Uterovaginal prolapse

1. Big picture

Uterovaginal prolapse is a type of pelvic organ prolapse (POP) in which the uterus and/or vaginal walls descend because the pelvic floor muscles, fascia, and uterosacral-cardinal ligament support system are weakened. It is common, benign, and quality-of-life affecting rather than malignant.

The examiner wants to hear three things:

1. Recognize the pattern: “something coming down,” vaginal bulge, pelvic pressure, urinary/bowel/sexual symptoms.
2. Stage and define the compartment: anterior wall, apical/uterine, posterior wall, or vault prolapse.
3. Treat according to symptoms, stage, age, fertility/sexual wishes, comorbidities, and surgical fitness.

Pelvic organ prolapse is commonly associated with vaginal bulge/pressure, voiding dysfunction, defecatory dysfunction, and sexual dysfunction; ACOG notes a lifetime risk of undergoing surgery for prolapse of about 13%, with peak symptomatic incidence in older women. ([acog.org][1]) NICE guidance covers pelvic organ prolapse assessment and management in adult women and emphasizes conservative and surgical options, including attention to mesh-related complications. ([NICE][2])

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