Genital Prolapse

Question 1

What is genital prolapse?

Answer 1

Characterized by the descent of one or more pelvic structures from their normal anatomical position, moving towards or through the vaginal opening.

Question 2

What are the risk factors for genital prolapse?

Answer 2

Vaginal childbirth, particularly with traumatic or complicated deliveries
Increasing age
Menopause
Hysterectomy
Obesity
Chronic cough
Heavy lifting
Connective tissue disorders

Question 3

What are symptoms of genital prolapse?

Answer 3

Pelvic discomfort or a sensation of ‘heaviness’
Visible protrusion of tissue from the vagina
Urinary symptoms such as incontinence, recurrent urinary tract infections or difficulties voiding
Defecatory symptoms, including constipation or incomplete bowel emptying
Sexual dysfunction

Question 4

What are the forms of genital prolapse?

Answer 4

Anterior vaginal wall
Cystocele: bladder (may lead to stress incontinence)
Urethrocele: urethra
Cystourethrocele: both bladder and urethra

Posterior vaginal wall
Enterocele: small intestine
Rectocele: rectum

Apical vaginal wall
Uterine prolapse: uterus
Vaginal vault prolapse: roof of the vagina (common after hysterectomy)

Question 5

What are the differentials for genital prolapse?

Answer 5

Gynecologic malignancy: associated with abnormal vaginal bleeding, weight loss, and pelvic pain

Cervicitis: characterized by vaginal discharge, bleeding, and pelvic pain

Urethral diverticulum: presents with dysuria, recurrent UTIs, and a palpable anterior vaginal mass

Question 6

What investigations are carried out?

Answer 6

Detailed pelvic examination

Ultrasound or MRI may also be useful in complex cases or for surgical planning. Urodynamic studies may be indicated if there are co-existing urinary symptoms.

Question 7

What are management options?

Answer 7

Conservative measures such as lifestyle modification (weight loss, smoking cessation, avoiding heavy lifting) and pelvic floor exercises

Pessary use, which can provide symptomatic relief and may be particularly suitable for women who are not surgical candidates

Surgical repair, which may involve native tissue repairs or the use of mesh. Surgical approach can be vaginal, abdominal, or laparoscopic/robotic.