Genital Prolapse

Genital prolapse is a common condition that can affect women of all ages. Multiple risk factors have been identified and studied that are thought to contribute to the development of genital prolapse, including age, parity, menopausal status, body mass index (>30kg/m2), race, genetics, connective tissue disease, tobacco use, chronic lung disease, chronic constipation, occupational straining, and previous surgery.

Genital prolapse is a general term for weakening or loss of support to the pelvic organs (bladder, vagina, uterus, and rectum) resulting in a herniation of those pelvic organs. Site-specific pelvic examinations are used to determine the exact location of pelvic floor weakness, and the current grading systems [Baden-Walker, pelvic organ prolapse quantification (POP-Q) system] allow documentation of the degree of prolapse, which can be communicated to other clinicians. The types of genital prolapse include:

• Vaginal vault prolapse - herniation of the vaginal vault caused by loss of support or weakening of the uterosacral ligaments, cardinal ligaments, and loss of attachment of the endopelvic fascia to the white line at the level of the sacrospinous ligament, or a combination of the above mentioned.

• Uterine prolapse - herniation of the uterus caused by loss of support of the uterosacral and/or cardinal ligaments.

• Cystocele - herniation of the anterior vaginal wall and bladder caused by tearing, stretching, or a combination of the two, of the anterior wall endopelvic fascia. The insult may either be midline, resulting in a central cys-tocele, or a lateral insult resulting in a paravaginal defect.

• Enterocele - herniation of the superior portion of the posterior vaginal wall caused by tearing, stretching, or a combination of the two, of the posterior vaginal wall endopelvic fascia.

• Rectocele - herniation of the inferior portion of the posterior vaginal wall and rectum caused by tearing, stretching, or a combination of the two, of the posterior vaginal wall endopelvic fascia.

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