The womb may descend or ‘drop down’ in varying positions, pressing on other pelvic organs such as the bladder or bowel and resulting in different types of prolapse. A prolapse may be described as ‘something coming down’ in the vagina. It may cause backache and difficulty in controlling the bladder and sometimes the bowel, or discomfort during sexual intercourse.
The sling (or ligaments), the walls of the vagina and the pelvic floor muscles have become weakened for various reasons, the most common being pregnancy and childbirth. Other causes may be a chronic cough (as with smokers or people with chest problems), straining when constipated, continuous heavy lifting, or following menopause when the decrease in production of female hormones effects the elasticity of the tissues.
The surgery to repair a prolapse is often combined with a hysterectomy, in which case the womb is usually removed vaginally and the vaginal walls are strengthened and repaired at the same time, using stitches which dissolve. If the womb is not removed, the sling (or ligaments) will be shortened to lift the womb back into place.
This will allow the bladder and bowel to return to their correct position. The supporting muscles (pelvic floor muscles) may also need repair due to stretching. On occasions these muscles and the vaginal walls need repairing at some time after a woman has had a hysterectomy.
A repair for prolapse would not ideally be advised until a woman has decided that she does not want any more children. However, ‘repair’ surgery can be performed without removing the womb. In this case periods, and therefore the possibility of pregnancy, will continue in women who have not yet reached the menopause, and contraception will still be necessary if they are sexually active. If pregnancy does occur, the baby will probably need to be delivered by caesarean section
Before the operation, the surgeon needs to know whether or not a woman is sexually active, as this may make a difference to how he/she performs the operation. For a woman who wishes to continue or resume sexual intercourse, following a vaginal repair, the surgeon will endeavour to ensure that the repair operation is such that it allows for the woman to have sexual intercourse comfortably, once the vaginal walls are healed and she has fully recovered from the operation. Following ‘repair’ surgery women may look forward to a better quality of life, without the uncomfortable symptoms of prolapse.
Related topics Hormones & Menopause