If the apex of the rectocele is drawn to one side, there is formed on the other side a triangular area (Fig. 46, _a_, _b_, _c_). The base of this area (_a_, _c_) is at the ostium vaginæ. The inner side (_a_, _b_) runs along the side of the rectocele. The outer side (_b_, _c_) runs along the lateral vaginal wall. The apex _b_ is approximately the highest point of the tear in the sulcus. The angle _c_ is immediately below the orifice of the vulvo-vaginal gland. The angle _b_ is fixed by a tenaculum held by an assistant, and the triangular area is denuded. The denuded area does not correspond exactly with the original tear in the sulcus, but the denudation exposes the sulcus, so that sutures may be passed in such a way as to include the muscles and fascia. The sulcus on the opposite side is then denuded in a similar manner, and the lower face of the rectocele is denuded. It is best to begin the denudation by seizing with tissue-forceps the mucous membrane of the posterior vaginal wall at the ostium vaginæ, at the junction of skin and mucous membrane, and to remove contiguous strips of tissue by cutting upward toward the apex of the vaginal sulcus (Fig. 47). [Illustration: FIG. 50.--Introduction of the sutures. The point of the emerging needle is held by the tenaculum.] [Illustration: FIG. 51.--Sutures introduced in both sulci.] In the denudation no skin is sacrificed. The denudation is not carried below the line of junction of vaginal mucous membrane with skin. Each sulcus is closed by sutures separately, as in the immediate operation. The first suture is passed across the upper angle _b_. [Illustration: FIG. 52.--Method of securing sutures with perforated shot.] [Illustration: FIG. 53.--Both sulci are closed. The support of the perineum is restored. The posterior wall of the vagina is brought forward. The rectocele is cured.] The second suture is introduced about an eighth of an inch from the edge of the mucous membrane on the left vaginal wall, is passed backward, downward, and outward so as to grasp retracted muscular fibers, and is made to emerge at the bottom of the sulcus. It is then re-introduced and passed forward between the mucous membrane of the rectum and the denuded surface, and somewhat upward, to emerge on the edge of the mucous membrane of the rectocele. A third and, if necessary, a fourth suture are passed in a similar manner. Similar sutures are then passed to close the right-hand sulcus. [Illustration: FIG. 54.--Sutures for closing the superficial perineum and fourchette. The anterior suture is called the “crown suture.”] [Illustration: FIG. 55.--Emmet’s operation of perineorrhaphy completed. Compare this figure with that representing the condition of the parts before operation (Fig. 45).]