Fast Five Quiz: Vaginal Health

Michel E. Rivlin, MD

Disclosures

October 01, 2021

Pelvic organ prolapse is the abnormal descent or herniation of the pelvic organs from their normal attachment sites or their normal position in the pelvis. The pelvic structures that may be involved include the uterus (uterine prolapse) or vaginal apex (apical vaginal prolapse), anterior vagina (cystocele), or posterior vagina (rectocele). Many parous women may have some degree of prolapse when examined; however, most prolapses are not clinically bothersome without specific pelvic symptoms, and they may not require an intervention. Approximately 3% of patients with pelvic organ prolapse are symptomatic.

Although signs of pelvic organ prolapse are frequently observed, the condition seldom causes symptoms. However, vaginal or uterine descent at or through the introitus can become symptomatic. Symptoms of pelvic organ prolapse may include:

  • A sensation of vaginal fullness or pressure

  • Sacral back pain with standing

  • Vaginal spotting from ulceration of the protruding cervix or vagina

  • Coital difficulty

  • Lower abdominal discomfort

  • Voiding and defecatory difficulties (an anatomic kinking of the urethra may cause obstructive voiding and urinary retention)

Nonsurgical (conservative) management of pelvic organ prolapse is recommended by the American College of Obstetricians and Gynecologists' Committee on Practice Bulletins and should be attempted before surgery is contemplated. Patients with mild pelvic organ prolapse do not require surgery because they are usually asymptomatic. Pelvic muscle exercises and vaginal support devices (pessaries) are the main nonsurgical treatments for patients with pelvic organ prolapse. Kegel exercises may help improve incontinence associated with mild pelvic organ prolapse.

Quality-of-life assessment by standardized questionnaires (eg, Pelvic Floor Distress Inventory Questionnaire 20 (short form), Pelvic Floor Impact Questionnaire 7 (short form), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire) are helpful in determining appropriate treatment. A detailed sexual history is crucial, and focused questions or questionnaires should include quality-of-life measures.

Read more on pelvic organ prolapse.

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