assessment of genital prolapse is essential prior to surgical treatment, says
an Australian consultant urogynecologist.
to Professor Ajay Rane of James Cook University in Townsville, Queensland the
pelvic organ prolapse quantification (POPQ) system is the best method of
grading the level of prolapse. Although POPQ is more complex than the
Baden-Walker classification, recent trials have proven the former is more
standardized and reproducible.
said that assessment was needed to ensure appropriate treatment, which should
primarily aim at restoring function instead of appearances.
want to look at the effectiveness of treatment and this does not only mean a
good looking vagina, it means restoration of function ... so longer, tighter
and higher is no longer the dictum for the vagina. You also want it to be
better from a functional point of view. The bladder, bowel and coitus have to
said that the mobility of the anterior part of the vagina was less compared
with its posterior component. This is because the anterior only has to allow
the passage of urine from the bladder while the posterior has to accommodate
the passage of solids through the rectum. If the vagina were a rigid organ,
nothing would come out.
said that a prolapse could be classified as a Level I, II or III defect through
I defects are observed when the cervix prolapses into the vagina. The prolapse
is visible and the patients normally have backache but may not have other
suffering from backache, patients with Level II defect are also unable to empty
their bladder properly and experience postmicturition dribble. Straining to
open the bowels and resorting to manual digitation to defecate are other
II defects are associated with functional disorder as both the anterior and
posterior vaginal walls have prolapsed.
presenting with Level III anterior defects that result from damage to the
pubourethral ligaments, have stress incontinence.
diagnosis of a Level III defect in the posterior vaginal wall is usually
missed, said Ajay.
added that this defect, however, could be corrected in about five minutes of
surgery, by attaching the perineal body to the lower one third of the vagina.
with a Level III posterior defect have an enlarged hiatus, a loose vagina and
suffer from vaginal flatus, an embarrassing symptom. Bubbling noises during
intercourse may lead them to refuse intercourse.
of parity, when women are standing up, their vagina should be turned backwards
at an angle of 135˚ posteriorly.
to Ajay, in treating genital prolapse, gyneurologists must counter the effects
of gravity on the vagina when women are standing or walking around.
pelvic floor is a collagenous fibromuscular type of tissue intersected with
nerves and blood vessels that supports the uterus, vagina, bladder and rectum.
is the best dynamic, antigravity trampoline because it has slow-twitch and
fast-twitch fibers, which constantly adjust muscle tone to the woman�s
the pelvic floor is akin to a dynamic hammock, women should take good care of
it by doing Kegel exercises regularly, he stressed.
dynamic hammock does get denervated with childbirth, lack of exercise and
depleting estrogen, Ajay added.