The pain is that which characterizes any local pelvic inflammation. It is most intense in the ovarian regions. Bimanual examination may reveal the enlarged, tender ovaries, which are very often prolapsed behind the uterus. The greatest gentleness should always be observed in making a vaginal examination in any case of inflammation of the pelvic structures, not only to avoid inflicting unnecessary pain, but because a much more satisfactory examination can be made if the woman does not fear and resist the examiner. _Treatment._--The treatment of acute oöphoritis is expectant. It is similar to that already advised for acute salpingitis. The physician should prescribe absolute rest in bed; hot fomentations over the abdomen; saline laxatives; and warm vaginal douches of sterile water if the pain is not increased by them. [Illustration: FIG. 161.--Cystic ovary.] If suppuration occurs, immediate laparotomy with removal of the diseased structures should be practised. If the acute inflammation subside, subsequent operation may be necessary for the chronic inflammation. =Chronic Oöphoritis.=--Chronic oöphoritis, like the acute form, may be either parenchymatous or interstitial. Usually both the connective tissue and the ovarian follicles are involved. The disease is usually bilateral. The tunica albuginea may become much thickened, and adhesions may form between the ovary and the adjacent structures. In practice we find chronic oöphoritis in two forms: The ovary may be cystic, filled with a number of cysts of varying size up to that of a marble (Fig. 161). These cysts are transformed ovarian follicles. The walls are thickened, and the ova and the membrana granulosa have undergone fatty degeneration and absorption. The fluid in the cysts may be clear, cloudy, bloody, or gelatinous. Sometimes the septa are absorbed, and several cysts are thrown into one cavity. The connective tissue of the ovary is increased in amount. The ovary becomes enlarged, though it rarely exceeds the size of a hen’s egg. [Illustration: FIG. 162.--Cirrhotic ovary from an old maid forty years of age.] It is probable that this form of inflammatory change is the origin of some kinds of small ovarian cystic tumors.