Prolapse Examination

The prolapse examination should be site specific, carefully looking for support defects of the uterus, vaginal apex, anterior vaginal wall, and posterior vaginal wall. This is performed using a standard Grave's speculum and needs to be done in a methodical manner. Typically, we evaluate uterine and vault support first by having the patient Valsalva with either the cervix or vaginal apex isolated with the speculum (Figure 3-1.2). The speculum is then split and the anterior and posterior vaginal compartments are evaluated independently (Figure 3-1.3). The vault should be supported during anterior and posterior wall evaluation to accurately develop an understanding of the patient's specific pelvic floor weaknesses. It is often necessary to have the patient stand to accurately assess their degree of prolapse. The prolapse should be documented with a standardized system, as described below.

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