Genital prolapse

Genital prolapse is the term used for prolapse of the uterus and / or vagina. It is is most commonly seen in older women after the menopause and also women who have had vaginal births. It is associated with a dragging pelvic ache, urinary incontinence and sometimes constipation. It can reveal itself with protrusion of the vagina or the uterus itself on bearing down. It impacts on the patients health both physically and emotionally.

Cause

The cause of genital prolapse is weakness of the muscular and ligamentous supports of the uterus and vagina. Pelvic floor damage after childbirth and weakness resulting from oestrogen deficiency following the menopause are the prime causes.

Treatment

Treatment may occasionally be achieved by conservative measures such as pelvic floor exercises under the care of a physiotherapist and the use of oestrogen cream over several weeks.

Often the prolapse may have progressed to a degree where conservative measures are unlikely to succeed. In this situation surgery is the only other treatment choice.

It is necessary to perform a gynaecological examination to assess the degree of prolapse and to assess the type of prolapse.

Classification

Uterine prolapse

  • 1st degree (prolapse down to 1/3rd of the vaginal length).
  • 2nd degree (prolapse down to 2/3rd of the vaginal length).
  • 3rd degree (prolapse of the full length of the vaginal length).
  • 4th degree (visible protrusion of the cervix outside of the vagina).

Vaginal prolapse

  • Bladder prolapse (anterior wall).
  • Bowel prolapse (posterior wall).
  • Enterocoele (vaginal vault behind the cervix).

Treatment should be directed to the main problem. It might include:

  • Vaginal repair.
  • Vaginal hysterectomy.
  • Vaginal hysterectomy and vaginal repair.

Some operations can involve insertion of synthetic material called mesh in an effort to give greater strength to the repair. There are concerns that this mesh could become infected and can also erode through the vaginal wall resulting in multiple operations to piecemeal removal of the mesh (Mesh erosion).

For this reason I do not favour the use of mesh in vaginal prolapse repair.