organs around a bit and get them to hang as high in the vagina as they can. Then you can expel the air and stand up again into WW posture. This isone of the tools I use to help my body to recover from low organs. It can be done discreetly anywhere with a handbag being opened on the pavement and with your butt towards the shop window. So next time you see an impatient, stubborn old cow backed up to a shop window rummaging around in her handbag somewhere on this fine planet, it is probably moi, doing some maintenance. Hang around until I've stood up again, and come and introduce yourself.

:-)

Cheers

Louise

alemama

November 18, 2009 - 10:15am

let's see if I can remember everything I want to say.....I thoroughly enjoyed this account. How excited he was.
So when I nauli and look with a mirror at my vagina (have to hold open the labia a bit) it opens wide up- like if the introits was bigger I could put a tennis ball inside- that is the way it looks- rounded and open. This is what the doctor saw and was totally stoked about. I bet he could see clear to the cervix. When you look at the vagina with a speculum even, you do not get this kind of view- yes it holds the space open but the walls squish all around it- I think this is one of the main reasons POP goes undiagnosed- we all look the same (or basically) with the walls squishing around the speculum-since that is what the vagina walls want to do- close together.
When you see the vagina held strongly open by abdominal vacuum you can really see an injury like a fistula. You would not be able to see a prolapse though because they are pulled right up! Probably why he was confused at first....
He had the lady on her knees and I am guessing hands or elbows-
Louise a young woman (or well toned pop free woman) does not get air trapped in her vagina because the walls are totally sealed together and the introits is sealed well shut-but if they were to hold open the labia they could easily pull air in.
hope I got it all down :)

louiseds

November 18, 2009 - 8:02pm

Yes Alemama, you are right. Doctors are looking with the wrong tool when they tell us we have the POPs that we already know we have.

It all goes back to the 19th century 'learn from horizontal cadavers' thing. The horizontal woman and the vertical woman are not the same creature. The cadaver cannot approximate the structure of the living vertical woman. If a woman or cadaver is horizontal she is in a sense just a skin bag with all her body parts inside (hope nobody is offended by this). She has no structure because her muscles won't work in the way they do to support her body and her pelvic organs. When she is horizontal her body is like a marionette with broken strings. The speculum is fighting the vagina's tendency to be flat. The valsalva manoeuvre without speculum is the telling thing for a doctor, but it still only shows what the woman already knows.

Yes, he really had an Aha! moment. He was open to learning.

Cheers

Louise

Christine

November 19, 2009 - 11:29pm

I guess I’m the fatalist here.

You may already know this, Aza, but Sims’ reputation was very dubious. He is heralded in medical books as the Father of Gynecology, but a “people’s” history tells quite another story: that he experimented first on black slave women in the South over and over again, and then white women at his “Women’s Hospital” in the North.

First of all, I think his account of replacing the prolapsed uterus is bizarre. The uterus moves up with no effort at all, and “pushing with all my might” sounds dramatic at best. All of us with prolapse know that air escaping into the vagina does nothing to restore organs to their proper positions. It was the patient’s hands and knees positioning that moved her organs out of her vagina and against her abdominal wall. A genteel woman of that era probably never assumed that position (certainly not during sex!)

Aza, I find your words very interesting: “To be totally honest, I don't quite understand what he experienced or saw” when he exclaimed:

“I cannot, nor is it needful to describe my emotions, when the air rushed in and dilated the vagina to its greatest capacity, whereby its whole surface was seen at one view, for the first time by any mortal man. With this sudden flash of light, with the fistulous opening seen in its proper relations, all the principles of the operation were presented to my mind...And thus in a moment, in the twinkling of an eye, new hopes and new aspirations filled my soul, for a flood of dazzling light had suddenly burst upon my enraptured vision, and I saw in the distance the great and glorious triumph that awaited determined and persevering effort.”

I think your instincts are right-on that this was the dawning of “new experiences and realities for care givers” - in other words, the Surgical Age of gynecology.

This patient with fistula was of “the very class of sufferers that I had all of my professional life most studiously avoided.” Not exactly an altruistic humanitarian, Sims. But she afforded him his first unobstructed view of female genitals and his reaction was orgasmic, to say the least. Prior to this, women were completely shrouded and the doctor would only feel under large skirts or heavy sheets. Of course he was familiar with prolapse and I believe what he saw in that instant “of great and glorious triumph that awaited” was not only fistula repair, but anterior and posterior colporrhaphy.

Astonishingly, if you read Dr. Romanzi’s site you will see that Sims set a paradigm, which carries on to this day. Medical doctors in general boast about their travels to Africa to relieve suffering women of fistula, yet never is a word spoken of the infibulation that causes it! These ancient practices were possibly transported to the American south? (until the black population was saturated with Christianity) and perhaps the reason Sims found himself “running headlong” after this population of surgical prospects. In STWW I wrote about the other reasons for fistula in this population - immature pelvis, etc., but could infibulation have played a role?

“Enraptured vision”? I say it was insanity. The good news is, we ended up with a most needed treatment for fistula. The bad news is, the most ill-conceived operations ever developed came along with the deal.

Christine

aza

November 22, 2009 - 12:02am

Louise and Alemama, everything you write makes clear sense. Though judging by the amount of air expelled by childless women in yoga classes that I have attended, I think there is more to the story than prolapse / lax vaginal walls ;) And I will never look at a woman rummaging through her handbag quite the same, either! I am actually a bit envious of what you seem to be able to feel in your pelvis - 'organs go slop' etc. I am sorry for the experiences that led you here, but at the same time I think the level of familiarity and recognition that comes with this reparative work is pretty amazing.
Christine, I know of Sim's reputation and the horror stories of all his surgeries on slave women without anesthetic, etc. Accounts of these practices render them truly unfathomable, as are some of the attitudes and colonial paternalism for fixing fistulas, etc. But I think at some level this was a time of simple discovery that must have been amazing, a time when information dissemination was slow as molasses, literally.
The account I quoted was supposedly a retroverted uterus (initially, I assumed prolapse as well until I read back through it). Perhaps when speaking of 'pushing with all his might' he was referring to the resistance of the part of the hand remaining on the outside and jammed against the pubic bone when the index and middle fingers are on the inside. I wonder if some of the enraptured vision was feeling the space created when the reproductive organs have fallen into their correct place (and it would make sense to me that this would put the uterus out of reach of the fingers, hence the pushing with all his might blather). You are also correct, Christine, in that right after this eureka moment, SIms began designing and using instruments and finding through much trial and error the right suturing material and needles, thus the beginning of the surgical age of gynecology.

louiseds

November 24, 2009 - 9:39am

I just did some Googling on that. It seems that there are some fistulae caused by genital infibulation, but it is a relatively minor cause, second to poor childbirth education, lack of health services, lack of transport for labouring women, poor nutrition, sexual assault, broken pelvis, very young mothers who have been malnourished in childhood. These women in third world countries are up against it in so many ways.

Louise