Female genital prolapse

Female Genital prolapse / Pelvic organ prolapse
Classification and external resources
Specialty	Gynecology
ICD-10	N81
ICD-9-CM	618
DiseasesDB	25265
MeSH	D014596

Female genital prolapse (or vaginal prolapse or pelvic organ prolapse) is characterized by a portion of the vaginal canal protruding (prolapsing) from the opening of the vagina. The condition usually occurs when the pelvic floor collapses as a result of childbirth or heavy lifting which can tear soft tissues, i.e. herniating fascia membranes so that the vaginal wall collapses, resulting in cystocele, rectocele or both. Remediation typically involves dietary and lifestyle changes, physical therapy, or surgery.

Types

• Cystocele (bladder into vagina)
• Enterocele (small intestine into vagina)
• Rectocele (rectum into vagina)
• Urethrocele (urethra into vagina)
• Uterine prolapse (uterus into vagina)
• Vaginal vault prolapse (roof of vagina) - after hysterectomy

The term uterovaginal prolapse is sometimes defined as any or several of the above,^[1] and sometimes as uterine prolapse specifically.^[2]

Grading

Pelvic organ prolapses are graded either via the Baden-Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.^[3]

Shaw's System

Anterior wall

• Upper 2/3 cystocele
• Lower 1/3 urethrocele

Posterior wall

• Upper 1/3 enterocele
• Middle 1/3 rectocele
• Lower 1/3 deficient perenium

Uterine prolapse

• Grade 0 Normal position
• Grade 1 descent into vagina not reaching introitus
• Grade 2 descent up to the introitus
• Grade 3 descent outside the introitus
• Grade 4 Procidentia

Baden-Walker

Baden-Walker System for the Evaluation of Pelvic Organ Prolapse on Physical Examination

Grade	posterior urethral descent, lowest part other sites
0	normal position for each respective site
1	descent halfway to the hymen
2	descent to the hymen
3	descent halfway past the hymen
4	maximum possible descent for each site

POP-Q

POP-Q Points

Pelvic Organ Prolapse Quantification System (POP-Q)

Stage	description
0	No prolapse anterior and posterior points are all -3 cm, and C or D is between -TVL and -(TVL-2) cm.
1	The criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen (less than -1 cm).
2	The most distal prolapse is between 1 cm above and 1 cm below the hymen (at least one point is -1, 0, or +1).
3	The most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than TVL.
4	Represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (TVL-2) cm.

Management

Vaginal prolapses are treated according to the severity of symptoms. They can be treated:

• With conservative measures (changes in diet and fitness, Kegel exercises, etc.)
• With surgery (for example colpocleisis). Surgery is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. A Cochrane Collaboration review^[4] found that limited data are available on optimal surgical approaches, including the use of transvaginal surgical mesh devices, in the form of a patch or sling, similar to its implementation for abdominal hernia. However, the use of a transvaginal mesh in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. According to the FDA, serious complications are "not rare."^[5] A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices.^[6]

Epidemiology

Genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females).^[7]

See also

• Perineometer
• Pessary

References

1. Vierhout ME (December 2004). "[Diagnosis of uterovaginal prolapse]". Ned Tijdschr Geneeskd (in Dutch and Flemish) 148 (49): 2432–6. PMID 15626307.
2. Monga, Ash (2011). Gynaecology. London: Hodder/Arnold. ISBN 0-340-98354-X.
3. "ACOG Practice Bulletin No. 85: Pelvic organ prolapse". Obstet Gynecol 110 (3): 717–29. September 2007. doi:10.1097/01.AOG.0000263925.97887.72. PMID 17766624.
4. Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM (2010). "Surgical management of pelvic organ prolapse in women". Cochrane Database Syst Rev (4): CD004014. doi:10.1002/14651858.CD004014.pub4. PMID 20393938.
5. "UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse: FDA Safety Communication". U.S. Food and Drug Administration. 13 July 2011. Retrieved 23 June 2015.
6. "Women Implanted with Transvaginal Mesh Suffer from Painful, Permanent Injuries". Parker Waichman LLP. Retrieved 23 June 2015.
7. Vos, T (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.

External links

• Selected abstracts from recent medical literature on vaginal and uterine prolapse