Genital prolapse in women
Genital prolapse (also known as pelvic organ prolapse) refers to uterine, uterovaginal, or vaginal prolapse. Genital prolapse has several causes but occurs primarily from loss of support in the pelvic region. For ease of understanding, in this review we have attempted to use the most common and descriptive terminology. In uterine prolapse the uterus descends into the vaginal canal with the cervix at its leading edge; this may, in turn, pull down the vagina, in which case it may be referred to as uterovaginal prolapse. In the case of vaginal prolapse, one or more regions of the vaginal wall protrude into the vaginal canal. Vaginal prolapse is classified according to the region of the vaginal wall that is affected: a cystocoele involves the upper anterior vaginal wall; urethrocoele the lower anterior vaginal wall; rectocoele the lower posterior vaginal wall; and enterocoele the upper posterior vaginal wall. After hysterectomy, the apex of the vagina may prolapse as a vault prolapse. This usually pulls down the anterior and posterior vaginal walls as well. The two main systems for grading the severity of genital prolapse, the Baden–Walker halfway system and the Pelvic Organ Prolapse Quantification (POPQ) system, are summarised in table 1. Mild genital prolapse may be asymptomatic. Symptoms of genital prolapse are mainly non-specific. Common symptoms include pelvic heaviness, genital bulge, and difficulties during sexual intercourse, such as loss of vaginal sensation. Symptoms that may be more commonly associated with specific forms of prolapse include: urinary incontinence, which is associated with cystocoele; incomplete urinary emptying, which is associated with cystocoele or uterine prolapse, or both; and the need to apply digital pressure to the perineum or posterior vaginal wall for defecation, which is associated with rectocoele.
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